• Mr Mrs Ms Miss Dr Prof Ven Rev Title
• Male Female Other Gender
• Preferred name
• First name
• Middle name(s)
• Last name
• Legal name as per other legal documents? (Ex: Passport, Driver licence, etc.)

  if this is not your legal name used in other documents, please correct it. By law, you are required to supply the full legal name for foreign currency transfers.

• Individual Joint/Partnership Company Trustee Incorporated Association Unincorporated Association If customer is an Individual, Partnership, Company, Association, etc. ?
• Family Remittance Utility Bill Payments Savings or Investments Loan Repayments/Settlement or Credit Card Payments Educational Support House Construction or Renovation Medical Assistance Donation for Charity Gift Business Payments (Imports/ Exports) Other Purpose of the account (Business Relationship)
• Purpose of the account - Other (Please specify)
• Date of birth
• Occupation

Contact Details

• Street address
• Suburb
• Postcode
• NSW TAS QLD WA SA VIC ACT NT State
• Australia Sri Lanka Country
• Your up-to-date address as per other legal documents? (Ex: Passport, Driver licence, etc.)

  if this is not your up-to-date address used in other documents, please correct it. By law, you are required to supply an up-to-date address for foreign currency transfers.

• Mobile
• Home phone
• Work phone
• Email

• Consent for ID Verification with Verifi Identity Services Limited

• Individual
  I confirm that I am authorized to provide the personal details presented and I consent to my information being passed to and checked with the document issuer, official record holder, a credit bureau and authorized third parties for the purpose of verifying my identity and address.
  
  I also confirm that if required, evidence of this consent can be produced.
• Company/ Trust/ Other
  I confirm that I am authorized to provide the personal details presented and have obtained the consent of the individuals to which the personal details related to this information to be passed to and checked with the document issuer, official record holder, a credit bureau, and authorized third parties for the purpose of verifying my identity and address.
  
  I also confirm that if required, evidence of this consent can be produced.
• I have read the above ID verification terms, understood and accept terms and conditions
• I hereby confirm that; All the above information provided on this form are true, correct and complete to the best of my knowledge, here with I have attached the original of the certified copy of Identity document. AusCey Exchange will retain all above information and certified documents securely further 7 years as a compliance requirement of record keeping and privacy (under the privacy act. 1988 when conducting activities to comply with the AML/CTF act. 2006)
• Do you want us to send emails regarding the rate and special offers?
• Do you want us to send SMS regarding the rate and special offers?

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• Mr Mrs Ms Miss Dr Prof Ven Rev Title
• Full name (Alpha only, no special characters or numbers allowed)
• Id. Number
• Date of birth
• Contact No (Ex : 0774578347)
• Street address
• Suburb
• Postcode
• State (Alpha only, No spaces, special characters or numbers allowed)
• Sri Lanka Australia Country
• Please select Alliance Finance Company PLC Amana Bank PLC Axis Bank Bank of Ceylon Cargills Bank Limited Central Finance PLC Citi Bank Citizen Development Business Finance PLC Commercial Bank PLC Commercial Credit & Finance PLC Commercial Leasing & Finance Deutsche Bank DFCC Bank PLC Habib Bank Lake View Hatton National Bank HDFC Bank Hongkong and Shanghai Bank ICIC Bank Indian Bank Indian Overseas Bank Kanrich Finance Limited Korea Exchange Bank Lanka ORIX Finance PLC LB Finance PLC MCB Bank Ltd Mercantile Investment & Finance PLC Merchant Bank of Sri Lanka & Finance PLC National Savings Bank Nations Trust Bank PLC NDB Bank Pan Asia Banking Corporation PLC People's Leasing & Finance PLC Peoples Bank Public Bank Berhad Regional Rural Development Bank Sampath Bank PLC Sanasa Development Bank Scotia Bank Senkadagala Finance PLC Seylan Bank PLC Societe Generale Standard Chartered Bank State Bank of India State Mortgage & Investment Bank Union Bank of Colombo PLC Vallibel Finance PLC Bank
• Branch
• Bank Account Number (Numeric only. No spaces, special characters or letters allowed)

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• Australian Drivers Licence Passport Birth Certificate Proof of Age card Photo ID Type
• Expiration Date
• Issuing authority
• Identity Document’s No
• What is card number ?
  You will need to provide your licence card number, how to find cand number ?
• Card Number
• Front of card, right-hand side, above photo.
  
  Front of card, parallel to photo.
  
  Back of card, top-right corner.
  
  Issued since 10th Dec 2020 – Back of card, along bottom of card.
  
  Issued since June 2019 – Front of card, under signature.
  
  Back of card, right-hand side.
  
  Back of card, top-right corner.
  
  Back of card, right-hand side, under enlarged number/on top of reverse strip.
  
• Identification Front (.jpg, .jpeg, .png & .pdf only)
• Identification Back (.jpg, .jpeg, .png & .pdf only)

Address verification

• Utility Bill Tenancy Agreement Bank Statement Letter from Employer
• Address Verification Document (.jpg, .jpeg, .png & .pdf only)

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