Turning 18: Confirmation of Information

Personal Details

Name of the person completing this form*

Title

First name(Required)

Middle name(s)

Surname(Required)

Preferred name

Date of birth(Required)

Gender

Email address(Required)

Phone/mobile

Residential address(Required)

The address provided must be a physical address and not a PO Box address.

Postal address, if different(Required)

Same as residential address

Different to residential address

Postal address(Required)

Tax Details

Prescribed Investor Rate (PIR)(Required)

10.5%

17.5%

28%

Don't know

The Prescribed Investor Rate (PIR) is the tax rate that will apply to your investment returns. If you do not know your PIR then you can click here to work it out or advise us of it at a later date. The default rate of 28.0% applies until you advise otherwise.

Declaration

I acknowledge that choosing an investment fund (or funds) is solely my responsibility, that the manager is not to be regarded as representing or implying that any particular fund (or funds) is (or are) appropriate for my personal circumstances, and that my choice of an investment fund (or funds) is a binding direction from me to the manager.

I consent to receive electronic communications from the Scheme. I understand that statements and other communication materials will be sent by email, unless I request they be sent by post. If no email address is supplied, I understand statements and other communication materials will be sent to my postal address.

I confirm I am authorised to provide the personal details presented and I consent to Anglican Financial Care using the personal information that I have provided to electronically verify my identity, my address and whether I am a politically exposed person, by using Verifi Identity Services Limited, and where necessary disclosing the information to external and independent agencies for the purpose of matching my information with identification information held in third party databases including but not limited to the Department of Internal Affairs, the New Zealand Transport Authority, White Pages, Land Information New Zealand, Centrix and Dow Jones Watchlist.

I understand that my personal information will be collected and held by the manager and used to administer my Scheme membership. I consent to that information being disclosed to other persons, including any government authority, to comply with applicable laws and (if relevant) to information about my Scheme membership being disclosed to any third party through whom I was referred to the Scheme. I acknowledge that I can access or correct my personal information by contacting the manager.

Agree(Required)

* I confirm and agree to the Declarations