KYC CORPORATE APPLICATION FORM Company Name Email Address ABN Legal Form Company Address Sector(s) of company activity Company Website Previous Next Please provide the following documents: Company Extracts Proof of Address Document (for the company) Certificate of Incorporation Company Resolution and Constitution AML policy (if applicable) Company Financial Report (most recent - if applicable) Previous Next Ownership Provide Breakdown of Beneficial Ownership or Structure Chart Please Provide names of all shareholders of the company (Including Institutions). List of Directors / UBO’s For each shareholder, please provide. One Identity document – A Photo of your Drivers Licence (Australian) front and back or photo of your Passport Front Back One Proof of address Document – A Bank Statement, Phone/Internet Bill, Council/Water/electricity bill If Company or trust, please provide company documents or trust deeds Previous Next Director / UBO 1 Name: Director / UBO 1 Signature: Date: Director / UBO 2 Name: Director / UBO 2 Signature: Date: Director / UBO 3 Name: Director / UBO 3 Signature: Date: Director / UBO 4 Name: Director / UBO 4 Signature: Date: Previous Next
