Premier Deposit Account Application - Personal …

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?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?

2 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 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?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 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? (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; 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.

4 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. 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( )

5 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)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 Counter-Terrorist Financing Laws and HSBC policy, we need toconfirm the oftransactionsRemarks( child student fees)

6 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, 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)

7 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).* If Savings/Investments or inheritance, give details of sourceof of opening an Account with HSBC Bank you are a non-resident, please state your rationale for openingthe Account (s). Note: One word answers are not 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 2 Source of wealthAdditional information for explanation of income and wealth( type of employment/business, inheritance, sale of assets).

8 * If Savings/Investments or inheritance, give details of sourceof of opening an Account with HSBC Bank you are a non-resident, please state your rationale for openingthe Account (s). Note: One word answers are not 5 of 9 TERM Deposit DETAILSA mount of term Deposit $Mark this box to authorise HSBC to debit the initial opening Deposit from my/our Account specified above^ If you choose to automatically renew your term Deposit on the maturity date, you may receive a lower interest rate on therenewed term Deposit than the interest rate quoted here. Please refer to for standard interest rates.* Fees and charges apply. Refer to Personal financial services charges your guideThe interest rate you will receive for your new Term Deposit will be:This rate is indicative and subject to change. You will receive the rate Application on the date your Account is payment frequency (select one)Options for interest payment frequency: Monthly, quarterly or at maturity for terms of 12 months or less Monthly, quarterly or annually for terms greater than 12 monthsPlease refer to or PDS for available terms and interest payment frequenciesTermAt MaturityAnnualQuarterlyMonthlyCurrency of term depositAUDHKDO therSpecifyUSDGBPNZDP rincipal instructions at maturityYou should advise us of your instructions for dealing with your term Deposit before its maturity date.

9 If you do not, we will renewthe Deposit for the same term at the applicable interest rate on the date of by bank cheque*Re-invest for the same term^Month(s)Year(s)Re-invest for new term^Note: To credit a non-HSBC Australia Account , please complete a separate Transfer of Funds form*Credit HSBC Bank accountBSBA ccount numberInterest payment instructionsRe-invest at maturity^Pay by cashPay by bank cheque*Specify Account details belowCredit to an external Account *Credit HSBC Bank accountBSBA ccount numberBSBA ccount numberName of InstitutionLocationInitial depositAmount$Debit initial opening Deposit of$from my/our HSBC accountBSBA ccount numberType of initial depositCashThird party HSBC Account transfer (complete separate form)ChequeType of access requiredPhone Banking accessOnline Banking accessPage 6 of 9 TRANSACTION Account DETAILSYe sYe sN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A N/AN/AN/AN/A^Products available to HSBC Premier applications only.

10 Applicants under 18 are not eligible for the Serious Saver Account . Each applicant can only open one HSBC Serious Saveraccount, and there is a maximum of 2 people per 1 joint Serious Saver Account . If one of the applicants already has a SeriousSaver Account then the Serious Saver Account will not be opened pursuant to the Product Disclosure Statement but thenominated Account will be opened.~ For information on how your HSBC Offset Savings Account operates, please refer to the HSBC Home and Investment PropertyLoans Booklet of Standard Terms and Conditions and the Product Disclosure Statement/or HSBC Offset Savings Accounts.#Online and Phone Banking and/or Visa Debit card access are not available if more than one signature is required to operate ajoint Account .* One offset savings Account is available in respect of a Standard Variable Home loan Account only and loans may not be linkedto regular Deposit Account with HSBC.