COMPANY MEMBERSHIP OPENING - REQUIRED DOCUMENTS Member number Date / / When to use this form Use this form when a new membership is required for the following: Company Business where the proprietor is a Company Documents - company Original or certified copy of Certificate of Registration of Company AND Company Name Search Extract (search fee applies if not supplied) Documents - business (if trading as a business) Original or certified copy of Certificate of Registration of Business Name AND/OR Business Name Extract required if Certificate of Registration of Business Name is more than 30 days old (search fee applies if not supplied) Original or certified copy of Australian Business Register showing the ABN (if applicable) Identification requirements Should an appointed signatory to the new membership be an existing Heritage customer; details of their existing membership are to be recorded in the Authorised Signatory section of the Membership Form. Should an appointed signatory not be a Heritage customer; they will be required to provide identification which meets an Acceptable Identification Combination and all their details will need to be recorded in the Authorised Signatory section of the Membership Form. Tax File Number Relevant Tax File Number for Membership Type (Whilst it is not compulsory to provide a tax file number, we recommend that it is supplied. If a tax file number is not provided, Heritage is required by law to deduct withholding tax from any interest earned above a certain threshold.) Page 1 of 8
COMPANY MEMBERSHIP APPLICATION FORM Member number Date / / Membership details - customer code Customer type: C - company Company sub-type: D - domestic R - registered foreign U - unregistered foreign Does the company operate under a registered business name (Y/N)? If yes, provide business name below Is the company 1 - Private (pty) or 2 - public Existing membership / relationship Do you have an existing membership titled in the same name under which you would like to open this account (Y/N)? If yes, list existing member number Referral information (Answer this question if you chose N above) Were any parties on this new membership referred to Heritage by a family member, friend or colleague (Y/N)? If Yes, enter the details of the member who referred you to Heritage. Referrer Member Number (if unsure, leave blank) Referrer Name Relationship Family Friend Colleague Signing instructions Number of directors Number of owners of issued ordinary shares Number to sign on accounts of to sign Is there a special signing authority (Y/N)? If yes, list name of person Membership address details Membership mailing address State Postcode Membership email address Company details Full name of company Company ACN Business details - if company is trading as a business Full name of business (if any) ABN Address of registered office for the company Address of registered office for company State Postcode Address of principal place of business Address of principal place of business State Postcode Page 2 of 8
Membership details continued Company contact details Work Mobile Fax Company occupation details Main business activity Industry Company Directors Provide the full name of each director of the company: 1 Surname 2 Surname 3 Surname 4 Surname 5 Surname 6 Surname Company Secretary Provide the full name of the secretary of the company: 1 Surname Page 3 of 8
Membership details continued Owners of issued ordinary shares (if applicable) Provide the full name and residential address of each owner of issued ordinary shares of the company: 1 Surname Residential address Property Unit/ flat # House # Street Street type Suburb State Postcode 2 Surname Residential address Property Unit/ flat # House # Street Street type Suburb State Postcode 3 Surname Residential address Property Unit/ flat # House # Street Street type Suburb State Postcode 4 Surname Residential address Property Unit/ flat # House # Street Street type Suburb State Postcode Nomination of primary contact Position of the primary contact Page 4 of 8
Membership details continued Company Director One / Authorised Signatory Existing relationship with Heritage Do you have an existing relationship with Heritage (Y/N): For example, do you have a membership or are you listed as a signatory on another membership If yes, list existing member number Personal details Title Surname Given names Commonly known as First school attended Mother s maiden name Date of birth Gender M/F Drivers licence Residential address details Property Unit/ flat # House # Street Street type Suburb State Postcode Mailing address details Mail address Suburb State Postcode Contact details Home Work Mobile Other If other, relationship: Specimen signature Company Director One / Authorised Signatory Note: if more than TWO Company Directors/Authorised Signatories - complete an Addition of Party form. Page 5 of 8
Membership details continued Company Director Two / Authorised Signatory Existing relationship with Heritage Do you have an existing relationship with Heritage (Y/N): For example, do you have a membership or are you listed as a signatory on another membership If yes, list existing member number Personal details Title Surname Given names Commonly known as First school attended Mother s maiden name Date of birth Gender M/F Drivers licence Residential address details Property Unit/ flat # House # Street Street type Suburb State Postcode Mailing address details Mail address Suburb State Postcode Contact details Home Work Mobile Other If other, relationship: Specimen signature Company Director Two / Authorised Signatory Note: if more than TWO Company Directors/Authorised Signatories - complete an Addition of Party form. Page 6 of 8
Signature of authorised account opener/s By signing this Membership Application Form, I/we agree to the following: To be bound by the Constitution of Heritage Bank Limited. To be bound by the terms and conditions as outlined in the Guide to Heritage Deposit Products. That it is an offence under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 to make a false and misleading statement. I/We declare that the details as shown on this form are complete and accurate. For my personal information to be collected, used and disclosed in accordance with Heritage s Privacy Policy. This includes verification of personal information as required by the Anti-Money Laundering and Counter-Terrorism Financing Act 2006. That any tax file number submitted will apply to all existing and future accounts opened under this membership. The signing instructions on this membership apply to all accounts and term deposits under this member number and will remain in force until Heritage receives notice in writing of cancellation, which is signed in accordance with the signing instructions. Heritage may use my electronic or telephone details to communicate with me regarding details about my account. Heritage may also send me required documents in an email. I understand that in these instances paper copy will not be sent. I should check my emails regularly and I can withdraw this consent at any time. If I change my personal details (for example address or email address). I will inform Heritage as soon as possible. If you do not wish to receive emails from Heritage in relation to your account please tick here [ ] Signature of Authorised Account Opener One Signature of Authorised Account Opener Two IF MORE THAN ONE DIRECTOR, AT LEAST TWO DIRECTORS MUST SIGN AND BE IDENTIFIED TO OPEN ACCOUNT. Branch Branch Stamp: Coded: Checked: Has KYC & ID been collected & verified (Y/N)? CSO Signature: Checking Officer Signature: use only NOTE: It is an offence under the Financial Transaction Reports Act 1988 and the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 to give false and misleading information. Page 7 of 8
COMPANY MEMBERSHIP OPENING - BRANCH CHECKLIST Member number Date / / Documents - company Are all the documents listed below that support the opening of this membership attached, certified and correct: Original or certified copy of Certificate of Registration of Company AND Company Name Extract Documents - business (if trading as a business) Original or certified copy of Certificate of Registration of Business Name AND/OR Business Name Extract if Certificate of Registration of Business Name is more than 30 days old Original or certified copy of Australian Business Register showing the ABN (if applicable) Membership application form Has the membership application form been completed in full, including the following: Has the membership application form been signed by the person/s authorised to open the membership in the Signature of Authorised Account Opener/s section in accordance with the signing instruction? Have the names of the Directors and Company Secretary been included on the application form? Have the names and residential addresses of the Owners of Issued Ordinary Shares been included on the application form? Has the Company ACN been provided? If the Company is not trading as a business, has a Tax File Number for the Company been provided? If the Company is trading as a business, has either a Tax File Number for the Company or the Business been provided? System Has the membership been opened correctly on the system, including the following: Is the membership titled correctly? Has the correct account type been opened? Has the correct sub-type been opened (sub-type should be D - Domestic)? Has the Entity Screen been completed? Identification Have all parties to the membership been fully identified (eg the ID provided meets an Acceptable Identification Combination)? Has ID been loaded on the system for all parties? Cheque book and card Have notes been added into Prosper to order after BOPS have notified they have finalised checking the account? Checking Officer responsibilities Has the Membership Application been reviewed to ensure correctness? Are all required supporting documents attached? Note: The application form and supporting documents are to be scanned to MDSS and the ORIGINALS forwarded via internal mail to Banking Operations Department. Opening Officer Signature Checking Officer Signature Heritage Bank Limited ABN 32 087 652 024. AFSL 240984. Australian Credit Licence 240984. Effective 04/16 C73 DMS 1401012C - Printed from website Page 8 of 8