Individual / sole trader identification

About this form

Under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (AML/CTF Act) we are required to identify and verify our clients, and certain people connected to them, before providing some services. Please complete this form if you are an individual or sole trader client, OR if you are a director, beneficial owner, trustee, appointor, settlor, partner or authorised representative of an entity client (company, trust, partnership or association). Each person must complete their own form.

I am completing this form as

Entity name (if connected to a company, trust, partnership or association)

Personal Details

Given name(s) (as shown on your ID)

Surname / family name

Other names you are or have been known by (e.g. maiden name, alias)

Date of birth

Country of citizenship

Country of residence

Occupation

Employer / business name

Email

Phone

Residential Address

Your current residential address. A PO Box is not acceptable.

Street address

Suburb / town

State / territory

Postcode

Country

Postal address (if different)

Sole Trader Details

Only complete this section if you operate a business as a sole trader.

Business / trading name(s)

ABN

Principal place of business

Industry

Nature of the business (what products or services do you provide?)

Proof of Identity

Please provide EITHER Option 1: one primary photographic ID (e.g. Australian driver licence, passport, proof of age card or foreign national ID card), OR Option 2: one primary non-photographic ID (e.g. birth certificate, citizenship certificate, pension/concession card) AND one secondary document showing your name and residential address (e.g. utility bill or ATO/Centrelink notice less than 3 months old). Enter the document details below and upload a clear copy of each document (front and back where applicable). We may also ask to see you in person or via video call to confirm your identity.

Which identification option will you provide?

Primary ID document type

Document number

Issuing state / country

Expiry date (if applicable)

Upload primary ID (front and back)

Secondary document type (Option 2 only)

Secondary document issuer / reference number

Upload secondary document (Option 2 only)

Services and Purpose

Tell us what you are engaging us for. Tick all that apply.

Acting on Behalf of Someone Else

Are you completing this form on behalf of another person?

If yes, full name of the person you are acting for

If yes, your authority to act

If yes, upload evidence of your authority (e.g. power of attorney)

Politically Exposed Person (PEP) Declaration

A politically exposed person (PEP) is someone who holds or has held a prominent public position or function in Australia (domestic PEP), in a foreign country (foreign PEP), or in an international organisation (e.g. the United Nations). Examples include heads of state or government, government ministers, members of parliament, senior judges, senior military officers, ambassadors, senior executives of state-owned enterprises, and senior officials of political parties. This also includes immediate family members (e.g. spouse, partner, parents, children and their partners) and known close associates of a PEP.

Are you, or any of your immediate family members or close associates, a politically exposed person?

If yes, please provide the person's name, their relationship to you, the position held, and the country or organisation

Source of Funds and Wealth

What is the main source of the funds for the services or transactions you are engaging us for?

Source of funds details (e.g. the property sold, the lender, the employer)

How did you accumulate your overall wealth? (e.g. career earnings, business ownership, inheritance, investments)

Privacy and Declaration

Privacy collection notice: Dalal Accountants collects the personal information in this form, including identification documents, to comply with our obligations under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (Cth) and associated Rules. We use it to identify and verify you, assess money laundering and terrorism financing risk, keep records as required by law, and make any reports required by law. We may verify your information with third parties such as government registries (e.g. ASIC and ABN Lookup), document verification and identity service providers, and screening services. Politically exposed person information may be sensitive information and is collected only for this purpose. We may disclose your information to AUSTRAC and other government agencies as required or authorised by law, and to our service providers. We are required to keep these records for at least 7 years. If you do not provide this information we will be unable to provide the requested services. Our Privacy Policy explains how you can access or correct your information and how to make a complaint. You can contact us on 03 8353 8247.

I have read and understood the privacy collection notice above

I consent to my identity being verified electronically, including by checking my details against government records and credit reporting body records (optional - if you do not consent we will verify your identity by other means)

I declare that the information provided in this form is true, correct and complete, and I will notify Dalal Accountants of any changes