KYC Onboarding (Individual) | Johnson Conveyancing

KYC Onboarding — Individual

Complete this form to help us meet our obligations under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (AML/CTF Act).

Johnson Conveyancing is required to collect certain information about you before we provide our services. The details below allow us to verify your identity and assess our obligations under the AML/CTF Act. Please complete every required field marked with an asterisk *.

If you have any questions, please do not hesitate to contact our office on (03) 4313 4343.

Client information

First name *

Please enter your first name.

Middle name

Last name *

Please enter your last name.

Are you known by any other names? *

Yes No

Date of birth * Format: DD / MM / YYYY

Please enter your date of birth.

Occupation *

Please enter your occupation.

Residential address * Your full current residential address, including suburb, state and postcode.

Please enter your residential address.

Politically exposed person (PEP)

A politically exposed person holds, or has held, a prominent public position or function. See the definitions in Annexure A below before answering.

Are you, or have you been, a politically exposed person listed in Annexure A? *

Yes No

Has a family member or close business associate been, or are they, a politically exposed person listed in Annexure A? *

Yes No

Are you, or a related party, operating a charity or other non-profit organisation (NPO)? *

Yes No

Services

Services requested * Select all that apply.

Purchase property Sell property Rent property Sale or transfer of a body corporate or legal agreement Managing client money or assets Equity or debt financing for body corporate or legal arrangement Shelf company sales or transfers Company or structure formation / restructuring Acting in corporate or legal roles Nominee shareholder services Registered office or business address services Other

Please select at least one service.

Sole trader

Is the individual a sole trader? *

Yes No

Registered business / trading name

ABN

Representative

Is there a representative who is authorised to act in relation to this service?

Yes No

Representative details

Full name

Capacity / authority to act e.g. attorney under power, director, trustee, guardian.

Date of birth

Phone

Residential address

A representative's identity must also be verified. We will be in touch about verifying their identity.

Important information

Our business must gather information from you to ensure compliance with our anti-money laundering and counter-terrorism financing obligations. We may stop providing services to you if you refuse to provide the information we request, or we decide you are not within our risk appetite.

It is an offence under sections 137 and 140 of the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (AML/CTF Act) to provide false or misleading information in this form or documents you provide to us, or to receive a designated service from us using a false name or anonymously.

By completing and signing this form you confirm that the information provided is correct and accurate. You also consent to your and any representative's identification being verified electronically, and to us disclosing your information to third parties to help us meet our obligations under the AML/CTF Act.

Annexure A: Politically Exposed Person definition

Below are definitions of different types of politically exposed persons (PEPs).

Consider if you or your representative are a politically exposed person. Note: family members and close business associates of persons who hold one of these positions are also considered politically exposed persons.

Foreign PEP

A foreign PEP is an individual who holds or has held a prominent office or position or public function in or for the legislature, executive or judiciary of a foreign country. This includes an individual who holds or has held any of the following offices or positions:

head of state or head of government
member of the executive council of government
member of a legislature
minister, deputy minister or equivalent office or position
judge of a supreme court, constitutional court or other court of general jurisdiction or last resort
ambassador, high commissioner or chargé d'affaires
high ranking military officer
head or board member of a government body
head or board member of a state-owned company or a state-owned bank
member of a governing body of a political party represented in a legislature

A foreign PEP is also a family member of an individual listed above, or an individual who is known (based on information that's public or readily available) to have:

joint beneficial ownership of a body corporate or legal arrangement with an individual listed above
sole beneficial ownership of a body corporate or legal arrangement on behalf of or for the benefit of an individual listed above
any other close business relations with an individual listed above

Domestic PEP

A domestic PEP is an individual who is in, or has been in, the following office or position:

member of the legislature of the Commonwealth or a state or territory
member of the governing body of a political party represented in the legislature of the Commonwealth or a state or territory
Governor-General
governor of a state
administrator of a territory
Justice of the High Court
Judge of the Federal Court of Australia
Judge of the Supreme Court of a state or territory
accountable authority, or member of the accountable authority, of a Commonwealth entity within the meaning of the Public Governance, Performance and Accountability Act 2013 (PGPA Act) (for example, a Secretary of a Department of State or parliamentary department)
member of the governing body of a wholly-owned Commonwealth company within the meaning of the PGPA Act
head (however described) of a department of state or territory, or an agency or authority of a state or territory that has a prominent public function
head (however described) of a local government council in a state or territory
the chair of the board, chief executive officer or chief financial officer of a company or other incorporated body that's wholly-owned or majority-owned by a state or territory
Chief of the Defence Force, Vice Chief of the Defence Force, Chief of Navy, Chief of Army or Chief of Air Force
officer of the Navy of the rank of Vice Admiral or higher
officer of the Army of the rank of Lieutenant General or higher
officer of the Air Force of the rank of Air Marshal or higher
any of the following offices of the Commonwealth in a foreign country, or to a public international organisation, to which appointments are made by the Governor-General: Ambassador, High Commissioner, Consul-General, Australian representative, special representative, representative, permanent representative, Chargé d'Affaires

A domestic PEP is also a family member of an individual listed above, or an individual who is known (based on information that's public or readily available) to have:

joint beneficial ownership of a body corporate or legal arrangement with an individual listed above
sole beneficial ownership of a body corporate or legal arrangement on behalf of or for the benefit of an individual listed above
any other close business relations with an individual listed above

International Organisation PEP

An international organisation PEP is an individual who is entrusted, or has been entrusted, with a prominent public function, position or office of a public international organisation. This includes a head, deputy head or board member in a public international organisation, such as a United Nations body.

An international organisation PEP is also a family member of one of these individuals, or an individual who is known (based on information that's public or readily available) to have:

joint beneficial ownership of a body corporate or legal arrangement with an individual entrusted with a prominent public function, position or office of a public international organisation
sole beneficial ownership of a body corporate or legal arrangement on behalf of or for the benefit of such an individual
any other close business relations with an individual entrusted with a prominent public function, position or office of a public international organisation

Family members

A family member includes:

a spouse, de facto partner, or equivalent under any applicable law of a foreign country
a child of the individual
a spouse or de facto partner of a child of the individual
a parent of the individual

Declaration

I declare that the information I have provided in this form is true, accurate and complete to the best of my knowledge. I understand it is an offence under the AML/CTF Act to provide false or misleading information, and I consent to my (and any representative's) identity being verified electronically and to my information being disclosed to third parties as needed for Johnson Conveyancing to meet its obligations under the AML/CTF Act.

Please confirm the declaration before submitting.

Signed by (type your full name) *

Please type your full name.

Date *

Please select a date.

✓

Thank you — your form has been sent

We’ve received your completed KYC onboarding form and it has been sent to our office. We’ll be in touch shortly to arrange identity verification. If anything changes, please call us on (03) 4313 4343.

Johnson Conveyancing • (03) 4313 4343 • angus@johnsonconveyancing.com.au