AML-CFT

Anti-Money Laundering and Countering Financing of Terrorism

The Anti-Money Laundering and Countering Financing of Terrorism Act 2009 (“AML-CFT”) requires law firms to obtain certain information from their clients before providing services to them. In order to meet these legal requirements, we ask that you please complete this form and supply the further documentation required at your earliest convenience. We cannot commence work without first having received this information from you.

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Each individual, director, trustee, beneficiary and settlor must complete the following form once

[radio title default:1 “Mr” “Ms” “Mrs” “Miss” “Dr” “Other”]

Full Name

Company/Trust Name (if applicable)

Your Relationship To Company/Trust (if applicable)

Individual/Entity IRD Number

Date of Birth

Place of Birth

Residential Address

Postal Address (If Different)

Email Address

Home Phone

Mobile Phone

Occupation

Citizenship Status
NZ CitizenNZ Resident VisaNZ Work VisaNZ Student Visa
Other

Where would you prefer to sign your legal documents (if any)?
In our officeElsewhere under witness

Nature/Purpose of Business

We are required by the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 to obtain information on the nature and purpose of your proposed business relationship with us.

Please confirm that the nature and purpose of your proposed business relationship with us is that you wish to transfer funds to or from our trust account to effect a change of ownership rights in property or to procure other legal services from us.

YesOther Purpose

If you are transferring funds to or from our trust account for another purpose, please provide information on the nature and purpose of your proposed business relationship with us:

Describe the originating source of any and all funds to be transacted to or from our trust account:

We will contact you if we require further information.

Responsibility for Non-Compliance

If you deviate from these requirements in any way, or knowingly provide false information, and incur a loss as a result, we will not be liable for any such loss howsoever arising.

Signed [please type your name below]

Date

Upload Identity Verification Information (see below)

Identity Verification

We are required by the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 to confirm and verify details about our clients. To do this, we require copies of the documents set out below. These documents must be certified by a trusted referee (see below).

In some circumstances we may need to ask you to provide further evidence of your identity, or ask you for other information.

If you cannot provide these documents, please contact us to discuss.

Individual Clients

Provide the items required by ONE of the following:

● The identity page of your current passport (showing your full name, date of birth, signature, and photograph) AND a rates, phone, electricity, or other utility bill, or a bank statement from the last three months, addressed to you at your residential address.

● Your current New Zealand driver licence AND your full birth certificate or a certificate of New Zealand or foreign citizenship AND a rates, phone, electricity, or other utility bill, or a bank statement from the last
three months, addressed to you at your residential address.

Companies

Provide ALL of the following:

● The certificate of incorporation.

● If the address you have given us as your postal address is not your registered office address, a bank statement (or similar formal communication) from the last three months addressed to the company at the mailing address given. You do not need provide this if your mailing address is the same as your registered office address.

● For each director, the information set out under the heading ‘Individual Clients’ above.

Trusts

Provide ALL of the following:

● The trust deed.

● A bank statement (or similar formal communication) from the last three months addressed to the trust or its trustee(s) at the mailing address given.

● The information set out under the heading ‘Individual Clients’ above for each trustee OR if the trustee is a company, the information set out under the heading ‘Companies’ above for that company (including the information set out under the heading ‘Individual Clients’ above for each director).

● A description of the class of beneficiaries (if it is not set out in the trust deed OR if the trust is a fixed trust with less than 10 beneficiaries, the information set out under the heading ‘Individual Investors’ for each beneficiary.

● The origin of the settlor’s wealth or the source of any trust income.

Beneficial owners
If the client entity (e.g. a company or trust) has a beneficial owner(s), provide the information set out under the heading ‘Individual Clients’ above for each such person OR if the person is a company, the information set out under the
heading ‘Companies’ above for that company OR if the person is a trust, the information set out under the heading ‘Trusts’ above for that trust.

A trusted referee can be any of the following:
● Authorised Financial Adviser
● Commonwealth representative
● Minister of Religion
● Police Officer
● New Zealand Lawyer
● Justice of the Peace
● Notary Public
● Registered Medical Doctor
● New Zealand Honorary Consul
● Kaumatua
● Member of Parliament
● Registered Teacher
● Chartered Accountant
● NZX Advisor

The trusted referee must sight the original document, and provide a written statement to the effect that the copy provided is a true and correct copy and represents your identity.

Certification must include the name, occupation, and signature of the trusted referee and the date of confirmation, and must have been carried out in the last three months. If you cannot identify a suitable referee please contact us to discuss.