Prospectus and Application Form
south australian government financing authortiy bonds
south australian government financing authortiy bonds
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AFS Licensee Information <strong>Form</strong>Anti-Money Laundering <strong>and</strong> Counter Terrorism Financing (AML/CTF) legislation 2006Investors full nameInvestor type:IndividualCompanyTrustIndividual – minor (under 18 years)Record of Investor identification procedure – To be completed by AFS licenseeIdentity detailsIdentity verified fromThe identity document isPrimary document – Individuals <strong>and</strong>non-individuals(Do not attach original documents)OriginalAttachedCertified CopyNot AttachedSecondary document – Individuals(Originals will not be returned)OriginalAttachedCertified CopyNot AttachedDocument details Primary document Secondary documentDocument issuerIssue dateExpiry dateDocument numberdd / mm / yyyydd / mm / yyyydd / mm / yyyydd / mm / yyyyAccredited English translationOriginal Attached Sighted Original Attached SightedAFS licensee details – Financial Planner, Financial Advisor, BrokerAFS Licensees or their representatives, who are arranging a designated service for the Investor must complete this sectionof the Investor identification information form verifying that they have confirmed the Investors identity.Full name of AFS representativeAFS licensee nameAFS licensee typePlanner Advisor BrokerAFS license numberLicensee addressAddress line 1Phone numberCountry code / area code / numberAddress line 2I confirm that I have sighted original or certified copies of the Investors identity documents; <strong>and</strong> (where applicable).I confirm that I have sighted original or certified copies of the Investors Agent or Power of Attorney, Parent or Guardian identity documents.AFS licensee signatureDate verifieddd/mm/yyyy