Account Application Form – Entity

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: Entity Information

1. Entity Details

Full name of the business*

Phone number*

Registration / Incorporation number*

Business Physical Address*

City*

Country*

Postcode*

Tax number*

Email*

2. Nature and Purpose

Nature of Business

a) What industry is your organisation in? I.e. Construction, import/export, commercial property investment etc.*

b) What does your organisation do in the above industry? I.e. Health food export, wine wholesaler, cosmetics import etc.*

c) List of countries normally dealing/trading with*

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*

Section B: Entity Ownership and Control Structure

Directors, Shareholders (with more than 25% shareholding), and Authorised persons

Section C: Foreign Account Tax Compliance Act (FATCA) and Common Reporting Standard (CRS) Declaration

1. Tax Residence

Is the Entity a tax resident of another country (other than New Zealand)?*
Yes (please list all other countries of tax residency)No (go to the next section)

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

2. Entity Classification

Please provide the status of the Entity*
Active Non-Financial EntityFinancial InstitutionPassive Non-Financial Entity

If you choose Passive Non-Financial Entity, then please complete Tax Residence of Controlling Persons in Section E: Additional Inofrmation)

Definition of terms for Entity Classification

Active Non-Financial Entity (ANFE):
A likely status for entities that derive the majority of their income, within a reporting period, through the course of an active trade or business (for example: retail or service-based business).

Passive Non-Financial Entity (PNFE):
an entity whose main source of income is passive (for example: your entity has ≥ 50% passive income AND ≥ 50% passive income generating assets (in the previous reporting period).

Financial Institution (FI):
A Custodian Institution, Depository Institution, Investment Entity, or Specified Insurance Company. Apart from more obvious entities such as banks, this can also include non-bank deposit takers, collective investment entities, mutual funds, private equity funds, hedge funds, investment managers and advisors, and certain brokers and trusts (including some managed family trusts).

Section D: 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 transactions 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 CFX.Notwithstanding the foregoing, I/we acknowledge that where a suspicious transaction 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 CFX.

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 advisd 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.

Section E: Additional Information

Entity Classification - Tax Residence of Controlling Persons

Tax Residence of Controlling Persons (only complete this section if your entity is a Passive Non-Financial Entity)