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

    2. Nature and Purpose

    Nature of Business

    Account Behaviour Baseline

    Section B: Entity Ownership and Control Structure

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

    Person 1


    Person 2


    Person 3


    Person 4


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

    1. Tax Residence

    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 2


    Country of Tax Residence 3


    2. Entity Classification

    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

    3. Personal Information and Privacy Act

    • 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.

    4. United Stated (US) Foreign Account Tax Compliance Act (FATCA) Automatic Exchange of Information (AEOI) and the Common Reporting Standard (CRS)

    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)

    Person 1

    List of Country of Tax Residence 1


    List of Country of Tax Residence 2


    List of Country of Tax Residence 3


    Person 2

    List of Country of Tax Residence 1


    List of Country of Tax Residence 2


    List of Country of Tax Residence 3


    Person 3

    List of Country of Tax Residence 1


    List of Country of Tax Residence 2


    List of Country of Tax Residence 3


    Person 4

    List of Country of Tax Residence 1


    List of Country of Tax Residence 2


    List of Country of Tax Residence 3


    Extra page for Section B: Entity Ownership and Control Structure

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

    Person 5


    Person 6


    Person 7


    Person 8



    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.