Instructions Print Clear
Customer Identification Form – Authorised Referee
Complete the form using blue or black pen and print in clear CAPITAL LETTERS
This form will be used to verify your identity only where an individual cannot attend an HSBC branch or meet a Mortgage Broker
in person. You must verify your identity using Primary and if necessary, Secondary documents overleaf. The total document(s)
must show your:
(1) FULL LEGAL NAME
(2) DATE OF BIRTH and
(3) RESIDENTIAL ADDRESS
Only an Authorised Referee (listed overleaf) may certify your identity documents.
Verified copy of documents must be signed and dated by Authorised Referee.
Where a Primary document contains all items and matches the applicant details in Part A (e.g. Australian drivers licence), no other
document is required. If the document cannot verify all items, then a Secondary document must be used to verify the missing item.
Mail the completed form to:
HSBC, GPO Box 5302, SYDNEY NSW 2001 or your Mortgage Broker (if applying for a home loan via a Broker)
Note: Make sure that you include the certified copies of your identity documents with this form.
PART A – INDIVIDUAL TO COMPLETE
Application reference number (if applicable) BSB Account number
Title First name Middle name Last name
Current residential address (cannot be a PO Box)
Suburb City State Postcode Country
Nationality
Date of birth (if not Australian, nationality must be verified via a foreign passport or foreign national identity card †)
DD MM YY
Declaration
I declare that the information contained above is true and correct and has been completed by me and not any other person.
YOUR SIGNATURE MUST BE WITNESSED BY THE AUTHORISED REFEREE
Applicant’s signature Date
On completion of this form, DD MM YY
please print and sign by hand
PART B – AUTHORISED REFEREE TO COMPLETE
Title First name Last name
Employer’s name Work phone number
( )
Work address
State Postcode
Identity documents sighted
Write name + identification number (if any) + date/place/office of issue
1.
2.
Continued over page
Issued by HSBC Bank Australia Limited ABN 48 006 434 162 AFSL 232595 HBAA302CUA 06/22 Page 1 of 2
PART B – AUTHORISED REFEREE TO COMPLETE continued
Declaration
I declare that:
(i) I have sighted the abovementioned Individual’s original identity documents as listed in the section “Identity documents
sighted” and can confirm that the full name, residential address and date of birth match the details provided above by the
Applicant;
(ii) I certify that all documents are a true and correct copy of the original presented to me; and
(iii) the Applicant signed this form in my presence.
THE AUTHORISED REFEREE MUST SIGN, DATE AND WRITE 'I have sighted the original of this document'
ON EACH COPY OF THE IDENTITY DOCUMENTS.
Authorised referee category
Authorised Referee’s signature Date (see below) ID number (if applicable)
On completion of this form, DD MM YY
please print and sign by hand
IDENTIFICATION DOCUMENTS AUTHORISED REFEREES
Important notes: Authorised Referees must satisfy one of the occupations below
• Expired documents will not be accepted and cannot be an immediate family member.
• Any document not written in English must be accompanied
by an accredited translation or translation from an HSBC a) Legal professional who is currently licensed or registered
staff member. An accredited translator means a person to practise under a law in force in a State or Territory
currently accredited by the National Accreditation Authority b) Accountant who is a member of:
for Translators and Interpreters Ltd. (NAATI) at the level 1. a fellow of the National Tax Accountants’ Association;
of Professional Translator, or above, to translate from a or
language other than English into English – 2. a member of any of the following:
see www.naati.com.au – Chartered Accountants Australia and New Zealand;
• Copies of identity documents must be of both sides – the Association of Taxation and Management
(where double-sided) and clear Accountants;
– CPA Australia;
– the Institute of Public Accountants
PRIMARY IDENTIFICATION DOCUMENTS
c) A current member of The Governance Institute of Australia
You MUST use one of the following to verify your identity: d) An officer with, or authorised representative of, a holder
• Photocard Australian drivers licence issued by an Australian of an Australian financial services licence, having 2 or
State or Territory # more years of continuous service with one or more
• Passport – signature and photo page(s) licensees
• Government issued Proof of Age card e) An officer with, or a credit representative of, a holder of
• Foreign National Identity card † an Australian credit licence, having 2 or more years of
• Foreign drivers licence * continuous service with one or more licensees
• Birth Certificate ¥ f) Bank officer with 2 or more continuous years of service
g) Australian Consular Officer or Australian Diplomatic Officer
SECONDARY IDENTIFICATION DOCUMENTS who is appointed by the Commonwealth to hold or act
You MUST use one of the following to verify your address the role in a country or place outside Australia
(except if using an Australian drivers licence as outlined overleaf): h) Justice of the peace
• Local Authority or Government Department letter, or i) An agent of the Australian Postal Corporation who is in
statement dated within the last 12 months, e.g. Australian charge of an office supplying postal services to the public
Taxation Office (ATO) notice letter
• Bank statements, Australian council rates notice or utility j) Police Officer
bills (including e-statements) dated within the last three k) Commissioner of Oaths/Affidavits of an Australian State
months (internet screenshots are not accepted) – must or Territory
contain full first and last names
l) A member of an Australian Commonwealth, State or
• Residential property lease agreement / Residential Serviced Territory Parliament
Apartment lease agreement ^
• Mobile phone bill, home internet bill, pay TV bill or utility m) A person who is enrolled on the roll of the Supreme Court
welcome letter ~ of a State or Territory, or the High Court of Australia, as
• A letter issued by an Australian school ¥. The letter must a legal practitioner
record the period of time the individual attended the school n) Notary public, including a notary public exercising
and be issued with the preceding 3 months, printed on the functions in an equivalent jurisdiction
school’s letterhead and be signed by the school principal.
o) A Person in an equivalent jurisdiction who is authorised
by law in that jurisdiction to administer oaths or
# Includes renewed, interim, learners, provisional, bus, motor cycle
or truck licence. This does not include a driving licence issued on
affirmations or to authenticate documents
paper or a boat licence. Please ensure that an image of both the
front and back of the licence is provided.
† Must be issued by a foreign government, the United Nations or a EQUIVALENT JURISDICTIONS
United Nations agency.
* Issued under a law of a foreign country for the purposes of driving Australia, Austria, Belgium, Canada, China, Denmark, Finland,
a vehicle (as detailed in the Australian driving licence above). This France, Germany, Greece, Guernsey, Hong Kong, Iceland,
does not include a driving licence issued on paper. Ireland, Isle of Man, Italy, Japan, Jersey,Korea (South),
¥ For primary or secondary school students aged under 18 only. Luxembourg, Mauritius, Netherlands, New Zealand, Norway,
^ Must record the individual’s lease of a residential property; be Portugal, Singapore, Spain, Sweden, Switzerland, Dubai
current; and be issued by a real estate agent or serviced apartment. International Financial Centre, United Kingdom, United States
~ Where the minimum contract length of 12 months for the provided of America.
service is confirmed and is dated within the last 3 months.
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