Open Account - Barclay Wells

Adviser Name*
Best Contact Person (Your Name)*
Entity Type*
- Individual
- Joint Persons
- Company Name
Select the type of account holder or trustee
Trust Account
- Yes
Select if the account is to be opened in the name of a trust
(e.g. Superannuation Fund, Family Trust, or Child's Name)

Number of Joint Holders*
- Two
- Three
Select the number of joint holders to the account name will be opened in.
Person One
Title 1*
Given Name(s) 1*
Surname 1*
Country of Birth 1*
Country of Citizenship or Permanent Residency 1*
TFN 1
Date of Birth 1*
Person Two
Title 2*
Given Name(s) 2*
Surname 2*
Country of Birth 2*
Country of Citizenship or Permanent Residency 2*
TFN 2
Date of Birth 2*
Person Three
Title 3*
Given Name(s) 3*
Surname 3*
Country of Birth 3*
Country of Citizenship or Permanent Residency 3*
TFN 3
Date of Birth 3*

Designation Type*
- Trust (Superfund, Family Trust, Unit Trust etc.)
- Person (Power of Attorney, Child, Deceased Estate etc.)
Select the type of trust designation the account is to be opened in
Designation Name*
Cannot be longer than 28 characters
Trust Details
Full Name of Trust*
Type of Trust*
Trust ABN or ARBN*
Trust TFN*
Superannuation Fund TFN*
Country of Establishment*
Business Name of Trustee
Number of Trust Beneficiaries*
- One
- Two
- Three
Beneficiary 1 - Full Name*
Beneficiary 2 - Full Name*
Beneficiary 3 - Full Name*

Authorised Agent*
- Yes
- No
Select if you wish to authorise a third party to operate your account. The person will be authoirsed to act on your behalf, including giving trading instructions and requests for account information.
Details of Authorised Agent
Title Authorised Person*
Given Name(s) Authorised Agent*
Surname Authorised Agent*
Country of Birth*
Country of Citizenship or Permanent Residency - Authorised Agent*
Date of Birth Authorised Agent*
Mobile Number Authorised Agent
Business Number Authorised Agent
Street Address - Authorised Agent*

Banking Details
Default Bank Account Authority
- Direct Debit
- Direct Credit
- Both (Direct Credit and Debit)
Account Holder Name*
BSB*
Account Number*
Name of Bank or Financial Institution*
Country of Financial Institution*
Dividend Direction*
- Yes
- No
Are dividends from holdings in the account to be paid into this bank account?
Number of Bank Account Holders*
- One
- Two
- Three
Bank Account Holder 1 Name*
Bank Account Holder 2 Name*
Bank Account Holder 3 Name*

Transfer Holder Identification Number (HIN)*
- Yes
- No
Select 'Yes' if you wish to transfer the shares on your HIN from another broker to your new account.
Broker to Broker Transfer
Name of Exisitng Broker
HIN at Existing Broker
Existing Broker Account Number

Please make sure you have read and understood these important documents:

1. Barclay Wells Financial Services Guide
2. Pershing Privacy Policy and Financial Services Guide
I have read and understood the account terms and conditions*
- Yes

Person One