Source of Wealth and Funds

Purpose of this form:

This information is sought pursuant to the Anti-Money Laundering and Counter-Terrorism Financing Act 2006.

Section 1 – Customer Details

Please select you are providing information for:

An individual
Full name Date of birth (DD/MM/YYYY)

Residential address (PO Box is not acceptable)

State Postcode
An organistion
Organisation’s registered name

Organisation’s Unique Identifier Number e.g. Australian Company Number (ACN), Australian Business Number (ABN), if any

Registered Office Address (PO Box is not acceptable)

State Postcode

Section 2 – Source of Wealth

Please indicate the main source of your accumulated wealth. You may choose more than one option if they are equally significant.
Documentary evidence may be required.
Source of Wealth (SOW) Individual
Employment income e.g. salary, bonus, commission Investment income e.g. interest, dividends, rent
Business income e.g. earnings, profits Liquidation or sale of assets
Family support or gift (overseas transfer) Real estate
Family support or gift (transfer within Australia) Super or pension
Government benefits or grants Windfall e.g. inheritance, redundancy, winnings
Compensation e.g. insurance, divorce settlement

Source of Wealth (SOW) Organisation

Business income (earnings, profits) Owns real estate/property
Compensation/Insurance payment Liquidation/sale of assets
Gift/Donation Windfall (Inheritance, Redundancy, Tax Refund)
Government benefits/grants Shares/Debt
Private grants/Owners' equity Capital Markets/Capital Infusion
Investment income (dividends, rental, profit) Same as main sources of income

Section 3 – Source of Funds

Please indicate the main source of your funds. You may choose more than one option if they are equally significant. Documentary
evidence may be required.
Source of Funds (SOF) Individual
Employment income e.g. salary, bonus, commission Liquidation or sale of assets
Business income e.g. earnings, profits Real estate
Family support or gift (overseas transfer) Super or pension
Family support or gift (transfer within Australia) Windfall e.g. inheritance, redundancy, winnings
Government benefits or grants Loan
Compensation e.g. insurance, divorce settlement Tax refund
Investment income e.g. interest, dividends, rent
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Section 3 – Source of Funds (continued)

Please indicate the main source of your funds. You may choose more than one option if they are equally significant. Documentary
evidence may be required.
Source of Funds (SOF) Organisation
Bank Borrowing/Loan Investment income (dividends, rental, profit)
Other Borrowing/Loan Owns real estate/property
Business income (earnings, profits) Liquidation/sale of assets
Compensation/Insurance payment Windfall (Inheritance, Redundancy, Tax Refund)
Gift/Donation Shares/Debt
Government grants/benefits Capital Markets/Capital Infusion
Private grants/Owners' equity

Section 4 – Declaration

I declare that the information provided on this form is correct. I agree to provide the Bank with supporting documentary evidence
upon request.
Full Name

*Signature Date (DD/MM/YYYY)

Section 5 – Source Descriptions*

Source Definition
Business income e.g. earnings, Wealth: Funds:
profits Accumulated income that is realised as a Any income that is realised as a result of
result of business activity. business activity.
Compensation Providing a person with money or other things of economic value in exchange for their goods,
e.g. insurance, divorce settlement labour, or to provide for the costs of injuries that they have incurred.
Employment income e.g. salary, Income as a result of your personal exertion (that is, by working) or from an investment.
bonus, commission Income may not always be in the form of money – in some situations goods and services may
be treated as income.
Gift/Donation A donation is a gift given by physical or legal persons, typically for charitable purposes and/or
to benefit a cause.
Government benefits or grants A payment made by a government agency or insurance company to those qualifying in time
of need.
Investment income e.g. interest, Income coming from interest payments, dividends, rental properties, capital gains collected
dividends, rent upon the sale of a security or other assets, and any other profit that is made through an
investment vehicle of any kind.
Liquidation or sale of assets A resource with economic value that a person or entity is owned is sold for financial gain
or when a business or firm is terminated/bankrupt, its assets sold and the proceeds pay
creditors
Bank Borrowing/Loan The act of obtaining money, property or other material goods through a financial institution
in exchange for future repayment of the principal amount along with interest or other
charges.
Real estate Customer wealth is retained in the form of Real Estate, Property or Land Holdings.
Super or pension A regular payment made by the state to people of or above the official retirement age and to
some widows and disabled people.
Tax refund The return of excess amounts of income tax that a taxpayer has paid to the state or federal
government throughout the past year.
Windfall e.g. inheritance, A large amount of money that is won or received unexpectedly
redundancy, winnings e.g. Lottery gambling, inheritance, redundancy payment
Family support or gift (overseas Financial support received from overseas based family members in the form of a gift without
transfer) an obligation for repayment.
Family support or gift (transfer Financial support received from family members based in Australia in the form of a gift
within Australia) without an obligation for repayment.
Shares/Debt One of the equal parts into which a company's capital is divided, entitling the holder to a
proportion of the profits.
Capital Markets/Capital Infusion Financial markets that bring buyers and sellers together to trade stocks, bonds, currencies,
and other financial assets. Capital markets include the stock market and the bond market.
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