NAB Intermediary Term Deposit.

Transcription

1 NAB Intermediary Term Deposit. Application Form. Dated 7 July 2014 Issued by National Australia Bank Limited ABN AFSL

2 Application form checklist To ensure that we are able to process your application promptly, please check that you: Read the NAB Term Deposits Terms and Conditions and receive a copy of the flyer Indicator Rates Selected Term Deposit Products. Check the deposit meets the minimum requirement of $25,000. Answer all applicable questions on the application form. Complete the TFN notification advice/exemption form. Ensure all signatories have signed and dated the application form at the Declaration and signature section. Please forward the completed application form with any other required documentation to: NAB Term Deposits (via Intermediary) Administration Team Level 30, 500 Bourke Street Melbourne VIC 3000

3 Application form Please use blue or black pen and write in BLOCK LETTERS You should read the terms and conditions for NAB Term Deposits before signing this application. Note: you must complete either Section 1 or Section 2 Office Use ONLY Account number Section 1 Individual or joint name details Applicant 1 Title Given name(s) Surname Mr Mrs Miss Ms Dr Other Date of birth Gender Telephone (Home) Work Mobile / / M F ( ) ( ) ( ) Residential address Postal address (no postal boxes will be accepted if a residential address has not been supplied) If you are an existing NAB Customer, please provide an account or card number If you are an existing NAB Customer, is the address provided above correct for all your NAB accounts? Yes No Applicant 2 Title Given name(s) Surname Mr Mrs Miss Ms Dr Other Date of birth Gender Telephone (Home) Work Mobile / / M F ( ) ( ) ( ) Residential address Postal address (no postal boxes will be accepted if a residential address has not been supplied) If you are an existing NAB Customer, please provide an account or card number If you are an existing NAB Customer, is the address provided above correct for all your NAB accounts? Yes No Section 2 Company name or Trustee details (Business/Company/Partnership/Association/Trust) Name of Company/Trust ABN number Contact name Business telephone ( ) Business address Postal address (if different to business address) If you are an existing NAB Customer, please provide an account or card number If you are an existing NAB Customer, is the address provided above correct for all your NAB accounts? Yes No

4 Section 3 Contributions Instructions for payments from you I wish to make all payments in connection with NAB Term Deposits (via Intermediary) via the following method (please tick): Direct Debit from my account you must complete the Direct Debit Request below Payment into NAB s nominated account Important Note: The Direct Debit Request contribution method has a limit of $5 million per transaction Direct Debit Request You must read the Direct Debit Request Service Agreement contained in section 11 of this application form before completing this section. The Direct Debit Service Agreement contains important information regarding the operation of the Direct Debit Request Service and should be retained by you. You can request a copy of the Direct Debit Service Agreement at any time by contacting the Administration team on Request and authority to debit the account named below to pay National Australia Bank Limited By signing this application form and completing this Direct Debit Request the applicant requests and authorises National Australia Bank Limited (the User ) (User ID number ) to arrange for any amount National Australia Bank Limited may direct debit the applicant under the agreement in respect of all payments to be debited through the Bulk Electronic Clearing System from or to an account held at the financial institution identified below subject to the terms and conditions of the Direct Debit Request Service Agreement (refer section 11). Name and address of financial institution at which account is held Name of Institution Address of Institution Details of account to be debited Name of account BSB Number Account Number Section 4 Payments Important Note: Where your contributions are via Direct Debit Request NAB will pay interest and principal payments to account detailed in Section 3 Interest payments Maturity payments I/We instruct NAB to distribute interest to my nominated account: On maturity NAB is instructed to: Monthly Reinvest principal and interest Quarterly Reinvest principal only and credit interest to the Australian Half-yearly financial institution account nominated below Annually Credit principal and interest to the Australian financial For terms less than 1 year, interest is paid on maturity only. institution account nominated below Nominated account details Principal Bank BSB Account number Account name Interest Bank BSB Account number Account name Section 5 Account authority Operating authority Where there is more than one account signatory, please indicate any requirements for signing authority. If no election is made, any signatory may sign solely. All applicants must sign for transactions Either applicant may sign for transactions Nominated representative Investors may appoint their financial adviser (and/or representatives of the AFSL Licensee listed in section 9) as Nominated Representative/s on their account. Please refer to the terms and conditions on this facility I/we authorise my/our financial adviser or representative from the licensee detailed in section 9 to be Nominated Representative/s pursuant to section 6 below.

5 Section 6 Customer authority (a) The person named in section 9 (or representative of the AFSL Licensee in section 9) is able to give NAB instructions by telephone, facsimile or in writing to do the following on your behalf: place money on term deposit; facilitate payment of interest to the account identified in section 4 for this purpose; facilitate full or part prepayment of a term deposit to account identified in section 4 for this purpose; extend a term deposit; and increase an amount on term deposit. (b) Any telephone instruction provided by your nominated representative (or representatives of the AFSL Licensee in section 9) must be given to your NAB Dealer. Instructions can t be given by visiting a branch. (c) Any telephone or facsimile instruction to pay interest or principal to any other account other than the accounts set out in section 4 must be supported by a written request and signed by you. (d) You agree that in relation to telephone or facsimile instructions properly made by your nominated representative (or representatives of the AFSL Licensee in section 9) to a NAB Dealer: NAB is authorised to accept and act upon any telephone or facsimile instruction given to NAB (for the purposes of each Term Deposit in your name) which purports to have been given by you or your nominated representative (or representatives of the AFSL Licensee in section 9). In accordance with this authority; NAB is under no duty to make any enquiry as to whether the telephone instructions have in fact been issued with your authority; NAB must receive all instructions given by telephone for processing on a particular day by 5pm (Melbourne time). NAB reserves the right to hold any instructions received after this time for processing on the following business day; that you will ratify each and every action taken by your Nominated Representative/s while this authority applies; NAB isn t responsible for any loss, damage or liability you may suffer or incur by reason of, or in connection with: (i) NAB acting on any telephone or facsimile instruction that purports to have been delivered from your nominated representative (or representatives of the AFSL Licensee in section 9) on your behalf; (ii) any error in the telephone or facsimile instruction; or (iii) any delays in following a telephone instruction. (e) NAB isn t liable if NAB acts on telephone or facsimile instructions which are the result of forgery, fraud or error or are given in excess of the authority of your authorised representative (or representatives of the AFSL Licensee in section 9) who issues the telephone or facsimile instruction. (f) NAB may choose not to accept or act upon any telephone or facsimile instruction given under this authority if for any reason we are unsatisfied that the instruction has been issued by your nominated representatives (or representatives of the AFSL Licensee in section 9). NAB may also choose to only accept or act upon a telephone or facsimile instruction after the instructions are confirmed or further information is provided. (g) NAB is not obliged to action any telephone or facsimile instruction unless there are enough funds available to carry out the request. (h) NAB may vary the terms of this authority or cancel the appointment of a nominated representative (or representatives of the AFSL Licensee in section 9) by giving you and the AFSL Licensee at least seven days written notice. (i) You may cancel the appointment of your nominated representative at any time by giving NAB written notice. Until NAB receives the written notice, NAB is entitled to continue to act on instructions of your Nominated Representative/s and notwithstanding any inconsistent instructions given or purported to be given by the Customer. (j) You agree that NAB may, by giving you notice, override this authority and require that you authorise all or specific future term deposits and/or other products nominated in Section 7. Section 7 Other authorities Nominated representative Investors may appoint their financial adviser (and representatives of AFSL Licensee) as Nominated Representative on their account for the purposes of providing instructions on other products and services limited to those outlined below: Money market securities I/we authorise my financial adviser or representative from the licensee detailed in section 9 to be a Nominated Representative and provide instructions in relation to the purchase or sale of bills of exchange, certificates of deposits, debentures or promissory notes pursuant to section 6 (b) to 6 (j) with standard settlement instructions per section 4. Fixed Income securities I/we authorise my financial adviser or representative from the licensee detailed in section 9 to be a Nominated Representative and provide instructions in relation to the purchase or sale of Fixed Income Instruments pursuant to section 6 (b) to 6 (j) with standard settlement instructions per section 4. On-line access through NAB Connect I/we hereby instruct NAB to provide to my financial adviser or representative from the licensee detailed in section 9 access to view transactions and balances on this account via their NAB Connect service.

6 Section 8 Declaration and signature I/We acknowledge that I/we have read and understood the flyer Indicator Rates Selected Term Deposit Products for NAB Term Deposits (via Intermediary) and the terms and conditions upon which the account would operate, and agree to be bound by them. I/We have legal power to invest in accordance with the details given on the application form and warrant that the details given are true and correct. If I/We have signed as Attorney, I/We declare that I/we have received no notice of revocation of that power. If investing as Trustee, on behalf of a superannuation fund or trust, I/we confirm that I/we am/are acting in accordance with my/our designated powers and authority under the Trust Deed. I consent to my/our personal information being collected, used and disclosed in accordance with the NAB Privacy Notification. I/We authorise National Australia Bank Limited to disclose to the financial adviser recorded on the application (if any), information relating to my/our NAB Term Deposit (via Intermediary) or any subsequent information relating to that deposit or any products transacted with NAB in accordance with this agreement. I/We understand this will not include disclosure of my/our TFNs or any information relating to it/them. Common Seal to be affixed in accordance with Constitution of the Company I/We appoint the individual/s appointed as my/our Nominated Representatives in section 5 of this application form to operate this account in accordance with the terms and conditions contained in section 6. If elected, I/We agree to be bound by the terms and conditions associated with the facility referred to in clause 6 of this application. I/We acknowledge that my financial adviser recorded in section 9 may be paid a commission (at no direct cost to me) of up to 0.50% pa of the term deposit or other products listed in section 7. (Note: This only applies if you are a wholesale client. If you are a retail client, NAB will not pay any commission to your financial adviser in respect of a term deposit opened from 1 July 2014.) I/We understand that although there are no bank fees associated with this term deposit, if I/we choose to withdraw any amount from the term deposit prior to the maturity of the term, I/we may incur a reduction in interest in accordance with the terms and conditions upon which this account will operate. We understand that we can contact NAB on if we require further information on this reduction in interest. Signature Signature Print name Date Print name Date / / / / Capacity* e.g. director/secretary Capacity* e.g. director/secretary *If signing on behalf of a Company investment, please state your capacity. Section 9 Financial Adviser Details Name Licensee adviser number Business name Work/Mobile number Facsimile number address ( ) ( ) Address Dealership (if applicable) Adviser signature (required if facsimile instruction facility and/or Nominated Representative selected) Financial adviser stamp or dealer group name

7 Section 10 Tax File Number/ABN notification It is not compulsory for an investor to quote their TFN. However, failure by an investor to quote a TFN or claim an exemption may cause NAB to withdraw tax at the top marginal rate, plus Medicare Levy, from interest earned by the investor. If you choose to supply NAB with your TFN(s), please select the appropriate box and complete the following details: Individual/joint name investment Sole Trader/Partnership/Trust/Company account Name applicant 1 TFN Name applicant 2 TFN Name company/trust applicant ABN/TFN *Please note - An ABN can only be quoted if the investment being made by you is in the course of furtherance of your enterprise. I/We authorise the application of the above TFN to this investment Exemption Details If you wish to claim an exemption, please select the appropriate box and complete the following details: Child under the age of 16 years and earning less than $ per year Investor in receipt of a pension Age Pension Disability Support Pension Veteran s Pension Wife Pension Carers Pension Widow Pension Special Benefits Pension Parenting Payment Pension Please write the full name of the pension you receive in the space provided below: Type of pension Organisation not required to lodge tax return Please provide the name of the organisation and the reason why a tax return is not required to be lodged in the space provided below: Name of organisation Reason If you are not an Australian resident for taxation purposes the interest paid to you from an Australian source may be subject to withholding tax. Select the appropriate box and complete the following details: Territory resident Non-resident of Australia for tax purposes Please provide an overseas address in the space provided below: Overseas Address FATCA Self Certification Individual/Joint Applicants, are you a U.S. citizen or resident for tax purposes? Yes No Company/Trust Applicants, is the Company/Trust organised or incorporated in the U.S.? Yes No Company/Trust Applicants, are there any U.S. persons or U.S. tax residents that are directly or indirectly, beneficial owners or controlling persons of the Company/Trust? Yes No NAB Customer Number If yes to either of the above and you are not an existing NAB customer, please complete the FATCA Self-Certification Declaration Form available on nab.com.au/adviser. The on-boarding process will not be completed until the FATCA Self-Certification Declaration Form is collected. Signature Date / / Signature Date / /

8 Section 11 Direct Debit Request Service Agreement You must retain this page for future reference 11.1 Debiting your Account By signing a Direct Debit Request, you have authorised us to arrange for funds to be debited from your Account. You should refer to the Direct Debit Request and this Direct Debit Request Service Agreement for the terms of the arrangement between us and you. We will only arrange for funds to be debited from your Account as authorised in the Direct Debit Request. If the Debit Day falls on a day that is not a Business Day, we may direct your Financial Institution to debit your Account on the following Business Day. If you are unsure about on which day your Account has been or will be debited you should ask your Financial Institution Changes by us to direct debits We may amend any details of the Direct Debit Request Service Agreement or a Direct Debit Request at any time by giving you at least 14 days written notice Changes by you to direct debits Subject to the other provisions of this clause 11.3, you may change the arrangements under a Direct Debit Request by contacting us on If you wish to stop or defer a Debit Payment, you must notify us or your Financial Institution in writing (which must be in a letter physically signed by you and posted or faxed to us or your Financial Institution) at least 14 days before the next Debit Day. This notice should be given to us in the first instance. If you first notify your Financial Institution, you must promptly let us know. You may also cancel your authority for us to debit your account at any time by giving us or your Financial Institution 14 days notice in writing (which must be in a letter physically signed by you and posted or faxed to us or your Financial Institution) before the next Debit Day. This notice should be given to us in the first instance. If you first notify your Financial Institution, you must promptly let us know Your obligations regarding direct debits It is your responsibility to ensure that there are sufficient cleared funds available in your Account to allow a Debit Payment to be made in accordance with the Direct Debit Request. If there are insufficient cleared funds in your Account to meet a Debit Payment: a. you may be charged a fee and/or interest by your Financial Institution; b. you may also incur fees or charges imposed or incurred by us; and c. you must arrange for the Debit Payment to be made by another method or arrange for sufficient cleared funds to be in your Account by an agreed time so that we can process the Debit Payment. You should check your Account statement to verify the amounts debited from your Account Disputes about direct debits If you believe that there has been an error in debiting your Account, you should notify us directly on and confirm that notice in writing (which must be in a letter physically signed by you and posted or faxed to us) with us as soon as possible so that we can resolve your query more quickly. If we conclude as a result of our investigations that your Account has been incorrectly debited, we will respond to your query by arranging for your Financial Institution to adjust your Account (including interest and charges) accordingly. We will also notify you in writing of the amount by which your Account has been adjusted. If we conclude as a result of our investigations that your Account has not been incorrectly debited, we will respond to your query by providing you with reasons and any evidence for this finding. Any queries you may have about an error made in debiting your Account should be directed to us so that we can attempt to resolve the matter between you and us. If we cannot resolve the matter, you can still refer it to your Financial Institution which will obtain details from you of the disputed transaction and may lodge a claim on your behalf Accounts for direct debits You should check: a. with your Financial Institution whether direct debiting is available from your Account as direct debiting is not available on all accounts offered by Financial Institutions; b. that the Account details which you have provided to us are correct by checking them against a recent Account statement; and c. with your Financial Institution before completing the Direct Debit Request if you have any queries about how to complete the Direct Debit Request Confidentiality around direct debits We will keep any information (including your Account details) in your Direct Debit Request confidential. We will make reasonable efforts to keep any such information that we have about you secure and to ensure that any of our employees or agents who have access to information about you do not make any unauthorised use, modification, reproduction or disclosure of that information. We will only disclose information that we have about you in relation to your Direct Debit Request: a. to the extent specifically required by law; or b. for the purposes of this Direct Debit Request Service Agreement (including disclosing information in connection with any query or claim) Notices regarding direct debits If you wish to notify us in writing about anything relating to this Direct Debit Request Service Agreement, you should write to: NAB Term Deposits (via Intermediary) Administration Team Level Bourke Street Melbourne, Victoria 3000

9 Directory The registered address of the issuer: National Australia Bank Limited Level 4 (UB4440) 800 Bourke Street Melbourne VIC 3008 Service and Support The Intermediary Term Deposit desk is available from 9.00am to 5.30pm, (EST) Monday to Friday on: Tel: Fax: intermediarytd@nab.com.au Preparation of this document was completed on 7 July National Australia Bank Limited ABN AFSL and Australian Credit Licence A-0514