Customer Identification – Authorised Referee

1 Customer Identification Form Authorised RefereeHBAA302 CUA 05/18 Page 1 of 2 Issued by HSBC Bank Australia Limited ABN 48 006 434 162 AFSL 232595 Complete the form using blue or black pen and print in clear CAPITAL LETTERSC ontinued over pagePART A INDIVIDUAL TO COMPLETEA pplicant s signatureAccount/Application reference numberYOUR SIGNATURE MUST BE WITNESSED BY THE Authorised REFEREED eclarationI declare that the information contained above is true and correct and has been completed by me and not any other MM YYCurrent residential address (cannot be a PO Box)CountryPostcodeSuburbStateCityNation ality(if not Australian, nationality must be verified via a foreign passport or foreign national identity card )DD MM YYDate of birthFirst nameTitleLast nameMiddle namePART B Authorised Referee TO COMPLETEWork phone number( )Employer s nameIdentity documents sightedWrite name + Identification number (if any) + date/place/office of nameTitleLast nameWork addressPostcodeThis form will be used to verify your identity only where an individual cannot attend an HSBC branch.

2 You must verify your identityusing Primary and if necessary Secondary documents overleaf. The total document(s) must show:(1) FULL NAME(2) DATE OF BIRTH(3) YOUR RESIDENTIAL ADDRESS and(4) NATIONALITY (Where nationality in Part A is not Australian, nationality must be verified via a foreign passport or foreignnational identity card )Only an Authorised Referee (listed overleaf) may certify your identity copy of documents must be signed and dated by Authorised a Primary document contains all items and matches the applicant details in Part A ( Australian drivers licence), no otherdocument is required. If the document cannot verify all items, then a Secondary document must be used to verify the missing the completed form to: GPO Box 5302, SYDNEY NSW 2001 Note: Make sure that you include the certified copies of your identity documents with this 2 of 2 PART B Authorised Referee TO COMPLETE continuedAuthorised Referee s signatureTHE Authorised Referee MUST SIGN, DATE AND WRITE 'I have sighted the original of this document'ON EACH COPY OF THE IDENTITY declare that:(i) I have sighted the abovementioned Individual s original identity documents as listed in the section Identity documentssighted and can confirm that the full name, residential address and date of birth match the details provided above by theApplicant.

3 (ii)where the Applicant is not an Australian permanent resident, I have verified the Applicant s nationality from the aboveidentity documents;(iii) I certify that all documents are a true and correct copy of the original presented to me; and(iv) the Applicant signed this form in my MM YYID number (if applicable) Authorised Referee category(see below)EQUIVALENT JURISDICTIONSA rgentina, Australia, Austria, Belgium, Brazil, Canada, China,Denmark, European Commission, Finland, France, Germany,Greece, Gulf Co-operation Council, Hong Kong, China, Iceland,India, Ireland, Italy, Japan, Republic of Korea, Luxembourg,Malaysia, Mexico, Netherlands, Kingdom of, New Zealand,Norway, Portugal, Russian Federation, Singapore, SouthAfrica, Spain, Sweden, Switzerland, Turkey, United Kingdom& United to the Financial Action Task Force (FATF) website formore information on Member Countries Identification DOCUMENTSYou MUST use one of the following to verify your identity.

4 Photocard Australian drivers licence issued by an AustralianState or Territory # Passport signature and photo page(s) Government issued Proof of Age card Foreign National Identity card Foreign drivers licence * Identification DOCUMENTSI mportant notes: Expired documents will not be accepted Any document not written in English must be accompaniedby an accredited translation or translation from an HSBC staff member Copies of identity documents must be of both sides(where double-sided) and clearSECONDARY Identification DOCUMENTS Accredited translator means a person currently accreditedby the National Accreditation Authority for Translators andInterpretors Ltd. (NAATI) at the level of Professional Translator,or above, to translate from a language other than Englishinto English see # Includes renewed, interim, learners, provisional, bus, motorcycle or truck licence.

5 This does not include a driving licenceissued on paper (see Secondary Documents section) or aboat licence. Must be issued by a foreign government, the United Nationsor a United Nations agency.* Issued under a law of a foreign country for the purposes ofdriving a vehicle (as detailed in the Australian driving licenceabove). This does not include a driving licence issued onpaper.^ Must record the individual s lease of a residential property;be current; and be issued by a real estate agent or servicedapartment.~ Where the minimum contract length of 12 months for theprovided service is confirmed and is dated within the last MUST use one of the following to verify your address(except if using an Australian drivers licence as outlined overleaf).

6 Local Authority or Government Department letter, orstatement dated within the last twelve months, AustralianTaxation Office (ATO) notice letter or Council Rates Notice Bank statements and utility bills (including e-statements)dated within the last three months (internet screenshots arenot accepted) must contain full first and last names Residential property lease agreement / Residential ServicedApartment lease agreement ^ Mobile phone bill, home internet bill, pay TV bill or utilitywelcome letter ~ Authorised REFEREESA uthorised Referees must satisfy one of the occupations belowand cannot be an immediate family member. All occupationsare in Australia or in an equivalent Justice of the Peace of an Australian State or Solicitor/Barrister practising in Australia3.

7 An officer of an Australian bank or finance company with2 or more years of continuous service with one or morefinancial institutions (for the purposes of the StatutoryDeclaration Regulations 1993 (Cth))4. Commissioner for Oaths/Affidavits of an Australian Stateor officer of an embassy, consulate or high commissionof the country of issue of documentary verification officer in a HSBC Affiliate that is a regulated financialinstitution7. Judges, Masters and Magistrates of an Australian Federal,State or Territory certified public accountant practising in Australia9. A member of an Australian Commonwealth, State orTerritory parliament10. A police officer11. Notary Public12. An officer with, or Authorised representative of, a holderof an Australian financial services licence, having 2 ormore continuous years of service with one or morelicensees