New Account Application New Zealand Form

American Express Foreign Exchange International Payments New Account Application New Zealand Please complete this form either Online Key in details using the tab key to move between fields. Print the form to have it signed* This form can also be saved for later use. Offline Print and complete in CAPITAL LETTERS* Ensure the declaration section is physically signed by the relevant Director s. Fax completed forms to 0800 027 360 or email the signed form to your FX Relationship Manager. Before completing this form please acknowledge you have received our Product Disclosure Statements for Telegraphic Transfers and Forward Exchange Contracts. Please confirm you have received and read those documents by ticking the box. Part A Business Information Trading as Registered Business Name Registered Street Address. As per NZ Companies Office not PO Box Phone No* Fax No* Country of Incorporation/Registration/Establishment City/Town Postcode Business Website/URL Incorporation Date As per NZ Companies Office Principal Address of Business Legal Structure Business please tick one 1. Limited Liability Company Public 2. Partnership 3. Sole Trader 4. Trust 5. Government Entity 6. Co-operative 7. Other Private Trade references and the most recently compiled financial statements may be required to support your application* By signing this agreement you acknowledge and agree that we may request trade references and/or financial statements from your company from time to time. All applications except for Company entities must be accompanied by a completed Addendum relevant to the legal structure of the applicant. Name on Card Is your business enrolled in Membership Rewards No Yes If you don t have an American Express Business Card are you interested in receiving more information How did you hear about American Express Foreign Exchange International Payments Part B Ownership Information List all owners with at least 10 ownership minimum of one required Name Ownership Part C Contact Information Title Primary contact for payment enquiries daily operations call-backs etc* Email Preferred means of contact Phone Part D Official Authorisation International Payments from American Express offers multiple levels of authorisation for online clients. Each user may be individually authorised to perform specific functions on FX International Payments online system* Authorised options include Single Verification User inputs the payments details approves the same payment and completes the transaction* Dual Verification User inputs the payment details but is not authorised to approve the same payment for release. Another user verifies the information and approves the payment to complete the transaction* Please list the person s and his/her signature s who are authorised to make International Payments on behalf of your company and indicate all applicable authorisations. For phone identification purposes each authorised user is required to provide their date of birth. I designate the following individuals as authorised to enter into foreign exchange transactions on behalf of the Business. Date of Birth Signature / Position Mobile Number Please indicate all applicable authorisation levels for this user Input and approve payments Input payment details View transaction history/generate reports Approve payments made by a different user Administer account changes and change user authorisation Account Administrator y providing us with your email address you consent to us sending to you email messages with details about changes to your account Terms and Conditions other important information B about your account commercial electronic messages and offers that may be suited to your needs. Please visit our website page http //americanexpress. co. nz/privacy and select How to Decline Email to review or change your email choices. Part E Payment Needs Your Industry/Type of Business e*g* food and beverage importer clothing wholesaler office equipment manufacturer etc* Goods and Services for which you make International Payments Currency in which you make payments Currency/Currencies required e*g* USD EUR GBP Foreign Currency New Zealand Dollars Country/Countries to which you make payments e*g* Germany Canada not Europe or North America Anticipated number of International Payments per month Requested Daily Limit Average value of one month s total payments in New Zealand Dollars Services required Telegraphic Transfers Drafts Forward Exchange Contracts Cross Currency Declaration For corporate applicants signed approval must be provided by 2 Partners 2 Directors or in the case of a one-director company the Sole Director. For individual applicants signed approval must be provided by the Sole Trader or individual* 1. By signing below you request American Express to approve this application for Foreign Exchange Services. Y 2. ou agree to be bound by American Express Terms and Conditions for Foreign Exchange Transactions contained in our Product Disclosure Statements for all transactions carried out at your request. 3. You understand and agree that American Express is entitled to require receipt of cleared funds before finalising the transaction* 4. Ou authorise American Express to obtain credit reports at its discretion from credit reporting agencies on your Business or where appropriate conduct commercial reports on individuals if you have selected your Business is a Sole Trader pursuant to Part A above. I 5. f you choose to settle via Direct Debit please refer to the separate Authority to Accept Direct Debits form and the specific Terms and Conditions related to Direct Debit Settlement in the Telegraphic Transfers Product Disclosure Statement. 6. The individual s signing below confirm s that he/she is/are authorised to sign the document and that all information given above is correct. Name of Signatory Signature of Individual Applicant/Sole Director signature Title/Position Date Executed for and on behalf of the Company in accordance with Section 180 of the Corporations Act 1993. Company Name Name of Partner/Director Secretary Signature of Partner/Director New Zealand Call Visit 0800 472 353 Registered Trademark of American Express Company.