Customer Identification Procedure (Cip) Form - Individuals - Australian Transaction Reports And Analysis Centre
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2Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (AML/CTF Act)
Customer identification procedure (CIP) form - individuals
This form may be used to verify the identity of a customer receiving a designated service (for example, a customer opening a bank
account) under Part 7 of the AML/CTF Act and chapters 4 and 5 of the AML/CTF Rules). A reporting entity may choose whether or not
to use this procedure depending on the requirements of their AML/CTF program – Part B.
IMPORTANT: This procedure may only be used where the relationship with the
The AUSTRAC Help Desk can be
individual is deemed by the reporting entity to present a medium or lower money
contacted on 1300 021 037 or at
laundering or terrorism financing risk. Other know your customer (KYC) information
help_desk@austrac.gov.au if you require
may need to be collected (refer section 2 below) if warranted by a customer’s money
general assistance to complete this form.
laundering or terrorism financing risk.
1. COLLECTION OF MINIMUM KYC INFORMATION
Full name of customer
________________________________________________________________________________________________
/
/
Date of birth
day
month
year
Residential address
________________________________________________________________________________________________
number
street name
suburb
state/territory
country
postcode
Where the customer is a sole trader also collect:
Full business name (if any)
________________________________________________________________________________________________
Full business address (if any) ________________________________________________________________________________________________
number
street name
suburb
state/territory
country
postcode
Australian Business Number ________________________________________________________________________________________________
2. COLLECTION OF ADDITIONAL KYC INFORMATION (where applicable)
Other information collected
________________________________________________________________________________________________
Other information collected
________________________________________________________________________________________________
If more information is required to be collected, please attach to this record.
3. VERIFICATION OF KYC INFORMATION (refer to instructions on the following page)
At a minimum, CUSTOMER’S FULL NAME and either their DATE OF BIRTH or RESIDENTIAL ADDRESS must be verified.
Type of document
Document number
Person to whom it relates
Date of birth (age if relevant)
Place of residence
Date of issue
Place/Office of issue
Expiry date
4. NAME OF CHECKING OFFICER
_____________________________________________________________________
Date
/
/
day
month
year
March 2008
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