Section 1: Shareholder Details

One form of identification: drivers licence or passport or birth certificate.

Section 2: New Zealand Bank Deposit Slip

Please visit your bank and upload a verified bank deposit slip

Section 3: Personal Details

Section 3: Declaration

I hereby certify that the information in this form is correct.

I consent to any of this information being available to the Trust/Incorporation for statistical purposes only.

I consent to the Trust/Incorporation contacting any Agencies to verify that information in this application is true and correct, in accordance with the Privacy Act 1993.