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AMP Banking Third Party Access Form (Dec 2009) - FPAustralia

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Please staple all relevant material together
AMP Banking
Third Party Access
Please complete all applicable sections of this form. Mark boxes with (7) where appropriate, otherwise use block letters and leave a space
between words.
1. Do you wish to add, change or remove a third party?
Add a new third party
Change an existing third party
Remove an existing third party
2. Account number
Please show the account number which you authorise the third party to access or which your third party can currently access.
Note: All accounts listed must have the same account holders.
3. Account holder details
Please include all account holders and guarantors.
First name
First name
Current address (primary account holder)
Unit No.
Street No.
Street name
4. Details of new or existing third party
Full name(s)
Are you known by any other name?
If Yes, please provide details
Current residential address
Unit No.
Street No.
Street name
Country of residence
If Other, please specify
Country of citizenship
If Other, please specify
Phone number
Mobile number
Date of birth
Fax number
Occupation/job title or if Sole Trader, business name
Issued by AMP Bank Limited ABN 15 081 596 009, trading as AMP Banking, AFSL No. 234517.
A1 of 2
304054 11/09
5. Level of access authorised to third party
Please select the level of access you would like to authorise to the third party(ies) above.
1. Enquiry access only - Identification Verification form required.
Third party can request a statement, enquire about balances, payments, credit limits, interest rates and transactions. Access also includes
enquiry access through telephone banking (BankPhone) and internet banking (BankNet).
2. Full access - Identification Verification form required.
Third party can deposit, withdraw, transfer funds, arrange or change payments, stop cheques, cancel or order a cheque book or deposit book,
report lost or stolen cards, order an additional card, establish fax, telephone (BankPhone) and internet (BankNet) banking, supply or change
information on the account such as the address or Tax File Number, close the account, change the authority to operate, notify of bankruptcy,
court order or death of a customer.
For Term Deposit products only:
3. Term Deposit Maturity Instructions - Identification Verification form may be required - see below.
Third party can instruct us to redeem term deposit at maturity, instruct us to make a partial withdrawal, change term deposit maturity
instructions including whether or not to re-invest the term deposit for a new term and with new interest payment instructions.
Identification Verification form is required for third party access by a person who is not the appointed AMP Financial Planner or AMP accredited
representative for the term deposit account.
Third party IS NOT the appointed AMP Financial Planner or AMP accredited representative for the term deposit product - Identification
Verification form required.
Third party is the appointed AMP Financial Planner or AMP accredited representative for the term deposit product - Identification Verification
form NOT required. Sales ID number must be provided.
Sales ID Number:
6. Bankphone
A TelePIN is required to access information and transact by telephone. Your third party will need to contact AMP Banking on 13 30 30 to register
for a TelePIN once their details have been set up.
7. Bankfax - Full access only
Yes, I/we would like to operate and transact by fax. I agree to the Terms and Conditions that apply to third party transactions by BankFax
as if I/we were making the transaction. Please note - BankFax is a service available at an account level. If you have registered for BankFax all
account holders and third parties are able to transact via fax.
8. AMP ACCESS CARD - Full access only
To request an AMP access card, please complete the form Adding or Cancelling an Access Card for an Authorised Signatory available at
9. Signatures
I/We request AMP Banking to add, change or remove, as specified, the person ("third party") whose details are noted aboveto operate the
account. By signing this Third Party Access form, I/we agree that the third party is my/our agent for the purpose of accessing the account noted
and that I/we are responsible for the actions of the third party, for example, I/we are liable for any withdrawals or fees and charges which the
third party incurs and which will be debited to the account. I/We further agree that the operating authority for the accounts noted above are
“any to sign”. I/We will notify AMP Banking in writing to cancel this authority and this authority remains in force until then. I/We warrant that
the information in this Third Party Access form is accurate and complete.
Signature of Account Holder 1 7
Signature of Third Party 7
Signature of Account Holder 2 /
A2 of 2
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