Abn / Tfn Declaration Form printable pdf download

ABN / TFN Declaration Form

Investor details

Declaration and signature(s)

APN Fund name

(the Fund)

Joint applicants must both sign

I/We declare that:

Investor number

All details provided by me/us in this Form are true and correct.

Investor name / Trust name / Company name / Partnership name

If this is a joint investment, each of us agrees, unless otherwise indicated on

this Form, our investment is as joint tenants. Each of us is able to operate

the account and bind the other(s) to any transaction including investments,

switches or withdrawal by any available method.

I/We will provide to APN FM or its nominee any information that APN

FM reasonably requires in order to enable APN FM to comply with all its

Are you exempt from quoting your tax file number?

obligations under the Anti-Money Laundering and Counter-Terrorism Financing

Act 2006 and its associated rules and regulations (in force from time to time).

If you elect to provide your ABN/TFN, APN Funds Management (APN

If investing as trustee on behalf of a superannuation fund or trust I/we am/are

acting in accordance with my/our designated powers and authority under the

FM) is required by law to safeguard it and only use it for approved lawful

trust deed. In the case of superannuation funds, I/we also confirm that it is a

purposes.

complying fund under the Superannuation Industry (Supervision) Act.

I/We acknowledge that APN FM and its related bodies corporate may disclose

and use personal information as contemplated in this form, APN FM’s Privacy

Investor A / Individual / Individual Trustee / Joint Investor / Partner

Policy available at and the Privacy Statement in the

PDS.

I/We acknowledge and agree that electronic instructions will be treated as

Title

Given name(s)

contemplated in the current PDS under the heading “Electronic Instructions”.

I/We will provide APN FM or its nominee any information that APN FM

Surname

reasonably requires in order to enable APN FM to meet all of its compliance,

reporting and other obligations under the United States of America Foreign

Male

Female

Date of birth

Account Tax Compliance Act (FATCA) and all associated rules and regulations

from time to time (including, without limitation, the Inter-Governmental

Residential address

(PO Box address is not acceptable)

Agreement (IGA) entered into between the governments of the US and

Australia). I/We understand that APN FM may disclose such information to the

Australian Taxation Office (ATO) who may in turn disclose the information to

the US Internal Revenue Service (IRS).

Suburb

State

Postcode

I/We understand that where I/we have provided APN FM or its nominee with

information about my status or designation under or for the purposes of

Country of residence

(only required if you are a foreign resident for tax purposes)

FATCA (including, but without limitation, US residency or citizenship status

and FATCA status as a particular entity type) and all associated rules and

regulations, APN FM will treat that information as true and correct without

any additional validation or confirmation being undertaken by APN FM except

ABN

where it is under a legal obligation to do so.

If this application is signed under Power of Attorney, the Attorney declares that

TFN or exemption code

he/she has not received notice of revocation of that power (a certified copy of

the Power of Attorney must be submitted with this application unless APN FM

have already sighted it).

SOLE SIGNATORIES signing on behalf of a company confirm that they are

Investor B / Joint Investor / Joint Trustee / Partner

signing as either a director or sole director and sole secretary of the company

by ticking the relevant box.

Title

Given name(s)

Signature of Investor A / Trustee / Company Officer

Surname

Male

Female

Date of birth

Residential address

(PO Box address is not acceptable)

Name of Investor A / Trustee / Company Officer

(please print)

Suburb

State

Postcode

Date

Country of residence

(only required if you are a foreign resident for tax purposes)

Director

Sole director

Trustee

Other

(please

and company

specify)

secretary

ABN

Signature of Investor B / Trustee / Company Officer

TFN or exemption code

Name of Investor B / Trustee / Company Officer

(please print)

Date

Director

Company

Trustee

Other

(please

secretary

specify)

ABN / TFN Declaration Form Page 1 of 2

Abn / Tfn Declaration Form

Related Articles

Related forms

Related Categories