Open Account - Barclay Wells

Adviser Name
Name of Person Managing this Application*
First Last
Type of Applicant*
- Individual Person
- Joint Persons
- Company
- Deceased Estate
Are the Applicants Acting as Trustee?*
- No
- Yes, for a Superannuation Fund (SMSF)
- Yes, for a Formal Trust (Family, Discretionary or Unit)
- Yes, for a Bare Trust (e.g. shares held for Children)
How Many Joint Holders / Trustees or Directors*
- One
- Two
- Three

Registration Details
Registration Address*
Address Line 1 Address Line 2 State Post Code Country

This is the address that shareholdings will be registered to. It can be a postal or street address.
Account Designation*
Do not use the word "Trust" in the account designation.

Individual Client # 1 (or Director / Trustee # 1)
Name*
Title Given Names Surname
Individual One*
- Is a Trustee of the Applicant
- Is a Director of Applicant Company
Select One Option Only
Residential Address*
Same as previous

Address Line 1 Address Line 1 City State Post Code Country

This must match your ID exactly.
Postal Address*
Same as previous

Address Line 1 Address Line 1 City State Post Code Country
Email*
Enter Email Confirm Email
Phone (Mobile)*
Phone (Fixed Line)
Country of Birth*
Date of Birth*
Occupation*
Tax File Number

Company Applicant
Company Name*
ABN or ACN*
Country of Incorporation*
Company Registered Address*
Same as registration address

Address Line 1 Address Line 2 State Post Code Country
Company Postal Address*
Same as registration address

Address Line 1 Address Line 2 State Post Code Country
Company Type*
- Proprietary (Pty Ltd)
- Public
Company Shareholders
Please provide full name and residential address of each individual who owns through one or more shareholdings, more than 25% of the Issued issued capital of the Company.
Shareholder 1*
Prefix Given Surname
If the shareholder is another company or trust, trace back to the ultimate beneficial shareholder.
Address for Sharehoder 1*
Same as previous

Address Line 1 Address Line 1 City State Post Code Country

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
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
Name
First Last

Registration Details