Premier Deposit Account Application - HSBC Australia

1 HPRE201 MKT (R37) 04/18 PERSONAL DETAILSC ountry of birthNationalityCountry of birthNationalityPremier Deposit Account ApplicationSurnameAPPLICANT 1 SurnameAPPLICANT 2 TAX FILE NUMBER NOTIFICATIONC ollection of Tax File Number(s) is authorised by taxation laws. Quotation is not compulsory and will not affect your Application . However tax may bededucted from any payments to you at the highest marginal rate plus Medicare levy if a TFN is not provided or you do not fall within an applicable 1 Tax file number or reason for exemptionAPPLICANT 2 Tax file number or reason for exemptionNoHome Premier countryAre you an existing HSBC Premier customer?

2 Ye s* Previous address (complete if less than 3 years at your current/permanent residential address cannot be a PO Box)PostcodeYearsMonthsCountryTime at previous addressPostcodePermanent residential address (complete only if different toyour current residential address cannot be a PO Box)CountryAt this address sinceDD MM YYFirst nameTitleMiddle name(s)NoNationality 2Do you have multiple nationalities?Ye sNationality 3 GenderMaleFemaleDD MM YYDate of birthNoList country(ies) outside Australia belowDo you have a relationship with HSBC outside Australia ?

3 Ye sFormer nameOther nameCurrent residential address (cannot be a PO Box)PostcodeCountryAt this address since *DD MM YYNoHSBC Customer you an existing HSBC customer?Ye sNoHome Premier countryAre you an existing HSBC Premier customer?Ye s* Previous address (complete if less than 3 years at your current/permanent residential address cannot be a PO Box)PostcodeYearsMonthsCountryTime at previous addressPostcodePermanent residential address (complete only if different toyour current residential address cannot be a PO Box)CountryAt this address sinceDD MM YYFirst nameTitleMiddle name(s)NoNationality 2Do you have multiple nationalities?

4 Ye sNationality 3 GenderMaleFemaleDD MM YYDate of birthNoList country(ies) outside Australia belowDo you have a relationship with HSBC outside Australia ?Ye sFormer nameOther nameCurrent residential address (cannot be a PO Box)PostcodeCountryAt this address since *DD MM YYNoHSBC Customer you an existing HSBC customer?Ye sFor Everyday Global, HSBC Premier Cash Management, HSBC Premier Childrens Savings,Serious Saver, Flexi Saver, Offset Savings and Term Deposit AccountsPage 2 of 9 PERSONAL DETAILS continuedAPPLICANT 1 Postal address (only if different to permanent residential address)PostcodeCountryWhich other countries and cities have you lived in over thepast 3 years?

5 (complete if time at current and previous addressesis less than 3 years attach a separate sheet if you have livedin more than 5 countries and cities) at thisaddressMMYYMMYYMMYYMMYYMMYYAPPLICANT 2 Postal address (only if different to permanent residential address)PostcodeCountryWhich other countries and cities have you lived in over thepast 3 years? (complete if time at current and previous addressesis less than 3 years attach a separate sheet if you have livedin more than 5 countries and cities) at thisaddressMMYYMMYYMMYYMMYYMMYYC ountry of residence for tax purposes and related Taxpayer Identification Number (TIN) or equivalentPlease complete the tables below indicating: Where you are a tax resident.

6 And Your TIN for each country a TIN is not available, please provide Reason A, B or C where indicated below:Reason AThe country where you are liable to pay tax does not issue TINs to TIN is required. Only select this reason if the authorities of the country of tax residence entered below do notrequire the TIN to be BReason CYou are otherwise unable to obtain a TIN or equivalent why you are unable to obtain a TIN in the space provided : Tax residents of Australia do NOT need to disclose their Tax File Number (TFN) for Common Reporting Standard (CRS) purposes.

7 If you listAustralia as a country of tax residence in the table below, you do not need to complete the corresponding TIN field and should select Reason you selected Reason B above, explain why you are unableto obtain a oftax residenceTINIf a TIN is not available,indicate reasonABCABCABCABCABCAPPLICANT you selected Reason B above, explain why you are unableto obtain a oftax residenceTINIf a TIN is not available,indicate reasonABCABCABCABCABCPage 3 of 9 PERSONAL DETAILS continuedHome phone number( )Work phone number( )Mobile phone numberEmployer s name/Business nameNature of business if self-employed or a business ownerOccupationJob titleAPPLICANT 1 Home phone number( )Work phone number( )Mobile phone numberEmployer s name/Business nameNature of business if self-employed or a business ownerOccupationJob titleAPPLICANT 2 INTERNATIONAL Premier DETAILS (if applicable)APPLICANT 1 APPLICANT 2 Overseas Premier countryOverseas Premier Customer numberOverseas Premier countryOverseas Premier Customer numberHSBC Premier PARENT/GUARDIAN DETAILS (if applicable)

8 HSBC Premier Parent/Guardian details are required for HSBC Premier Children s Savings Account applicant(s)APPLICANT 2 HSBC Premier Parent/Guardian CountryHSBC Premier Parent/Guardian Customer NumberAPPLICANT 1 HSBC Premier Parent/Guardian CountryHSBC Premier Parent/Guardian Customer NumberEmail addressEmployer's address (cannot be a PO Box)PostcodeCountry$Gross annual incomeEmployment typeBusinessownerEmployee*Key controllerSoletrader*A Key controller is a person who exercises control over a company/entityEmail addressEmployer's address (cannot be a PO Box)PostcodeCountry$Gross annual incomeEmployment typeBusinessownerEmployee*Key controllerSoletrader*A Key controller is a person who exercises control over a company/entityEmployment statusCasualPart-timeFull-timeContractor Home dutiesSelf employedNot employedRetiredStudentAnticipated course end dateMM YYEmployment statusCasualPart-timeFull-timeContractor Home dutiesSelf employedNot employedRetiredStudentAnticipated course end dateMM YYPage 4 of 9 ADDITIONAL Account SERVICING INFORMATIONTo ensure we are complying with Anti-Money Laundering and

9 Counter-Terrorist Financing Laws and HSBC policy, we need toconfirm the oftransactionsRemarks( child student fees)DebitCredit$$Details of expected transactions per monthLocal (within Australia )InternationalSpecify countriesCashLocal (within Australia )$$$$$$Transaction amountInternationalSpecify countriesAPPLICANT 1 TypeNon-cashNumber oftransactionsRemarks( child student fees)DebitCredit$$Local (within Australia )InternationalSpecify countriesCashLocal (within Australia )$$$$$$Transaction amountInternationalSpecify countriesAPPLICANT 2If you are opening a personal joint Account , please indicate the number of signatures required to operate the accountIn respect to the operation of Serious Saver Accounts.

10 If more than one person signs this Application I/we authorise HSBC BankAustralia Limited to act on instructions from any one source of funds being used to open this Account *Savings/InvestmentsInvestment incomeGovernment benefitsSuperannuation paymentsSalary*InheritanceStudent allowancePensionOtherSpecifySalary creditsPrimary source of income (select one)Centrelink paymentsStudent allowancesSuperannuation paymentsInvestment incomeDependent on family memberTelegraphic Transfer in/outCash depositCash withdrawalsTypes of expected Account activityCheque creditsClearing chequesTransfers in/outAPPLICANT 1 Source of wealthAdditional information for explanation of income and wealth( type of employment/business, inheritance, sale of assets).