Personal Application Form

Title*
MrMrsMissMsDrProf

Given Name(s)*

Last Name*

Have you ever been known by a different name?*
Please select..YesNo

Date of Birth***If your Macbook won't allow you to submit this field, just leave it blank and we'll manually input it later.

Nationality*
Please select..New ZealanderAustralianCanadianHong KongeseIrishJapaneseSingaporeanSouth AfricanBritishAmerican-------------AlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentina"ArmeniaArubaAustriaAzerbaijanBahrainBangladeshBarbadosBelarusBelgiumBeninBhutanBosnia And HerzegowinaBotswanaBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsComorosCongoCosta RicaCroatiaCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHungaryIcelandIndiaIsraelItalyJamaicaJordanKazakhstanKiribatiKorea Republic ofKuwaitKyrgyzstaLaos Lao People's Democratic RepublicLatviaLesothoLithuaniaMacaoMacedonia The former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaFederated States OfMoldova Republic OfMongoliaMontenegroMontserratMoroccoMozambiqueNamibiaNauruNetherlandsNetherlands AntillesNew CaledoniaNicaraguaNigerNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPalauPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts And NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSenegalSerbiaSlovakiaSloveniaSolomon IslandsSouth Georgia And The South Sandwich IslandsSpainSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandTaiwanTajikistanTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (U.S.)Wallis and Furuna IslandsWestern SaharaZambia

Residential street address*

Town/City*

Post Code

Country*
Please select..New ZealandAustraliaCanadaHong KongIrelandJapanSingaporeSouth AfricaUnited KingdomUnited States of America-------------AlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentina"ArmeniaArubaAustriaAzerbaijanBahrainBangladeshBarbadosBelarusBelgiumBeninBhutanBosnia And HerzegowinaBotswanaBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsComorosCongoCosta RicaCroatiaCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHungaryIcelandIndiaIsraelItalyJamaicaJordanKazakhstanKiribatiKorea Republic ofKuwaitKyrgyzstaLaos Lao People's Democratic RepublicLatviaLesothoLithuaniaMacaoMacedonia The former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaFederated States OfMoldova Republic OfMongoliaMontenegroMontserratMoroccoMozambiqueNamibiaNauruNetherlandsNetherlands AntillesNew CaledoniaNicaraguaNigerNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPalauPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts And NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSenegalSerbiaSlovakiaSloveniaSolomon IslandsSouth Georgia And The South Sandwich IslandsSpainSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandTaiwanTajikistanTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (U.S.)Wallis and Furuna IslandsWestern SaharaZambia

Length of time at this address*
Please select..less than 1 year1 year2 years3 or more years

Email*

Phone(Please include the area code)*

​Are you a tax resident of a country other than New Zealand?*
Please select..YesNo

Have you or an immediate family member held in the last 12 months, any of the following positions?*
Head of State, country, or government; Government minister, or equivalent senior politician; Supreme Court Judge or equivalent senior Judge; High ranking member of the armed forces; Senior officer of a State enterprise
Please select..YesNo

Have you ever been declared bankrupt or sentenced to a period of imprisonment?*
Please select..YesNo

Nature and Purpose

Providing the below responses helps us give you the best service we can, as quickly as possible. These answers do not commit you to deal, they are simply designed to help us help you.

The currency I need to buy is*
Please selectNew Zealand dollarsAustralian dollarsCanadian dollarsEurosHong Kong dollarsJapanese yenPounds sterlingSingapore dollarsSouth African randSwiss francsUS dollars

The currency I need to sell is*
Please selectNew Zealand dollarsAustralian dollarsCanadian dollarsEurosHong Kong dollarsJapanese yenPounds sterlingSingapore dollarsSouth African randSwiss francsUS dollars

My bought currency needs to be transferred to*
Please select..New ZealandAustraliaCanadaHong KongIrelandJapanSingaporeSouth AfricaUnited KingdomUnited States of America-------------AlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentina"ArmeniaArubaAustriaAzerbaijanBahrainBangladeshBarbadosBelarusBelgiumBeninBhutanBosnia And HerzegowinaBotswanaBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsComorosCongoCosta RicaCroatiaCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHungaryIcelandIndiaIsraelItalyJamaicaJordanKazakhstanKiribatiKorea Republic ofKuwaitKyrgyzstaLaos Lao People's Democratic RepublicLatviaLesothoLithuaniaMacaoMacedonia The former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaFederated States OfMoldova Republic OfMongoliaMontenegroMontserratMoroccoMozambiqueNamibiaNauruNetherlandsNetherlands AntillesNew CaledoniaNicaraguaNigerNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPalauPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts And NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSenegalSerbiaSlovakiaSloveniaSolomon IslandsSouth Georgia And The South Sandwich IslandsSpainSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandTaiwanTajikistanTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (U.S.)Wallis and Furuna IslandsWestern SaharaZambia

My sold currency will be transferred from*
Please select..New ZealandAustraliaCanadaHong KongIrelandJapanSingaporeSouth AfricaUnited KingdomUnited States of America-------------AlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentina"ArmeniaArubaAustriaAzerbaijanBahrainBangladeshBarbadosBelarusBelgiumBeninBhutanBosnia And HerzegowinaBotswanaBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsComorosCongoCosta RicaCroatiaCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHungaryIcelandIndiaIsraelItalyJamaicaJordanKazakhstanKiribatiKorea Republic ofKuwaitKyrgyzstaLaos Lao People's Democratic RepublicLatviaLesothoLithuaniaMacaoMacedonia The former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaFederated States OfMoldova Republic OfMongoliaMontenegroMontserratMoroccoMozambiqueNamibiaNauruNetherlandsNetherlands AntillesNew CaledoniaNicaraguaNigerNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPalauPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts And NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSenegalSerbiaSlovakiaSloveniaSolomon IslandsSouth Georgia And The South Sandwich IslandsSpainSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandTaiwanTajikistanTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (U.S.)Wallis and Furuna IslandsWestern SaharaZambia

Approximate amount of your sold currency(Please enter numbers only)

Is your currency transfer a one off requirement?
Please select..YesNo

Please let us know the reason for you transfer?*

My transfer needs to occur*
Please select..As soon as possibleWithin a weekWithin a monthWithin 3 monthsWithin 6 months6 months plus

Is your currency transfer to a third party?*
Please select..YesNo

Any other comments you think we should know?

I/we have read, understood and agree to be bound by the Direct FX Terms and Conditions.*

I/we have read, understood and agree to the terms and conditions in the Forward Exchange Product Disclosure Statement and the Financial Services Guide and the Foreign Exchange Product Disclosure Statement and Financial Services Guide.*

How did you hear about us?*
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