Form for Identification by Certified Documents

SportsbetABN87088326612

IMPORTANTPLEASEREAD

TheAn MoneyLaunderingandCounterTerrorismFinancingAct2006(theAct)cameintoeectinAustraliainDecember2006.Gamblingservice
providersarecapturedundertheActandarerequiredtocomplywiththeAML/CTFobliga onsandthesupplementaryAML/CTFRules(theRules).
InaccordancewiththeActandRules,Sportsbetneedstocollectinforma onaboutyouriden tyandverifythatitiscorrect.Asaresult,whenyou
openyourSportsbetaccount,wewillaskyouforarangeofiden fica oninforma ontohelpusverifyyou.Thisformhasbeencreatedtoassistyou
infulfillingtheIden fica onrequirementsforopera nganaccountwithanAustralianBookmaker.

ACer fiedcopymeansadocumentthathasbeencer fiedasatruecopyofanoriginaldocumentbyoneoftheAuthorizedcer fiers.Toproducea

cer fiedcopy,youshouldmakeaphotocopyoftheoriginaldocumentandtaketheoriginalandthecopytoanAuthorizedcer fier.Pleasereferto
thea achedWhoCanAuthorisemyDocumentsFactSheetforassistanceinloca ngacer fier.Foryourprivacy,ado edlinehasbeenprovided
atthetopofthisformshouldyouwishtoremovetheSportsbetheaderofthisform.
Howtocompletethisform:
1.

CompletePartAofthisform

2.
3.

InPartB,Tickthedocumentsyouareprovidingandphotocopyeachoriginalofthesedocuments
TaketheoriginalandphotocopieddocumentstoapersonAuthorisedtocer fydocuments.SeeWhoCanAuthorisemyDocumentsforassistance.

4.
5.

HavetheAuthorisedpersonsignyourdocumentsandcompletetheirdetailsinPartC
CompletePartDandEmail,FaxorPostthecer fieddocumentstogetherwiththisformtoSportsbet(Pleasedonotsendyouroriginaldocuments)

PartA:CustomerDetails
SportsbetAccountNumber
Title

DateofBirth

ContactPhoneNumber
Surname

GivenNames
EmailAddress
CurrentResiden alAddress
UnitNumber/StreetNumber/StreetName
State

Suburb/Town

PostCode

PartB:DocumentsCer fied
PleaseprovideONEDocumentfromSec on1ANDONEDocumentfromSec on2.AtotalofTWOdocumentsmustbesubmi ed
toSportsbet.

SECTION1

SECTION2

PleaseprovideONEofthebelowdocuments

PleaseprovideONEofthebelowdocuments

Passport

MedicareCard

MotorVehicleRegistra on

DriversLicense

Centrelink\DVACard

PropertyRatesNo ce

ProofofAgeCard/KeyPass

RecentBankStatement

PropertyLeaseAgreement

Na onalIden tyCard

RecentU li esBill(Issuedwith
inthelast3Months)

HomeInsurancePapers

Page1

DOCREF:IDCERT01

Identification by Certified Copy Form

SportsbetABN87088326612

PartC:Cer fierDetails
FullName
Occupa on

ContactPhoneNumber

EmploymentAddress
UnitNumber/StreetNumber/StreetName
State

Suburb/Town

PostCode

Pleaseensurethebelowinforma oniswri enontheFRONTOFEACHPHOTOCOPIEDIDENTIFICATIONDOCUMENT

PartD:ChecklistandDeclara on
PleaseTick( )priortosendingthisform:

PartA,B,andCofthisformhavebeencompletedinfull
Theauthorizedcer fierhassignedonthefrontofallcopiesoforiginaldocumentsprovided
YouhavehadALLtherequireddocumenta oncer fiedasperPartB(TotalofTWODocumentsarebeing
submi edtoSportsbet
Ideclarethatthecopiesoforiginaliden fica ondocumenta onsenttoSportsbetforthepurposeofverifyingmyiden ty,aretrueandcorrect.IacknowledgethatSports
betwillnotbeheldliableforanycostsincurredbycer fyingmydocumentstocomplywiththelegisla on,thisincludes,butnotlimitedtoanyphotocopy,facsimile,postal,
Internetusageorcallchargesthatmaybeincurredbythisprocess.Sportsbetreservestherighttorefuseiden fica ondocumenta onthathasnotbeencer fiedcorrectly
ordoesnotcomplywiththeinforma onprovidedinthisform.Sportsbetwillinthesecases,no fyyouviaemailofanyfurtherac onthatmayberequiredtocomplete
youriden fica on.

AccountHolderSignature

Date

HowtoSendyourCer fiedDocuments
Scanyourcer fieddocumentstogetherwiththisformandemailto:verifica

Email
Fax

on@sportsbet.com.au

Faxyourcer fieddocumentstogetherwiththisformandsendto:1800131238

Post

Postthephotocopiedcer fieddocumentstogetherwiththisformto:GPOBOX4755,Melbourne,VIC,3001

SportsbetUseOnly
Verifica onOcer

DateProcessed
Cer fica onChecklist
IDDocumentReq.Met
AccountDetailsMatch
ValidAuthorizedPerson
Cer fierDetails
DocumentLegible
FormComplete
Page2

Verifica onStatus

Verifica onNotSa sfied

Sa sfied/NotSa sfied

Verifica onSa sfied

No fyCustomer

CustomerNo fied

FormResent

AccountUpdated

SecureDocumentsStored
Verifica onComplete

DOCREF:IDCERT01

Cer fiedDocumentHelpSheet
HowcanIfindpeopletoauthorisemydocuments?
PleaserefertothebelowlistofthemostcommonAuthorizedOccupa onsandPosi onsthatareabletocer fyyourdocuments.Ifyou
areexperiencingproblemsfindinganauthorisedcer fierinyourlocalarea,Pleasevisitthebelowsuggestedwebsitesfordetailsofloca
ons:

AustraliaPostLocator:h p://apps.nowwhere.com.au/austpost/PostOceLocator/default.aspx
Jus ceofthePeaceLocator:h p://www.ag.gov.au/www/agd/agd.nsf/Page/Legalsystemandjus ce_Jus ceso hePeace
YournearestPoliceSta on,BankorCreditUnioncanbelocatedthroughh p://www.whereis.com/

WhoCanAuthorisemyDocuments?
AuthorisedOccupa ons
1
2
3
4
5
6
7
8
9
10

Chiropractor
Den st
Legalprac oner
Medicalprac oner
Nurse
Optometrist
PoliceOcer
Pharmacist
Physiotherapist
Psychologist

11

Jus ceofthePeace

12

Veterinarysurgeon

14

PermanentemployeeoftheAustralianPostalCorpora onwith2ormoreyearsofcon nuousservicewhoisemployedinanocesupplyingpostalser

vicestothepublicORAgentoftheAustralianPostalCorpora onwhoisinchargeofanocesupplyingpostalservicestothepublic

15
16
17
18
19
20

Bankocerwith2ormorecon nuousyearsofservice

OtherAuthorisedPosi ons

Buildingsocietyocerwith2ormoreyearsofcon nuousservice
Creditunionocerwith2ormoreyearsofcon nuousservice
Judgeofacourt
Jus ceofthePeace
Magistrate
MemberoftheAustralianDefenceForcewhois:

21

(a)anocer;or
(b)anoncommissionedocerwithinthemeaningoftheDefenceForceDisciplineAct1982with5ormoreyearsofcon nuousservice;or

22

(c)awarrantocerwithinthemeaningofthatAct
MemberoftheIns tuteofCharteredAccountantsinAustralia,theAustralianSocietyofCer fiedPrac cingAccountantsortheNa onalIns tuteof
Accountants
Memberof:

23

(a)theParliamentoftheCommonwealth;or
(b)theParliamentofaState;or
(c)aTerritorylegislature;or

(d)alocalgovernmentauthorityofaStateorTerritory
Permanentemployeeof:

24

(a)theCommonwealthoraCommonwealthauthority;or
(b)aStateorTerritoryoraStateorTerritoryauthority;or
(c)alocalgovernmentauthority;

25
26

with5ormoreyearsofcon nuousservicewhoisnotspecifiedinanotheriteminthisPart

27

Teacheremployedonafull mebasisataschoolorter aryeduca onins tu on

Page3

Policeocer
Sherisocer

DOCREF:IDCERT01