Onboarding 1Introduction2General Information3Personal Information4Foreign Citizenship or Residency5AML Information6Client Authority/Declaration CompanyThis field is for validation purposes and should be left unchanged.Introduction Personal Information - Privacy Statement We collect personal information from you, including information about: your name your contact information your responses to this form We collect your personal information in order to onboard you as a client (or as a contact of a client – for example a Family Trust or a Company) of our practice and/or update your information from time to time. Please complete this form If you’re new to Blackwood Montagna or haven’t dealt with us since 1 July 2018. You have the right to ask for a copy of any personal information we hold about you, and to ask for it to be corrected if you think it is wrong. If you’d like to ask for a copy of your information, or to have it corrected, please contact us at reception@bmlegal.co.nz, or call on 09 283 8432 or at 12/18 Seddon Street, Pukekohe 2120 Completing this form We need your IRD number. Please have it available to enter in the form. If there is another person or there are people also onboarding our practice with you, we need that person or people to each complete this form. Depending on the nature of the work you want us to do for you, we may need to receive from you further information, including verifying your identity. This is under our mandated Customer Due Diligence requirements under the Anti-Money Laundering and Countering Financing of Terrorism Act 2009. If this is required then, in the form, you will be offered options for documents we need to see to verify your identity. We ask you, if you can, to scan the relevant documents and upload the copies as part of this process. Here are the options. Please review these now to ensure you have the relevant documents available to scan and upload. Option 1 - Current New Zealand Passport and Proof of Address (see below) Option 2 - Current New Zealand Drivers Licence and Proof of Address (see below) Proof of Address means evidence of your current residential address and must be dated within the last 3 months and not be addressed to a PO Box number. Proof may be provided by using any one of the following; Utility invoice (e.g. Council Rates invoice, Power Bill) Insurance policy correspondence Tenancy agreement Government Agency correspondence (e.g. IRD, WINZ, New Zealand Transport Agency) Option 3 - If you do not have the documents identified in Options 1 and 2 including the Proof of Address document(s) then please call us to discuss what alternative documents you may have that will allow us to fulfil our obligations to accept you as a client. In some circumstances we may need some more information from you and we have a separate form available for that purpose. We will advise you if that is required and provide a link to the form for you to access and complete. Once you have completed and submitted this form, we will receive by email a copy of the questions and your answers and responses. You will receive an email confirming that receipt. If you need to take a break from the form, you can do so by clicking the Save and Continue Later link at the bottom of each page. You will then receive an email with a link which will allow you to resume where you left off. Your answers will all be saved automatically. General InformationExisting Blackwood Montagna Client Account number (if applicable)Is there a separate identity or organisation (such as a Trust or Company) which is or will be our client, and for which you are a contact (such as a Trustee, Shareholder or Director)? Yes No Please name the identity or organisation here.Is there another person or are there other people also onboarding our practice as a client or contact(s)? Yes No Please name them here. Note they will also need to complete and submit their own form.First NameMiddle NameLast Name Add Remove Your DetailsTitle:(Required) Mr Mrs Miss Ms Other Gender(Required) Male Female Non-Binary First Name(Required)Middle Name(s)Surname(Required)Date of Birth(Required) DD slash MM slash YYYY OccupationDaytime PhoneMobileEmail address(Required) Current home address: (please note we cannot accept a P.O. Box number)Current Address Street Address Address Line 2 City Region Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Have you lived at this address for more than two years? Yes No If no, please enter your previous address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Is your Mailing Address different from your current home address Yes No If Yes, please enter your current mailing address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country IRD Number(Required)What is your tax rate? Please note that if you don’t advise us your tax rate we will deduct tax at 39% on any investments made through our on-call account, and you will be liable for any under-paid tax. 10.5% 17.5% 30% 33% 39% Non-Resident withholding Tax Are you a New Zealand Resident? Yes No If no, what is your country of residence? AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Declaration of Foreign Citizenship or Residency for tax purposesAre you a US Citizen? Yes No Are you a tax resident in a country other than New Zealand? Yes No Please list all countries other than New Zealand in which you are a tax resident and provide the Tax Information Number (T.I.N) for each country Client Name Country Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. AML InformationHave we asked you to provide us with information relating to our obligations under the Anti-Money Laundering and Countering Financing of Terrorism Act 2009? Yes No We will need to verify your identity from the following Options. Please note that although you will be asked to scan and upload copies of the relevant document(s) we will also need to see the originals when you visit us. By providing copies you will reduce the time needed by both you and us to complete our statutory obligations. Option 1 Current New Zealand Passport and Proof of Address (see below) Option 2 Current New Zealand Drivers Licence and Proof of Address (see below)Option 3 - Other as discussed with us If you do not have the documents identified in Options 1 and 2 including the Proof of Address document(s) then please call us to discuss what alternative documents you may have that will allow us to fulfil our obligations to accept you as a client.Proof of Address means evidence of your current residential address and must be dated within the last 3 months and not be addressed to a PO Box number. Proof may be provided by using any one of the following Utility invoice (e.g. Council Rates invoice, Power Bill) Insurance policy correspondence Tenancy agreement Government Agency correspondence (e.g. IRD, WINZ, NZ Transport Agency) Please select the Option you wish to use to verify your identity Option 1 Option 2 Option 3 Option 1Current New Zealand Passport I confirm I have a current New Zealand Passport. Which Proof of Address document are you using to verify your address? Utility invoice (e.g. Council Rates invoice, Power Bill) Insurance policy correspondence Tenancy agreement Government Agency correspondence (e.g. IRD, WINZ, NZ Transport Agency) If you can, please scan and upload the NZ Passport and Proof of Address document here. Drop files here or Select files Max. file size: 100 MB. Option 2Current New Zealand Drivers Licence I confirm I have a current New Zealand Drivers Licence. Which Proof of Address document are you using to verify your address? Utility invoice (e.g. Council Rates invoice, Power Bill) Insurance policy correspondence Tenancy agreement Government Agency correspondence (e.g. IRD, WINZ, NZ Transport Agency) If you can, please scan and upload the NZ Driver’s Licence (front and back, showing expiry date) and Proof of Address document here; Drop files here or Select files Max. file size: 100 MB. Option 3I confirm that I cannot comply with Options 1 & 2 and that I have contacted you to discuss what identification and verification documents will be required. Click to Confirm This field is hidden when viewing the formPlease select which of the following documents you are using for identification verification; NZ Driver’s Licence (must be current) Hospitality NZ 18+ card Current International driving permit This field is hidden when viewing the formAND which of the following documents you are using for identification verification; NZ Birth Certificate NZ Citizenship Certificate Overseas Birth Certificate Overseas Citizenship Certificate If you can, please scan and upload the identification and verification documents as we have discussed. Drop files here or Select files Max. file size: 100 MB. Client Authority/DeclarationThe Information you provide to Blackwood Montagna will be kept strictly confidential and will be securely held by Blackwood Montagna. You have a right to access the information by enquiring at our office and you may also request that is be correct. A fee may be payable. So Blackwood Montagna can ensure your information is accurate, please let us know of any changes in your personal details (like a change of address). Blackwood Montagna may use this information to: Administer, manage and monitor any services that we provide to you; Meet our obligations under the Anti-Money Laundering and Countering Financing of Terrorism Act and associated Regulations; Conduct market research, data processing and statistical analysis; and Unless you disagree, provide you with information about updates in law or other services that we can offer you. I do not wish to receive information about other services. Consent(Required) I agree to the following declarationBlackwood Montagna may disclose information about you for the above purposes. I declare that; The information in the application forms the basis of the agreement between Blackwood Montagna and me. I certify that the information on this form is true and correct. I certify that I am not an undischarged bankrupt and am not liable under proceedings under the insolvency Act 1967 and its amendments. Date DD slash MM slash YYYY What happens next?If you have any concerns or issues relating to completing this form, please feel free to contact us directly or you can use the following field to outline those matters.Once you have completed and submitted this form, we will receive by email a copy of the questions and your answers and responses. You will receive an email confirming that receipt. Important. If you have completed the AML section (Step 5) and uploaded copies of identity verification documents we will still need to sight the originals of those documents when you visit us.
