7/24/2019 BetfairKYC

1/1

AMLV1.0PREPOP31/0

1/2008/BETFAIR

Please use BLACK INKand print within the boxes in BLOCK LETTERS(make corrections to pre-filled information where required)

A. Details of Applicant

Unit number/street number/street name (with a gap between numbers and words)

Suburb/locality Postcode

Customer reference number

(.. Family name/surname

Given name/s (full name no initials)

B. Current Residential Address of Applicant

State

Contact phone numberDate of birth

C. Declaration by Applicant

DO NOT SIGN UNTIL YOU LODGE THIS FORM AT AUSTRALIA POST

I acknowledge that the information on this form is true and correct. The details on this form have been completed by me and not anotherperson.

Applicants signature

D Y Y Y YD M M

Please sign

and use black inkDate

D. Australia Post use only

on this form. signature

Comments

Date

D Y Y Y YD M MWork centre code

How to lodge your Application

At Australia Post

auspost.com.au/pol and select .

Your Identity Document Requirements

You MUST supply ONE primary document from the list.

Does your primary document contain BOTH a photo AND yourcurrent residential address of applicant?

Yes No You must also supply one secondary document that

contains your current residential address.

(current and government issued)

(less than 3 months old)

(less than 12 months old)

For assistance completing this form please

phone the Betfair Helpdesk on 1300 238 324

For assistance processing this form please

phone the Betfair Helpdesk on 1300 238 324

Betfair Pty Limited ABN 30 110 084 985 GPO Box 192 Hobart TAS 7001

*2956 913 01 0 9417338028 29

9417338028

MR Dias Barros

Alex

Gold Coast Hwy

BROADBEACH QLD 4218