Company identification

About this form

Under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (AML/CTF Act) we are required to identify and verify our clients before providing some services. This form collects details about the company. In addition, EACH director, each beneficial owner (any individual who directly or indirectly owns 25% or more of the company or otherwise controls it) and the person submitting this form must each complete the separate 'AML – Individual' form at dalal.com.au/aml/individual, entering this company's name.

Company Details

Full registered company name

Business / trading name(s) and any other names

ACN / ARBN (or foreign registration number)

ABN

Company type

Country of incorporation

Is the company listed on a stock exchange?

If listed, which exchange and ticker code?

Is the company regulated (e.g. by APRA, or holds an AFSL or ACL)?

If regulated, regulator and licence number

Addresses

Registered office address

Principal place of business (if different)

Nature of the business (industry, products or services, and where it operates)

Governance

How is the company governed?

Upload a current ASIC company extract (or foreign registration certificate)

Upload the company constitution (if applicable)

Full name and Director ID of every director (one per line)

Company secretary full name (if any)

Ownership and Control

We are required to identify every individual who directly or indirectly owns 25% or more of the company, or who otherwise controls it (for example through voting rights, board appointment rights or practical influence). Where shares are held by another company or trust, please trace ownership through to the individuals.

Shareholders: name, number and class of shares, and % held (one per line)

Beneficial owners: full name, date of birth, residential address, % owned or controlled, whether held directly or indirectly, and how control is exercised (one per line)

Upload an ownership / group structure chart (if the structure has more than one layer)

Contact Person / Authorised Representative

The person submitting this form on behalf of the company.

Full name

Position / role

Email

Phone

Your authority to act for the company

Upload evidence of your authority if you are not a director (e.g. board resolution, power of attorney, letter of authority)

Services and Purpose

Tell us what the company is engaging us for. Tick all that apply.

Politically Exposed Person (PEP) Declaration

A politically exposed person (PEP) is someone who holds or has held a prominent public position or function in Australia (domestic PEP), in a foreign country (foreign PEP), or in an international organisation (e.g. the United Nations). Examples include heads of state or government, government ministers, members of parliament, senior judges, senior military officers, ambassadors, senior executives of state-owned enterprises, and senior officials of political parties. This also includes immediate family members (e.g. spouse, partner, parents, children and their partners) and known close associates of a PEP.

Is any director, beneficial owner or authorised representative of the company (or any of their immediate family members or close associates) a politically exposed person?

If yes, please provide the person's name, their connection to the company, the position held, and the country or organisation

Source of Funds and Wealth

What is the main source of the funds for the services or transactions you are engaging us for?

Source of funds details (e.g. the asset sold, the lender, the shareholder contributing capital)

How has the company (and its owners) accumulated its wealth? (e.g. trading history, asset sales, investment)

Privacy and Declaration

Privacy collection notice: Dalal Accountants collects the information in this form, including personal information about directors, owners and representatives, to comply with our obligations under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (Cth) and associated Rules. We use it to identify and verify our client and the people connected to it, assess money laundering and terrorism financing risk, keep records as required by law, and make any reports required by law. We may verify information with third parties such as government registries (e.g. ASIC and ABN Lookup), document verification and identity service providers, and screening services. Politically exposed person information may be sensitive information and is collected only for this purpose. We may disclose information to AUSTRAC and other government agencies as required or authorised by law, and to our service providers. We are required to keep these records for at least 7 years. If this information is not provided we will be unable to provide the requested services. Our Privacy Policy explains how to access or correct information and how to make a complaint. You can contact us on 03 8353 8247. By submitting this form you confirm that the individuals named have been made aware that their information is being provided to us.

I have read and understood the privacy collection notice above

I declare that I am authorised to provide this information on behalf of the company, that it is true, correct and complete, and that I will notify Dalal Accountants of any changes