Your Salary Packaging Visa card How to apply To receive your card as soon as possible, follow our two step process. STEP 1 Verify your identity – using the ANZ Know Your Customer (KYC) identification process If you are already an ANZ banking customer – with products other than a Maxxia card – you do not need to verify your identity. Simply indicate that you are an existing customer on your application form and also ensure that the name, address and birth date you provide exactly match your details currently held with ANZ. If you are a first-time ANZ customer, there are two ways you can verify your identity: By certified documents, if you are unable to attend an ANZ branch In-person at any ANZ branch • Review the accepted combinations of ID in the attached ANZ KYC Flyer. ! • Visit your local ANZ branch with two forms of identification, at least one government-issued photographic ID, such as a current Passport or Australian Drivers Licence. OR • Complete the attached ANZ Identification by Certified Copy for Individuals Form and send certified photocopies of approved ID documents to ANZ. ! • Complete the seven-step checklist provided with the application form. • Ask your ANZ Branch Officer for a KYC reference number. STEP 2 Complete and return your application form Complete the attached Salary Packaging Cardholder Application Form ensuring the name, address and birth date you provide exactly match that supplied to ANZ. Then return your form to Maxxia by: ! Email: [email protected] ! Fax: 1300 733 444 or ! Post: Maxxia Pty Ltd, Locked Bag 18, Collins Street East, Melbourne VIC 8003 ! Important notes • The name, address and birth date provided on your identification, or held with ANZ if you’re an existing ANZ customer, must exactly match those provided on your form or your application will not be approved. • Complete your ID process and your application as soon as possible; otherwise you may not receive your full tax savings in the current Fringe Benefits Tax year for benefits payable to your salary packaging card. • Your pre-tax deductions will be held in your salary packaging account until the application process is complete. • If ANZ has provided you with a KYC reference number as a part of your identity verification process, please ensure you include this on your Salary Packaging Cardholder Application Form. • Remember, your salary packaging Visa card application cannot be processed by Maxxia until ANZ has verified your identity. Maxxia Pty Ltd ABN 39 082 449 036 Authorised Representative (No. 278683) of McMillan Shakespeare Limited (AFSL No. 299054) MAXMKG_MESPVisaCard_Process_0314 Salary Packaging Cardholder Application Form This form must be signed by the Cardholder and the Authorised Person listed overleaf. To complete the form, please complete Parts 1-6. 1. CARD TYPE & AMOUNT Please select Primary and/or Additional Card. Primary Card Additional Card Both Primary and Additional Cards Please select the type of Salary Packaging Card you require. If a Primary Card, nominate the amount you wish to salary package per pay cycle*: A. Salary Packaging Card If Primary, the amount to be deducted per salary cycle $ * Your pay cycle is determined by your employer. The nominated amount will be deducted from your pre-tax salary by your employer and will be made available on your Salary Packaging Card. If you wish to change the nominated amount you will need to arrange this change with your employer. ANZ is not responsible for and accepts no liability for, your salary deduction arrangements with your employer. Any questions or concerns regarding your salary deductions or the nominated amount must be referred to your employer. 2. PRIMARY CARDHOLDER EMPLOYER DETAILS Employer Site/Campus If applying for an Additional Card Primary Cardholder full name 3. PRIMARY CARDHOLDER DETAILS *All fields mandatory Title First Name Middle Name (if any) Employee ID Salary Packaging Provider Reference/ID (if different) M a x x i Surname a Date of Birth (DD/MM/YYYY Security Code - You need to choose an identification password to be used to identify yourself over the phone or for online set up. This can be a combination of numbers or letters. Phone Number Mobile Email Address Residential Address Suburb/town State Postcode Postal Address (if different from above) Suburb/town State Postcode If you are an existing ANZ customer and you need to update your account details with ANZ, there are three fast and easy ways to do this: - Log on to ANZ Internet Banking and select ‘Update Details’ - Call 13 13 14; or - Visit an ANZ Branch 4. ADDITIONAL CARDHOLDER DETAILS Title First Name Middle Name (if any) Surname Primary Cardholder’s Employee ID Salary Packaging Provider Reference/ID (if different) Date of Birth (DD/MM/YYYY Phone Number M a x x i a Mobile Security Code - For over the phone identification only. This can be a combination of numbers or letters. Residential Address Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Suburb/town State Postcode Page 1 of 2 Salary Packaging Cardholder Application Form 5. Identification (Know Your Customer) Verification It is a legislative requirement that cardholders complete an identity verification check before the card is activated. If you do not currently hold a valid identification record with ANZ, you will need to complete identification and verification (NB: cardholders who hold other ANZ products and have been identified previously may not be required to be identified again. The address you were previously identified with ANZ must be the same as your current address that you have detailed on this form). You must have a valid identification record with ANZ before your card will be activated. The easiest way to do this is by visiting an ANZ Branch with the identification documentation outlined in the accompanying flyer. PLEASE ENSURE YOU HAVE COMPLETED IDENTIFICATION PRIOR TO SUBMITTING THIS APPLICATION. YOUR CARD WILL NOT BE ACTIVATED UNTIL YOUR IDENTITY HAS BEEN SUCCESSFULLY VERIFIED BY ANZ. ALL CARDHOLDERS (BOTH PRIMARY AND SECONDARY) WILL NEED TO COMPLETE IDENTIFICATION. Please advise which of the following is applicable: Primary Additional Cardholder Cardholder I am an existing ANZ customer (for a product other than Salary Packaging).(NB: By ticking this box you may still be required to be re-identified by ANZ, subject to existing account and identification status. Account details with ANZ must be the same as the details listed on this form) I have been to an ANZ Branch for the purposes of an identity verification check I have been identified by ANZ through other means 6. Account Authority If a Primary Card, by use of the Card, I accept that I will be liable to ANZ for any credit extended arising out of the use of the Card, including the use of the Card by an Additional Cardholder, and agree to all applicable terms and conditions included within ANZ Commercial Card Terms and Conditions for the ANZ Salary Packaging Card or ANZ Meal Entertainment Card which can be viewed at anz.com/aus/ratefee/default.asp?section=SBS I declare that the details contained on this application form are true and correct and request that ANZ issue the card to me. I acknowledge that additional rules may be imposed by my salary packaging provider regarding the use of this card and a copy of these rules have been made available to me. I hereby declare to abide by such rules and variations which are made by salary packaging provider from time to time. Also, I have read and understood (and agree to) the declaration below. Primary Cardholder Signature (Mandatory) Date (dd/mm/yyyy) If an Additional Card, by use of the Card, I agree to all applicable terms and conditions included within ANZ Commercial Card Terms and Conditions for the ANZ Salary Packaging Card or ANZ Meal Entertainment Card which can be viewed at anz.com/aus/ratefee/default.asp?section=SBS I declare that the details contained on this application form are true and correct and request that ANZ issue the card to me. I acknowledge that additional rules may be imposed by my salary packaging provider regarding the use of this card and a copy of these rules have been made available to me. I hereby declare to abide by such rules and variations which are made by salary packaging provider from time to time. Also, I have read and understood (and agree to) the declaration below. Additional Cardholder Signature Date (dd/mm/yyyy) 7. Declaration ANZ’s collection, use and disclosure of personal information Australia and New Zealand Banking Group Limited ABN 11 005 357 522 (ANZ) is collecting the Cardholder’s information in order to provide the Cardholder with the ANZ Salary Packaging Card. Without this information, ANZ will not be able to provide the Cardholder with the Card. By signing this Salary Packaging Cardholder Application Form, the Cardholder acknowledges and agrees that: (a) ANZ may also use this information and disclose this information for internal administration and operations; and (b) ANZ may also disclose this information to third parties, including but not limited to the Cardholder’s Employer and any salary packaging service providers, for the purposes of the administration and operation of the ANZ Salary Packaging Card The Cardholder may request access to this information by calling 1800 614 741. Access will be granted in accordance with the Privacy Act (1988) for ANZ’s usual fee. If any of the Cardholder’s information is inaccurate, the Cardholder may request that it be corrected. Other Information Your agreement to the use and disclosure of your personal information applies to any personal information collected by ANZ in the course of your relationship with ANZ. By signing this form, you acknowledge that the Consumer Credit Code does not govern the Salary Packaging card. ANZ is the issuer of the Salary Packaging Card Your employer or salary packaging provider has entered into an arrangement with ANZ for ANZ to issue Salary Packaging Cards to eligible and approved cardholders. By signing this form, you acknowledge that ANZ is not responsible for the deduction of the nominated amount listed in section 1 or for making any changes to this amount. Any questions, concerns or request for changes to this amount must be referred to your employer. ANZ accepts no liability in connection with your salary deduction arrangements. ANZ will make your salary deduction available for use on your selected Salary Packaging Card once your application is approved and ANZ has processed your salary deduction from your employer or salary packaging provider. You are only eligible to use the Salary Packaging Card while you are employed by your employer listed in section 2. Upon termination of your employment (either by you or your employer), your eligibility ceases and ANZ may in its discretion immediately cancel your Salary Packaging Card and return any available funds to your employer or salary packaging provider. Your employer may then deal with any returned funds in accordance with your employment contract or arrangement. You must immediately notify ANZ (either directly or indirectly via your salary packaging provider) if your employment is terminated. You acknowledge that ANZ’s responsibility is to make salary deductions from approved cardholders available for use on their Salary Packaging Cards once ANZ has processed them. ANZ is not responsible for, and accepts no liability for, salary deductions until such time as they are received and processed by ANZ. ANZ accepts no liability for acts or omissions of your employer or any salary packaging provider in any way connected with your Salary Packaging Card that in any way causes loss or damage to you. Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Australian Credit Licence Number 234527. Item No. 74020 09.2013 W343637 Page 2 of 2 Marriage Certificate Certificate of Divorce (must show married name as maiden name) Court Order • • • Adoption Papers Birth Certificate with Endorsement Change of Name Certificate (Deed Poll) Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Australian Credit Licence Number 234527. ANZ’s colour blue is a trade mark of ANZ. Item No. 88622 08.2013 W357582 • • • Any Questions? Call ANZ Salary Packaging on 1800 614 741. M-F 8am-8pm AEDST. • Other Australian Bank Passbook • Other Australian Bank Credit Card • Other Australian Bank Debit Card • Medicare Card • Financial Institution Bank Statements (less than 3 months) – this must be a bank statement issued by: - Members of the Australian Bankers Association - Australian-owned banks that are regulated by APRA • Australian Tertiary Institution Student Card • Tax Assessment Notice issued by ATO (less than 12 months old) • Utility Bill (less than 3 months old) • Government Benefits Notice (less than 12 months old) • School Attendance Letter (less than 3 months old) • Registered Aged Care Facility Letter (less than 3 months old) • Rates Notice (less than 3 months old) • Birth Certificate • Australian Citizenship Certificate • Foreign Citizenship Certificate (translated into English if required, by a translator accredited by the National Accreditation Authority for Translators and Interpreters (NAATI)) • One of the following Centrelink Pension Cards: - Health Care Card - Commonwealth Seniors Health Card - Pensioner Concession Card • Interim Concession Card • Foreign Drivers Licence (must not be expired) • Australian Passport (current or expired less than 2 years) or Foreign Passport • Australian Drivers Licence or Learner Permit • One of the following other photo ID: - Proof of Age Card - Army, Navy or Air Force ID - Department of Defence ID - Police ID - Government issued Foreign ID - Firearms / Shooting Licence - Explosives Licence - Waterways / Boat Licence It is not acceptable to produce two forms of the same ID type e.g. an Australian passport and a British passport, or drivers licence and a learners permit or foreign drivers licence Acceptable linking documents (if identification document is in a different name to that recorded in Customer key details) Other ID Evidence of Address Government-issued non-photographic ID Government-issued photographic ID Category C Category B Category D One category B and one category C One category A and one category B One category A and one category C One category A and one category D Two category A Below is a list of documents that you can provide when visiting an ANZ branch. Once you have been identified by ANZ, you should submit your Salary Packaging or Meal Entertainment card application form to your provider for processing. F or your nearest ANZ branch visit www.locate.anz.com/anz/australia Category A The Customer Identification Process requires only two identification documents, but in a limited number of combinations. If an identification document is in a different name to that recorded in the Key Details, a linking document will also be required, e.g. a marriage certificate that links the married name in the Key Details to the maiden name on a driver licence. You can provide any of the following combination of documents: All primary and secondary cardholders will need to be identified by ANZ. • A Medicare Card • An Australian Bank Credit or Debit Card • A Proof of Age Card • An Australian Drivers Licence isit an ANZ branch and provide two forms of identification before applying for your card. V For example, in your wallet you may currently be carrying: Don’t forget to identify yourself with ANZ prior to submitting your application. How to identify yourself with ANZ using certified documents If you can’t access an ANZ Branch, you may wish to identify yourself with ANZ using certified documents. ALL SECTIONS OF THE DOCUMENT ARE MANDATORY Any Questions? Call ANZ Salary Packaging on 1800 614 741. M-F 8am-8pm AEDST. CERTIFIED DOCUMENTS CHECKLIST If any of these actions are not completed, this will delay card activation. Step Action 1 Complete ‘Part A’ on the following page (page 2) Photocopy your original documents Please make sure these documents are legible and the photocopy is clear to avoid having to re submit documents NB: Acceptable Documents for Individuals and Acceptable Linking Documents are shown below Complete ‘Section B’ on the following page (page 2) Take your original documents along with the photocopied documents to have them certified by one of the authorised persons (Authorised persons are listed on page 3) Have the authorised person complete ‘Section C’ and make sure that the authorised persons are accepted by ANZ (Authorised persons are listed on page 3) Please ensure the writing is legible and clear and ensure that they sign Section C Post certified copies, along with the completed form to: ANZ SALARY PACKAGING CARDS Attn Salary Packaging Cards Lock bag 10 Collins Street West Post Office Melbourne VIC 8007 Australia Once received, certified documents can take up to three working days to be processed. Please allow for standard postage time. Send your Salary Packaging or Meal Entertainment card application form to your provider for processing Your card will not be activated until your certified documents have been processed 2 3 4 5 6 7 Complete The Customer Identification Process requires only two identification documents in the combinations outlined below. If an identification document is in a different name to that recorded in the Key Details, a linking document will also be required, e.g. a marriage certificate that links the married name in the Key Details to the maiden name on a driver licence. Acceptable combinations of documents ü Two category A ü One category A and one category B ü One category A and one category C Category A Government-issued photographic ID ü ü Category B Government-issued non-photographic ID •Birth Certificate •Australian Citizenship Certificate •Foreign Citizenship Certificate (translated into English if required, by a translator accredited by the National Accreditation Authority for Translators and Interpreters (NAATI)) •One of the following Centrelink Pension Cards: - Health Care Card -Commonwealth Seniors Health Card It is not acceptable to produce two forms -Pensioner Concession Card of the same ID type e.g. an Australian •Interim Concession Card passport and a British passport, or •Foreign Drivers Licence drivers licence and a learners permit (must not be expired) or foreign drivers licence •Australian Passport (current or expired less than 2 years) or Foreign Passport •Australian Drivers Licence or Learner Permit •One of the following other photo ID: - Proof of Age Card - Army, Navy or Air Force ID - Department of Defence ID - Police ID - Government issued Foreign ID - Firearms / Shooting Licence - Explosives Licence - Waterways / Boat Licence One category A and one category D One category B and one category C Category C Evidence of Address Category D Other ID • Tax Assessment Notice issued by ATO (less than 12 months old) •Utility Bill (less than 3 months old) •Government Benefits Notice (less than 12 months old) •School Attendance Letter (less than 3 months old) •Registered Aged Care Facility Letter (less than 3 months old) •Rates Notice (less than 3 months old) •Other Australian Bank Passbook •Other Australian Bank Credit Card •Other Australian Bank Debit Card •Medicare Card •Australian Tertiary Institution Student Card •Financial Institution Bank Statements (less than 3 months) – this must be a bank statement issued by: -Members of the Australian Bankers Association -Australian-owned banks that are regulated by APRA Acceptable linking documents (if identification document is in a different name to that recorded in Customer key details) •Adoption Papers •Court Order •Birth Certificate with Endorsement •Marriage Certificate •Change of Name Certificate (Deed Poll) •Certificate of Divorce (must show married name as maiden name) Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Page 1 of 3 Identification by Certified Copy for Individuals (including Signatories and Agents) Form All fields on this form are mandatory This form must be signed by an Authorised Person as listed overleaf. To complete this form, complete Part A, Part B and Part C and attach the certified copies. PART A: INDIVIDUAL’S DETAILS Full Name of Individual (no initials) First name(s) Middle name(s) - if any Last name(s) Date of birth Residential address (PO Box is not acceptable) Occupation Suburb State PostcodeCountry Signature PART B: DOCUMENTS CERTIFIED – ENSURE CERTIFIED COPIES ARE ATTACHED TO THIS FORM First Identification Document Type of Document Secondary Identification Document Type of Document Linking Document (If either or both identification documents are in a different name to Individual’s details) Type of Document Acceptable Documents for Individuals and Acceptable Linking Documents are listed overleaf. Warning: It is an offence under Part 12 of the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (Cth) to produce false or misleading information, produce a false or misleading document or forge a document for use in an applicable customer identification procedure. Guidance Notes for Certified Copies Certified copy means a document that has been certified as a true copy of an original document by one of the authorised persons. To produce a certified copy, you should make a photocopy of the original document and take the original and the copy to an authorised person. PART C: DETAILS OF AUTHORISED PERSON Full Name of Authorised Person (no initials) Title Name of Organisation First name(s) Address of Organisation Last name(s) Suburb Phone Number State PostcodeCountry Professional Membership Number (if applicable) Signature Date Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Page 2 of 3 Identification by Certified Copy for Individuals (including Signatories and Agents) Form Authorised Persons The following is a list of persons authorised to certify a copy. Unless it is specified that the Authorised Person may be overseas, an Authorised Person must be either an Australian Citizen or Permanent Resident of Australia. 1. A person who is enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a legal practitioner (however described); 2. A judge of a court in Australia or overseas; 3. A magistrate in Australia or overseas; 4. A chief executive officer of a Commonwealth court; 5. A registrar or deputy registrar of a court; 6. A Justice of the Peace; 7. A notary public (for the purposes of the Statutory Declaration Regulations 1993) in Australia or overseas; 8. A police officer; 9. An agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public; 10. A permanent employee of the Australian Postal Corporation with 2 or more years of continuous service who is employed in an office supplying postal services to the public; 11. A n Australian consular officer or an Australian diplomatic officer (within the meaning of the Consular Fees Act 1955); 12. An officer with 2 or more continuous years service with one or more Australian financial institutions (for the purposes of the Statutory Declaration Regulations 1993) or overseas financial institutions with which ANZ has an existing correspondent banking relationship; 13. A finance company officer with 2 or more continuous years of service with one or more finance companies (for the purposes of the Statutory Declaration Regulations 1993); 14. A n officer with, or authorised representative of, a holder of an Australian financial services licence, having 2 or more continuous years of service with one or more licensees; 15. A member of the Institute of Chartered Accountants in Australia, CPA Australia or the National Institute of Accountants; 16. A pharmacist. Exemptions – one identification document permitted (Only for persons who cannot otherwise provide two identification documents) The Customer Identification Process allows exemptions for some persons who cannot otherwise provide two identification documents. This section lists the types of persons who are eligible for this exemption, and lists the types of document they are permitted to provide as their single identification document. Recent arrivals in Aust (less than six weeks) Persons under 18 Australian passport (current) Foreign passport (current) Travel certificate (issued by foreign country) National foreign government photo identity card (current) Australian passport (current or expired less than two years) Foreign passport (current) Australian driver licence or learner permit (current) Australian citizenship certificate Foreign citizenship certificate (translated into English if required) School attendance letter (less than 3 months old) Birth certificate School leavers over 18 Aboriginals and Torres Strait Islanders Australian driver licence or learner permit (current) Electoral Card issued by Australian Electoral Commission (current residential address) Rent or lease papers (current residential address) Letter signed by two Indigenous Community Leaders* Indigenous community ID card (left school in last 6 months and not currently working) *Must be dated and include senders’ full names, titles or ranks, organisation name(s) and address(es). Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Australian Credit Licence Number 234527. Item No. 60877 08.2013 W357584 Page 3 of 3