personal details - Horizon Credit Union

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PERSONAL DETAILS Title:

 Mr  Mrs Ms  Miss  Other ___________

First Name

Middle Name

Surname

Date of Birth

It is an offence under the AML/CTF ACT 2006 for a person to open or operate an account if the person has not disclosed any other commonly known name or names to the credit union. Other commonly known names do not include nicknames, abbreviations or Anglicised versions of given names – eg Bob for Robert, Joe for Guiseppe. If you are in doubt, record the name(s) below:

ACCOUNT TYPES EVERYDAY ACCOUNT - Ask us for information on each account  S1 Redisavings (members aged 18 or more)  S25 Advantage  S55 Advantage 55 (members aged 55 or more) OTHER ACCOUNTS - Ask us for information on each account  S6 Cash Management  S7 Reward Saver  S8 Christmas Club  Term Deposit ACCESS FACILITIES I would like to apply for a Visa Debit Card To enable access to my:  S1 Redisavings  S25 Advantage  S55 Advantage 55 ONLINE BANKING (HandyNet)  I would like to register for online banking (HandyNet)

Preferred Name (what would you like us to call you) You have the ability to choose the daily default limit of funds you’d like to transfer if the limit is to be set at $1,500 or less. Email Address BPAY: $ ___________ per day on my S_____ account Home Phone

Mobile Phone

External Transfer: $ __________ per day on my S_____ account Total combined maximum daily limit of $__________ per day

Work Phone

Identification Password

RESIDENTIAL ADDRESS Unit/Floor/Street No. & Street

Suburb/Town

State

Postcode

MAILING ADDRESS (If same as residential, write “As Above”)

Unit/Floor/Street No. & Street

Suburb/Town

State

Postcode

OFFICE USE:  Individual Member No.: ______________________ OR Joint: PJT or SJT Linked Member No.:_______________

As additional security, SMS One Time Passwords (a code sent to your mobile) needs to be added to verify your identity before any online transactions are processed. You are required to set this up after you have been registered for HandyNet. SMS MESSAGING After you have registered for HandyNet, you may register for SMS Messaging. Ask us for information on this. PHONE BANKING (HandyLine)  I would like to register for phone banking (HandyLine) STATEMENTS You will be able to view your statements via HandyNet. If you are not registered for HandyNet, you will receive paper statements. MARKETING PREFERENCES From time to time we may provide you with information about products, services, specials and competitions from us and other businesses with whom we have a relationship with. If you do not wish to receive notification of these you may do so by ticking this box:  You may advise us at any time if you wish to change this. INFLUENCES It’s important for us to understand what influenced you or motivated you to join Horizon  Branch presentation  Radio  Broker  Householder  Friend/Family/Colleague  Internet  Newspaper/Magazine  Window Signage  Television  Other _______________ *010_10/17

Common Reporting Standards (CRS) & Foreign Account Taxation Compliance Act (FATCA) Under an Australian/United States of America tax agreement, Horizon Credit Union is required to ask you to confirm whether you are a US tax resident or a US citizen. Please select the appropriate box to confirm your US status.  NoYes, I am a US tax resident or a US citizen and my TIN (Tax ID Number) is _______________________ Horizon Credit Union is required to ask you to declare if you are a tax resident or citizen of any other country.  NoYes - Country ____________________________and my TIN (Tax ID Number) is ___________________________

People in Public Office or Chief Executive Officer Do you hold a public office such as a politician or CEO? If yes, details required:

 Yes

Tax File Number (TFN)

 No Yes No

Collection of Tax File Numbers is authorised, and the tax laws and Privacy Act strictly regulate its use and disclosure. Quotation is not compulsory but tax may be taken out of your interest if you do not quote your tax file number or claim an exemption. CONDITIONS/DECLARATION I hereby apply for membership and purchase a share with a value of $2 in Horizon Credit Union Ltd. I agree to pay any charges required by the Credit Union as listed in the Product Disclosure Statement and General Terms & Conditions brochure, Transaction Fees & Charges brochure and Miscellaneous Fees and Charges brochure and further agree to be bound by the constitution, terms and conditions of the credit union and any alterations thereof registered in accordance with the constitution. I understand that the credit union may charge my shares or the balance of my deposit account for any debt owed by me to the credit union. For the purposes of AML/CTF ACT 2006, all account and signatory information provided to the Credit Union on this form will apply to all accounts that may be held by the applicant with the Credit Union unless otherwise specified. AML/CTF ACT 2006 requires that you produce proof of identity before your membership may be accepted. I confirm that the access facilities I have selected have been explained to me. I agree to the Terms & Conditions of each. I have read and understand the General Terms and Conditions of Horizon Credit Union Ltd. I agree to be bound by these conditions. I acknowledge that I have been given a copy of the following Terms & Conditions: *Product Disclosure Statement & General Terms & Conditions *Visa Debit Card (if applicable) *HandyLine/HandyNet/BPAY (if applicable) I acknowledge that I have been advised of : (applicable if applying for Visa Debit Card)

*Guidelines for ensuring security of the card and PIN *Activating the card *PIN changing facilities *Daily withdrawal limits

I’ve also been given a copy of: *Transaction Fees & Charges brochure *Miscellaneous Fees and Charges brochure *Interest Rate brochure *Privacy Notice * Financial Services Guide

SIGNATURE

DATE

_____/______/_____

FOR JOINT ACCOUNTS In the case of a joint membership, we understand that any sum standing to our credit in the Credit Union at any time shall be jointly owned by us, the right of survivorship, and payment to any of us, or the survivors, in accordance with the authority given in this document, shall be valid and discharge the Credit Union from any liability for such payment. This authority shall not be changed or terminated except by written notice to the Credit Union signed by any one of us, and such notice shall not affect transactions made to that time. Any details in the terms and conditions for a particular account override this general information. The credit union is hereby authorised in respect of withdrawal of funds or any other transaction to act upon the signatures of: (delete whichever is not applicable) All of us / Any one of us. Both joint members must sign and date below to acknowledge. PJT - SIGNATURE

DATE _____/______/_____

SJT - SIGNATURE

DATE _____/______/_____ *010b_10/17

OFFICE USE (FOR BEST RESULTS COMPLETE AS YOU PROCESS – Tick for YES) GENERAL  Have you explained that Horizon is a not-for-profit financial cooperative?  Has the PAC code been loaded?  Has the identification of the member been fully verified and copied?  Have the owner(s) had TFN options explained?  Has the signing instruction been obtained e.g. one to sign, all to sign etc?  Have any related memberships been established & loaded?  Have you marked the opening deposit slip with a highlight pen to assist your document retention? Has member been advised of:  Statement frequency  Refund of shares upon closure of membership  Dispute resolution process

 Minimum balance and account restrictions  Cheque clearance policy and special clearance option  Overdrawn account interest/fees applicable

REFERENCE DOCUMENTS Has the member been given a new member pack containing:   Membership & Services brochure  Insurance Information brochure  Interest Rate brochure  HandyLine brochure  Dispute Resolution brochure  HandyNet brochure  Financial Advisory Service brochure  Financial Services Guide (FSG)  Privacy  Transaction Fees & Charges brochure and Miscellaneous Fees and Charges brochure  Product Disclosure Statement and General Terms & Conditions VISA DEBIT CARD Has member been advised of:   card activation  PIN changing facilities at the Credit Union (if applicable)  access points e.g. rediATM, EFT etc.  signing the card immediately when it’s received  daily withdrawal limits  fees applicable for replacement cards  account/card restrictions  advise member to check statements for any errors  PIN and security for it  advise member of process when card reaches expiry date  advise member of penalty interest fees for overdrawn accounts   has the member been given a copy of Visa Debit Card Conditions of Use  advice on lost/stolen/damaged cards: hotline numbers in Terms and Conditions HANDYLINE/HANDYNET Has member been: registered for HandyNet advised they must not use their member number, date of birth, name, card number etc as their password and to never divulge their password to anyone informed about eStatements registered for eStatements advised about SMS OTP If member has requested a limit different to the standard limit, has a task been sent to Admin If member has requested HandyLine access, has a task been sent to Admin *010c_10/17

VERIFICATION

If you have taken a photocopy of the following documents you will need to delete the following from each document using a black marker: Tick once completed

Document

Delete

Drivers Licence

Organ Donor



Passport

Country of Birth, Gender



Birth Certificate

Place of Birth, Siblings, Parents name & occupation



Marriage Certificate, Death Certificate, Legal Name Change

Everything other than Name, DOB, Address, Date of Change/Death



Citizenship Certificate

Place of Birth



NSW Photo Card

Gender, Organ Donor



Identification Card for Public Employees

Service Number, Rank



Medicare Card

Card Number & other names that are not applicable



School Letter, Student Card

Attending School



Health Concession Card Centrelink Card

Customer Reference Number & other names/numbers that are not applicable



Electoral Roll

Ward Name



Land Rates & Utilities Bills

Everything other than Name & Address, and other names that are not applicable



NOTE: Please make sure only the relevant information is recorded and filed as per APP/Privacy.

Staff - original to be kept for seven years after the membership is closed. TOTAL PROCESS COMPLETE Staff Signature

Date

/

/ *010d_10/17