1. No category

CUSTOMER IDENTIFICATION VERIFICATION
AND BROKER DECLARATION.
For any enquiries contact the Credit Hotline on 1300 728 154
Visit mebank.com.au/broker
Broker use only
Please complete the Customer Identification section below for all customers/guarantors (new and existing).
Supply one primary photographic identification document
Primary Photographic Identification Document:
All documents must be current (with the exception of Australian passports expired within the last two years but not cancelled) and contain the person's
full name, date of birth OR current residential address.
Driving licence or permit (Australian only)
Passport or similar document issued for international travel (Australian or foreign)
Proof of age card (Australian only)
Record of identification document received
Applicant 1 Applicant 2/Guarantor
ID Record
Full name verified:
Yes
No
Yes
No
Date of birth verified:
Yes
No
Yes
No
Residential address verified:
Yes
No
Yes
No
Verified from:
Original
Certified copy
Original
Certified copy
Copy of ID document:
Attached
Not attached
Attached
(complete details below)
Type of document:
Document number:
(if applicable)
D D M M Y Y Y Y Date of issue:
(e.g. passport)
Not attached
(complete details below)
D
D
M
M
Y
Y
Y
Y
D
D
M
M
Y
Y
Y
Y
(if applicable)
Place of issue:
(if applicable)
Expiry date:
D
D
M
M
Y
Y
Y
Y Promo code
Please provide (if applicable)
Additional details
Does the customer have multiple applications in progress?
Yes
No
Has the customer sold a property that will settle on or prior to the new purchase?
Yes
No
If yes, please specify the property address below.
Members Equity Bank Limited ABN 56 070 887 679 AFSL and Australian Credit Licence: 229500.
State
Postcode
1.
Responsible Lending
Please confirm you have discussed with the customer and made appropriate notes in your application submission regarding:
Equity Release
Yes
N/A
Exit Strategy if the customer is aged over 55
Yes
N/A
Please confirm the customer's stated objectives and nature of the credit requested.
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Broker Declaration
1. I declare that any information contained in this declaration and in the application is true and correct and obtained directly from the applicant(s)/guarantor(s).
2. I certify that I have provided the applicant’s with the Customer Information pack.
3. I certify that:
- I have the documents provided to me by the applicant(s)/guarantor(s) and confirm that the originals of the documents sent to ME Bank are held by me.
- I will retain these documents, and will make them available to ME Bank when required.
Broker name Broker signature
Date
D
D
M
M
Y
Y
ME Bank Broker Identification Number
BC0004/7/WEB/0115/214141.
2.