AMENDMENT TO ACCOUNT AUTHORITY
Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch)

For Individual/Joint/Sole Proprietors
Complete sections 1 and 2

DateDDMM20Y

Y

Companies, Partnerships, Trusts and Other Entities
Complete sections 1 and 3
SECTION 1
Customer information
Customer’s name
Customer number
Account nameAccount number
Authority for Operations
To: Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch) (Bank)	In the case of a company or an incorporated entity, I/we certify that the following resolution was passed at a meeting of the Board of Directorsof the Customer onDDMMYYYYand that it has been recorded in the minutes book of the Customer.

For all others, I/we certify that I/we have authorised the following.
Resolved/Authorised that:(A)Any 1 signatory; or
Any 2 signatories; orOther (please specify)		

to act fully and effectively in all dealings, matters and transactions (including withdrawals) in respect of the above account with the Bank.

Page 1

AMENDMENT TO ACCOUNT AUTHORITY
Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch)(B) the following persons be included amongst the persons authorised to operate the account:
Signatory 1

Signatory 2First nameFirst nameMiddle name(s) (if applicable)

Middle name(s) (if applicable)

Surname

SurnameAny other name commonly known as

Any other name commonly known as

Date of birth

DDM

M

YY

Y

Date of birth

YDDM

M

YY

Y

Y

Place of birth (town and country)

Place of birth (town and country)

Nationality/Citizenship(s)Nationality/Citizenship(s)Tax Identification Number

Tax Identification Number

Full residential address (Do not provide a PO Box or in-care-of address)
StreetFull residential address (Do not provide a PO Box or in-care-of address)
StreetSuburbSuburb

CityCityCountry

PostcodeCountry

Phone number

Phone number

Mobile number

Mobile number

Email address

Email address

Employment date

DDM

M

YY

Y

Y

Employment datePostcode

D

DM

Employer name

Employer name

Employer address

Employer address

Office/Title

Office/Title

Signature

Signature

Signatory Customer Number

Signatory Customer Number

Customer Identification and Verification complete

M

YY

Y

Y

Customer Identification and Verification completePage 2

AMENDMENT TO ACCOUNT AUTHORITY
Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch)(B) the following persons be included amongst the persons authorised to operate the account: (cont.)
Signatory 3

Signatory 4First nameFirst nameMiddle name(s) (if applicable)

Middle name(s) (if applicable)

Surname

SurnameAny other name commonly known as

Any other name commonly known as

Date of birth

DDM

M

Y

Y

Y

Date of birth

Y

DDMM

YYYY

Place of birth (town and country)

Place of birth (town and country)

Nationality/Citizenship(s)Nationality/Citizenship(s)Tax Identification Number

Tax Identification Number

Full residential address (Do not provide a PO Box or in-care-of address)
StreetFull residential address (Do not provide a PO Box or in-care-of address)
StreetSuburbSuburbCity

City

Country

PostcodeCountry

Phone number

Phone number

Mobile number

Mobile number

Email address

Email address

Employment date

D

DM

M

Y

Y

Y

Y

Employment datePostcode

D

DM

Employer name

Employer name

Employer address

Employer address

Office/Title

Office/Title

Signature

Signature

Signatory Customer NumberSignatory Customer Number

Customer Identification and Verification complete

MYYYY

Customer Identification and Verification complete

Page 3

AMENDMENT TO ACCOUNT AUTHORITY
Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch)(C) the authority for the following persons to operate the account is hereby revoked:
Authority Revoked 1Authority Revoked 2First nameFirst nameMiddle name(s) (if applicable)

Middle name(s) (if applicable)

Surname

Surname

Customer number

Customer number

Office/Title

Office/Title

Authority Revoked 3

Authority Revoked 4First nameFirst nameMiddle name(s) (if applicable)

Middle name(s) (if applicable)

Surname

Surname

Customer number

Customer number

Office/Title

Office/Title

This authority
supercedes and replaces
is in addition to
all previous authorities relating to the above account except for any liabilities not yet determined and any instruments already drawn or
executed on the account but not yet presented or paid.
All information on this form and any identification document provided with this document is true and correct.
Where this declaration is signed by two or more people, it is given by each individually.
In the event of any inconsistency between the English and the other language of this form, the English version shall apply.
Special Instructions:
In the case of a company, two directors or a director plus company secretary must sign.
In the case of a partnership, all partners must sign.
In the case of a trust, all trustees must sign.
SECTION 2 FOR INDIVIDUAL/JOINT/SOLE PROPRIETORS
Primary account holder

Joint account holder

Full name

Full nameSignature

Signature

DateDDMM

20YYDateDDMM

20Y

Y

BANK USE ONLYReceived byDate received

DDM

M

20YY

Reviewed byDate reviewed

DDMM

20YY

Forwarded to Client Enablement by

D DM M
Date

20YY

Client Enablement checks and update by

D DM M
Date

20YY

Amendment Form filed with Customer records
Page 4

AMENDMENT TO ACCOUNT AUTHORITY
Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch)

SECTION 3 FOR COMPANIES, PARTNERSHIPS, TRUSTS AND OTHER ENTITIESCOMPANY WITHOUT SEAL
Dated thisday of20

SIGNED for and on behalf ofbySignature of DirectorSignature of Director/Secretary

Name of Director

Name of Director/Secretary

Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch) 09/23

22975

Page 5

AMENDMENT TO ACCOUNT AUTHORITY
Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch)

COMPANY WITH SEAL
Dated thisday of20

THE COMMON SEAL ofwas affixed in accordance with its Articles of Association in the presence of:*
Signature of Director

Signature of Director/Secretary

Name of Director

Name of Director/Secretary*Care should be taken to ensure the seal is affixed and attested in accordance with the company’s Articles of Association.

Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch) 09/23

22975

Page 6

AMENDMENT TO ACCOUNT AUTHORITY
Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch)

PARTNERSHIP
Dated thisday of20

EXECUTED by the PARTNERS OF
Signature

Signature

Name of Partner

Name of Partner

Signature

Signature

Name of Partner

Name of Partner

Signature

Signature

Name of Partner

Name of Partner

Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch) 09/2322975

Page 7

AMENDMENT TO ACCOUNT AUTHORITY
Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch)

TRUST
Dated thisday of20

EXECUTED by the TRUSTEES OF
Signature

Signature

Name of Trustee

Name of Trustee

Signature

Signature

Name of Trustee

Name of Trustee

Australia and New Zealand Banking Group Limited, Representação Permanente (Timor-Leste Branch) 09/23

22975

Page 8