Thank you for choosing Direct FX Limited (“DFX”). This Account Application Form must be read together with our Terms and Conditions on our website. If we accept your application for an Account, the agreement between us and you (the “Account Holder”) will comprise this Account Application Form and the Terms and Conditions (“Agreement”). Section A: Account Information 1. Personal Details Given name* Surname* Other names and aliases Gender* MaleFemale Date of Birth (DD/MM/YYYY)* Place of Birth* Nationality* Mobile number* Residential Address* City* Country* Postcode* Email* 2. Employment or Business Details Employer / Trading Name Registration / Incorporation number Job Title Business phone number Business Physical Address City Country Postcode Email 3. Nature and Purpose Account Behaviour Baseline a) Approx. number of annual transactions* b) Approx. annual trade volume (in NZD)* c) Approx. number & frequency of transactions I.e. 5 weekly / 3 monthly / 2 quarterly* d) Approx. average transaction volume (in NZD)* e) Source of funds/wealth E.g. Business revenue; sale of company assets; product trading revenue; shareholder capital injection* f) Purpose of transactions E.g. Paying suppliers in Germany; repatriating overseas sales revenue back to NZ; purchasing stock from NZ supplier* g) List of countries normally dealing/trading with* Section B: Account Ownership and Control Authorised persons Authorised person 1 Relationship with the Applicant Given name Surname Other names and aliases Gender MaleFemale Date of Birth (DD/MM/YYYY) Place of Birth Nationality Mobile number Residential Address City Country Postcode Email Authorised person 2 Relationship with the Applicant Given name Surname Other names and aliases Gender MaleFemale Date of Birth (DD/MM/YYYY) Place of Birth Nationality Mobile number Residential Address City Country Postcode Email Section C: Foreign Account Tax Compliance Act (FATCA) and Common Reporting Standard (CRS) Declaration 1. Tax Residence Is the Individual (not entity) a tax resident of another country? Yes (please list all other countries of tax residency)No (go to the section D) If you are a US person, please complete Form W-9 or submit a self-declaration of FATCA status. (You may also wish to visit the IRS website to determine if you need to complete and submit any additional IRS forms) The term ‘US person’ means: US citizens, including those resident outside US US permanent residents, including green card holders US tax residents People born outside the US with a US parent Certain persons who spend a significant number of days in the US each year Corporations, estates and trusts, and other entities controlled by US persons Country of Tax Residence 1 Country of Tax Residence Tax Number (or equivalent) Not available YesNo Please provide an explanation if Tax Number is not available Country of Tax Residence 2 Country of Tax Residence Tax Number (or equivalent) Not available YesNo Please provide an explanation if Tax Number is not available Country of Tax Residence 3 Country of Tax Residence Tax Number (or equivalent) Not available YesNo Please provide an explanation if Tax Number is not available Section D: Politically Exposed Person (PEP) Self-certification Under Anti-Money Laundering and Countering Financing of Terrorism Act 2009, Financial Institutions have an obligation to check whether a client is a Politically Exposed Person (PEP). Please read definitions below carefully, answer "Yes" or "No" in each case. Positions Do you, or an immediate family member*, hold (or held at any time in the last 12 months) any of the following positions in any country: 1. Head of state or head of a country or government YesNo 2. Government minister or equivalent senior politician YesNo 3. Supreme court judge or equivalent senior judge YesNo 4. Governor of a central bank or any other position that has comparable influence to the governor of the Reserve Bank of New Zealand YesNo 5. Senior foreign representative, ambassador, or high commissioner YesNo 6. High-ranking member of the armed forces YesNo 7. Board chair, chief executive, or chief financial officer of, or any other position that has comparable influence in, any state enterprise YesNo Beneficial Ownership Do you have: 1. Joint beneficial ownership of a legal entity or arrangement (e.g. a trust), or any other close relationship, with a person in any of the positions above? YesNo 2. Sole beneficial ownership of a legal entity or arrangement (e.g. a trust) that to exists for the benefit of a person in any of the positions above? YesNo * The term 'Immediate family member' means: a spouse or partner (a person who is considered by relevant national law as equivalent to a spouse); a child, and a child’s spouse or partner; or a parent. Section E: Acknowledgment 1. Electronic Verification To meet the requirements under the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 (AML/CFT Act), we must verify our client’s identity and residential address. One option is to try and do this electronically; however, as not everyone can be verified electronically, please be advised that we may still contact you for further verification if the electronic verification fails. As part of the electronic verification processes, your personal details are disclosed to and matched with information held by the issuer of the identity document containing your personal details e.g. your drivers’ licence or the official record holder of your information, via third party systems. We will only use your personal details for the purpose of verification under the AML/CFT Act. By signing this form, you confirm that you are authorised to provide personal details presented and you consent to your information being checked with the documents issuer or official record holder via third party systems for the purpose of confirming your identity. 2. Anti-Money Laundering and Countering Financing of Terrorism Act 2009 I/We acknowledge that DFX is subject to AML/CFT laws in New Zealand. This may include reporting of suspicious activities required by AML/CFT laws to the Commissioner of the New Zealand Police. I/We acknowledge that DFX may use a third party system to verify my identity to determine whether I am/we are recorded with any notation as Politically Exposed Persons and whether I/we have a criminal record. I/We agree to provide DFX (and its employees, agents, nominees and related entities) with reliable information and other assistance it reasonably requires to establish the bona fides of the source of my/our funds/wealth, and to comply with the AML/CFT laws. I/We represent and warrant that I/we have no cause to believe the funds used to FX trades are the proceeds of crime or will be used to finance terrorism. I/We agree to indemnify DFX (and its employees, agents, nominees and related entities) against any loss it suffers as a result of me/us providing incorrect or incomplete information. I/We understand that failure to comply with the reasonable request for information by DFX to satisfy AML/CFT laws will result in my/our application being rejected. 3. Personal Information and Privacy Act I/We consent and agree that all information about me/us disclosed in this form may be used by DFX (and its employees, agents, nominees and related entities) or disclosed to and used for the purpose of completing/monitoring the transactions, including disclosure to the regulatory bodies and in compliance with the AML/CFT laws. I/We know that DFX may use the information on this form for the purpose of: Creating and maintaining risk related models, including but not limited to risk assessment, risk analysis and risk management; Fulfilling reporting obligations, including but not limited to Annual AML/CFT Report, SAR, PTR, CRS, FATCA and any other reporting obligations imposed by New Zealand laws and regulations; Responding to the inquiries of banks or any other regulatory bodies; Marketing products, services and other subjects under the umbrella of Collinson & Co; Meeting the requirements to make disclosure under the requirements of any law binding on us or under and for the purpose of any guidelines issued by regulatory bodies or other authorities to comply; Any other purposes relating to the purposes listed above. I/We know that I/we can request such access to and correction of any information held about me/us by DFX. Notwithstanding the foregoing, I/we acknowledge that where a suspicious activity report has been made about me/us, the person who has made that report is not able to give me/us access to any information about that report (including its existence) and I/we have no right to request information in that report to be corrected. I/We will inform DFX of any changes to the information provided by me/us to DFX. 4. United Stated (US) Foreign Account Tax Compliance Act (FATCA) Automatic Exchange of Information (AEOI) and the Common Reporting Standard (CRS) I/We acknowledge that DFX has certain obligations to report information held about me/us under FATCA and CRS and I/we consent to DFX (and its employees, agents, nominees and related entities) disclosing all such information to the necessary parties. I/We acknowledge that I have examined the information provided and it is true, correct, and complete to the best of my/our knowledge and belief. I/We understand and agree that on specific request from any relevant tax authorities or any party authorised to audit or conduct a similar control for tax purposes, the information contained in this section and/or a copy of this form can be disclosed to such tax authorities or such party. In case of any change in circumstances that causes the information contained herein to become incorrect I/we recognize that I/we will have to provide a suitable updated declaration within 30 days of such change in circumstances. Please be advised that penalties under the AEOI laws may apply if you provide false or misleading information, fail to provide this information, or fail to provide an update if there is a material change to the information you have provided. This includes civil penalties of $1,000 per offence that Inland Revenue can apply. Substantial criminal penalties can be imposed by the courts for knowledge-based offences. These penalties apply for the purposes of both FATCA and CRS. Confirmation I confirm to consent: Acknowledgement of this application Terms and Conditions Electronic Verification Consent Terms & Conditions: The Client consents to Direct FX using information gathered from the Client during the application process, being used to electronically verify the Clients identify, for the purpose of compliance with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009.e. The Client consents to Direct FX passing information gathered from the Client during the application process, to Data Zoo (NZ) Ltd, for the sole purpose of verifying the Clients identify, for the purpose of compliance with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009. Declaration and Signature By signing this form, I agree and confirm that: - My answers above are correct - I will promptly send confirmation should my answer in any category above change in the future. Date (dd/mm/yyyy)* Full legal name/signature of Director/Authorised Signatory* Δ
Thank you for choosing Direct FX Limited (“DFX”). This Account Application Form must be read together with our Terms and Conditions on our website. If we accept your application for an Account, the agreement between us and you (the “Account Holder”) will comprise this Account Application Form and the Terms and Conditions (“Agreement”).
Given name*
Surname*
Other names and aliases
Gender* MaleFemale
Date of Birth (DD/MM/YYYY)*
Place of Birth*
Nationality*
Mobile number*
Residential Address*
City*
Country*
Postcode*
Email*
Employer / Trading Name
Registration / Incorporation number
Job Title
Business phone number
Business Physical Address
City
Country
Postcode
Email
a) Approx. number of annual transactions*
b) Approx. annual trade volume (in NZD)*
c) Approx. number & frequency of transactions I.e. 5 weekly / 3 monthly / 2 quarterly*
d) Approx. average transaction volume (in NZD)*
e) Source of funds/wealth E.g. Business revenue; sale of company assets; product trading revenue; shareholder capital injection*
f) Purpose of transactions E.g. Paying suppliers in Germany; repatriating overseas sales revenue back to NZ; purchasing stock from NZ supplier*
g) List of countries normally dealing/trading with*
Relationship with the Applicant
Given name
Surname
Gender MaleFemale
Date of Birth (DD/MM/YYYY)
Place of Birth
Nationality
Mobile number
Residential Address
Is the Individual (not entity) a tax resident of another country? Yes (please list all other countries of tax residency)No (go to the section D)
If you are a US person, please complete Form W-9 or submit a self-declaration of FATCA status. (You may also wish to visit the IRS website to determine if you need to complete and submit any additional IRS forms)
The term ‘US person’ means:
US citizens, including those resident outside US
US permanent residents, including green card holders
US tax residents
People born outside the US with a US parent
Certain persons who spend a significant number of days in the US each year
Corporations, estates and trusts, and other entities controlled by US persons
Country of Tax Residence
Tax Number (or equivalent)
Not available YesNo
Please provide an explanation if Tax Number is not available
Under Anti-Money Laundering and Countering Financing of Terrorism Act 2009, Financial Institutions have an obligation to check whether a client is a Politically Exposed Person (PEP). Please read definitions below carefully, answer "Yes" or "No" in each case.
Do you, or an immediate family member*, hold (or held at any time in the last 12 months) any of the following positions in any country:
1. Head of state or head of a country or government YesNo
2. Government minister or equivalent senior politician YesNo
3. Supreme court judge or equivalent senior judge YesNo
4. Governor of a central bank or any other position that has comparable influence to the governor of the Reserve Bank of New Zealand YesNo
5. Senior foreign representative, ambassador, or high commissioner YesNo
6. High-ranking member of the armed forces YesNo
7. Board chair, chief executive, or chief financial officer of, or any other position that has comparable influence in, any state enterprise YesNo
Do you have:
1. Joint beneficial ownership of a legal entity or arrangement (e.g. a trust), or any other close relationship, with a person in any of the positions above? YesNo
2. Sole beneficial ownership of a legal entity or arrangement (e.g. a trust) that to exists for the benefit of a person in any of the positions above? YesNo
* The term 'Immediate family member' means:
a spouse or partner (a person who is considered by relevant national law as equivalent to a spouse);
a child, and a child’s spouse or partner; or
a parent.
To meet the requirements under the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 (AML/CFT Act), we must verify our client’s identity and residential address.
One option is to try and do this electronically; however, as not everyone can be verified electronically, please be advised that we may still contact you for further verification if the electronic verification fails.
As part of the electronic verification processes, your personal details are disclosed to and matched with information held by the issuer of the identity document containing your personal details e.g. your drivers’ licence or the official record holder of your information, via third party systems.
We will only use your personal details for the purpose of verification under the AML/CFT Act.
By signing this form, you confirm that you are authorised to provide personal details presented and you consent to your information being checked with the documents issuer or official record holder via third party systems for the purpose of confirming your identity.
Creating and maintaining risk related models, including but not limited to risk assessment, risk analysis and risk management;
Fulfilling reporting obligations, including but not limited to Annual AML/CFT Report, SAR, PTR, CRS, FATCA and any other reporting obligations imposed by New Zealand laws and regulations;
Responding to the inquiries of banks or any other regulatory bodies;
Marketing products, services and other subjects under the umbrella of Collinson & Co;
Meeting the requirements to make disclosure under the requirements of any law binding on us or under and for the purpose of any guidelines issued by regulatory bodies or other authorities to comply;
Any other purposes relating to the purposes listed above.
Notwithstanding the foregoing, I/we acknowledge that where a suspicious activity report has been made about me/us, the person who has made that report is not able to give me/us access to any information about that report (including its existence) and I/we have no right to request information in that report to be corrected.
In case of any change in circumstances that causes the information contained herein to become incorrect I/we recognize that I/we will have to provide a suitable updated declaration within 30 days of such change in circumstances.
Please be advised that penalties under the AEOI laws may apply if you provide false or misleading information, fail to provide this information, or fail to provide an update if there is a material change to the information you have provided. This includes civil penalties of $1,000 per offence that Inland Revenue can apply. Substantial criminal penalties can be imposed by the courts for knowledge-based offences. These penalties apply for the purposes of both FATCA and CRS.
Terms & Conditions:
The Client consents to Direct FX using information gathered from the Client during the application process, being used to electronically verify the Clients identify, for the purpose of compliance with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009.e. The Client consents to Direct FX passing information gathered from the Client during the application process, to Data Zoo (NZ) Ltd, for the sole purpose of verifying the Clients identify, for the purpose of compliance with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009.
By signing this form, I agree and confirm that:
- My answers above are correct
- I will promptly send confirmation should my answer in any category above change in the future.
Δ