BT Premium Cash Fund Application form

BT Premium Cash Fund
Application form
Issue date 1 July 2013
BT Customer Relations ✆ 132 135 (8.00am – 6.30pm Mon – Fri Sydney time)
Units in the Fund will only be issued on receipt of this
application form, issued together with the BT Premium Cash
Fund Product Disclosure Statement (PDS) dated 1 July 2013.
You must have read the PDS before completing this application
form. We also recommend that you read the Additional
Information Booklet dated 1 July 2013 which forms part of
the PDS.
• All words and phrases used in this application form have the
same meaning, if any, given to them in the PDS.
• Please complete the form using a black pen and mark answer
boxes with a cross [✘].
• If you have more than two joint investors or trustees, please
photocopy this form, and use it to supply additional Investor
details (Section 3) and signatures (Section 10).
• New Zealand Investors cannot use this form and should instead,
complete the Application Form attached to the current NZ Offer
Document.
BT Funds Management Limited ABN 63 002 916 458, AFSL 233724
is the Responsible Entity of BT Premium Cash Fund.
• New Investors – please complete Investor details below
• Existing BT Investors – is this investment to be in the same
name?
Yes – specify investor number
C
Title
Mr
Mrs
Miss
Ms
Other
Given name(s)
Surname
Date of birth (dd/mm/yyyy)
/
/
investor B – JOINT INVESTORS OR TRUSTEES
Title
Mrs
Miss
Ms
Other
Given name(s)
Surname
Date of birth (dd/mm/yyyy)
/
Now go to section 4
No – please complete Investor details below.
2. TYPE OF INVESTOR – CROSS [✘] THE RELEVANT BOX
Individual/Joint
Go to Section 3A
Partnership
Go to Section 3A (partners’ details)
and 3C (partnership name)
Trust/Superannuation
Fund
Individual Trustee(s)
Go to Section 3A (trustee(s)
details) and Section 3C (trust/
superannuation fund name)
Corporate Trustee
Go to Section 3B (corporate
trustee name) and 3C (trust/
superannuation fund name)
Company
Go to Section 3B
Adult(s) investing for a
child under 18
Go to Section 3A (adult(s) details)
and 3C (child’s name)
Deceased Estate
Go to Section 3A (executor(s) details)
and 3C (estate’s name)
Club/Associations and
unincorporated bodies
Go to Section 3A (office bearer(s)
details) and 3C (club/association’s
name)
BTF30357-0513ex
investor A – INDIVIDUALS, JOINT INVESTORS OR
TRUSTEES
Mr
1. BT INVESTOR DETAILS
3A.INVESTOR DETAILS
/
Joint investors – agree to hold the units as joint tenants and
acknowledge that unless otherwise stated below, all signatures are
required on all transactions.
Joint (non corporate) investors only – Indicate account-signing
authority for future transactions. If no option is nominated, future
transactions will require both investors to sign.
Either Investor A or B
   A only
  B only
3B.COMPANY, ASSOCIATIONS OR OTHER INVESTORS
Full name of company, association or other investor
Operators and custodians of master trusts or wrap accounts
• undertake to us that you and each other operator or custodian of
the master trust or wrap account will comply with any requirements
of law or applicable ASIC policy in relation to the master trust or
wrap account
• confirm that you are authorised by each operator or custodian of
the master trust or wrap account to give this undertaking on their
behalf.
Page 1 of 8
6A.INVESTMENT AMOUNT
Provide an account reference where opening an account on behalf
of others – name of partnership, trust or superannuation fund, child,
estate, club/association
Enter the amount to be invested. The minimum initial investment is
$5,000 or $2,000 if a Regular Investment plan is set up.
$
,
,
l
BTA0173AU
6B.how will your investment be made?
4. CONTACT DETAILS
I am an existing BT Investor; these are changes to my existing
contact details.
Postal address
State
Postcode
Cheque
Made payable to: BT Funds Management Limited –
<investor name>
Direct debit
Please complete section 7
Transferring ownership of units from another BT investment
to this investment
if transferring ownership, provide investor number for the
investment that units are being transferred out of (if known):
Country, if not Australia
Home phone number
(
Mobile phone number
)
Work phone number
(
C
)
6C.REGULAR INVESTMENT PLAN
Fax number
(
Would you like to make a regular monthly or quarterly investment?
If not, proceed to Section 6D.
)
$
Email address*
*In the future, BT may elect to email correspondence to you.
5. TAX FILE NUMBER, AUSTRALIAN BUSINESS NUMBER (ABN)
OR EXEMPTION
Clubs/
Associations
and
uninicorporated
bodies
The club,
association or
unincorporated
body
Tax file number of Investor A
Tax file number of Investor B
Australian Business Number (if applicable)1
Or reason for exemption
Non-resident2 Charity Other
l
How is your Regular Investment Plan investment to be made?
Cross [ x ] one of the below only.
Direct debit
Make sure you also complete section 7
Payroll deduction
Complete the below if you wish to start a Regular Investment
Plan via payroll deduction.
Specify the total amount to be deducted each month:
$
Whose TFN or ABN required?
Individual Joint
Partnership Trust or
Company Adult(s)
Deceased
Investor Both
The
Superannuation The
Investing Estate
A’s
Investor partnership’s Fund (individual company’s for a child The Estate’s
A’s and
trustee(s) and
under 18
B’s
corporate
Investor A’s
trustee(s))
(and
The Trust’s or
Investor B’s
Superannuation
if relevant)
Fund’s
,
,
l
First regular deduction is to commence on or after date
(dd/mm/yyyy)
/
/
Upon receipt of your completed application, we will send you a form to
provide to your employer.
How often will your Regular Investment Plan investment be made?
Monthly
Quarterly
I would like my first investment to be made on or around the
19th of:
January February March April
May June July August
September October November December
Note: if you do not indicate otherwise, your Plan will commence as
soon as possible.
6D.DISTRIBUTION OPTIONS
1 Investors can only provide an ABN instead of a TFN where the
investment is made in the course or furtherance of an enterprise
(eg business or trade).
2 Non-resident please specify country of residence above.
BTF30357-0512ex
How would you like your income paid?
If you do not select a distribution option, this will be treated as a
request to reinvest your distribution.
Page 2 of 8
Paid to nominated bank account
Please complete section 8
Reinvested
3C.ACCOUNT REFERENCE
7. DIRECT DEBIT REQUEST
Account holder(s) must complete this section if you want us to
debit an account with your financial institution. Only Australian
bank account details will be accepted.
Name of financial institution
Branch name
BSB number
Account number
Account Name
Direct Debit Request Service Agreement
By completing the Direct Debit Request that forms part of the
application form, you will be providing us with the ability to debit
your nominated account and transfer the amount you request to your
investment. This agreement sets out the terms on which you authorise
us to deduct from your account with your financial institution any
amounts that become payable to an investment with us.
Direct Debit arrangements
• for initial applications made by completing a Direct Debit Request,
we will debit the amount nominated from your account generally
within two Business Days of receiving a valid application
• for subsequent investments, when we receive a valid instruction
either by phone, letter or over the internet, we will debit your
account generally within two Business Days of receiving the
instructions (provided we have previously received a valid Direct
Debit Request)
• a valid instruction will be an instruction given by you or from a
person nominated by you to provide such instructions.
Your responsibilities
It is your responsibility to:
• ensure that your financial institution allows direct debits on your
nominated account
• ensure that your nominated account details are correct, and if
uncertain, to check with your financial institution before completing
the Direct Debit Request
• ensure that sufficient cleared funds are available in your nominated
account by the due date to permit payments under the Direct
Debit Request
• ensure that the authorisation given to draw on your nominated
account is identical to the account signing instruction held by your
financial institution where the nominated account is based
• advise us if your nominated account is transferred or closed or
your nominated account details change
• arrange with us a suitable alternate payment method if the drawing
arrangements are cancelled either by you or your financial
institution.
Your rights
• you may cancel, alter, defer or suspend your Direct Debit Request,
or stop or suspend an individual debit from taking place, by calling
132 135. In some cases we will require your written confirmation
• you must notify us at least seven Business Days before the next
scheduled debit to ensure changes are effective that month.
Notification received after that time may result in your changes
taking effect in the following month. You may also be able to stop
an individual debit by contacting your own financial institution.
You may be liable for financial institution charges if you do this;
the financial institution should have information on these
BTF30357-0512ex
• if you have any questions or concerns about your Direct Debit
Request, such as where you consider that a drawing has been
initiated incorrectly, you should take the matter up directly with
us by calling 132 135. Alternatively, you can contact us by email
or in writing to us at the addresses set out on the back cover of
the PDS. We will let you know that we have received your complaint
and try to resolve your complaint within 30 days. If you are still
not satisfied you can refer the matter to the Financial Ombudsman
Service by calling 1300 780 808.
Our commitment to you
• we will only change the amount of the payment under the Direct
Debit Request on receipt of a valid instruction
• we will only vary the terms of this agreement after giving you 30
days’ notice in writing
• we reserve the right to cancel your drawing arrangements if two
or more consecutive drawings are returned unpaid by your
nominated financial institution. Standard government fees, duties
and bank charges (including dishonour fees and conversion costs)
may apply to investments. These are paid by the investor
• we will keep all your records and information pertaining to your
nominated account at the financial institution private and
confidential, except where you have made a claim relating to a
debit you believe has been made incorrectly, or wrongfully, in
which case Westpac Banking Corporation ABN 33 007 457 141
(as our sponsor in the Bulk Electronic Clearing System) may require
us to provide this information to them in connection with your
claim to the extent necessary to resolve your claim.
all bank ACCOUNT signatories must sign and date
below
Direct Debit Authority: I/We authorise BT Funds Management Limited
ABN 63 002 916 458 (User ID 001538) to, until further notice, arrange
for funds to be debited from my/our account at the financial institution
identified above through the Bulk Electronic Clearing System. I/We
acknowledge that this direct debit arrangement is governed by the
terms of the Direct Debit Request Service Agreement found in this
application form.
Where the investor is not the nominated bank account holder:
I/We consent to the investor(s) increasing amounts or making
additional investments without further approval from me/us. If you
do not agree with this declaration, please cross [✘] this box
Signature of Bank Account Holder A
Date (dd/mm/yy)
Signatory name (please print)
/
/
Company signatories must indicate their company title
Director
   Sole Director and Sole Company Secretary
Signature of Bank Account Holder B
Date (dd/mm/yy)
Signatory name (please print)
/
/
Company signatories must indicate their company title
Director
Page 3 of 8
  Company Secretary
Please ensure section 10 ‘Investor Declaration and
Signature’ is also completed.
10.investor’s declaration and signature
Complete this section if distributions or withdrawals are to be
paid to a bank account. The bank account must be an Australian
bank account in the name of the BT investment.
Write ‘as above’ if same as direct debit account.
Name of financial institution
Branch name
BSB number
Account number
Account Name
9.authorised representative – optional
Complete this section if you wish to appoint another person to
act as your authorised representative.
Title
Mr
Mrs
Miss
Ms
Other
Given name(s)
Surname
Signature of Authorised Representative
Date (dd/mm/yy)
/
/
Our electronic facilities
BT Link and BT Online
By completing the application form you may use BT’s electronic
transaction facilities, BT Link and BT Online.
The following conditions apply in relation to these facilities
• a confidential personal identification number (PIN) and/or password
will allow you to transact and you remain responsible for their
confidentiality
• your PIN and/or password may be issued to you electronically
• access will be given to any person who uses your PIN or password
or complies with any other of our security procedures, which we
may put in place from time to time. Any action by that person will
be taken to be by you – any action or request taken or given to
the Responsible Entity cannot be countermanded
• we may vary these conditions at any time after giving you notice
in writing (or by email or other electronic communication for BT
Online users)
• we may suspend or cancel your ability to transact electronically
at any time without notice
• you must tell us immediately if you lose your PIN or password or
think an unauthorised person has knowledge of it.
Indemnity
You release and indemnify us and any other member of the Westpac
Group from and against all liability which may be suffered by you or
brought against us or any other member of the Westpac Group in
respect of
• any act or omission of your authorised representative, whether
authorised by you or not
• your use, or purported use, of BT Online facility
• your use, or purported use, of a facsimile.
BTF30357-0512ex
Important notes: The PDS and the Additional Information Booklet
contain important information about investing in the BT Premium
Cash Fund. If you give this application form to another person you
must, at the same time and by the same means, give them the PDS.
If you received this application form from the internet or other
electronic means, we will send you on request a paper copy of the
PDS and the Additional Information Booklet together with the application
form, free of charge.
By signing this application form, you:
• Acknowledge that you have read the PDS in full and agree to be
bound by the terms of the PDS and the terms of the relevant
constitution(s), each as amended from time to time
• Declare that all the details given on this application form are true
and correct
• Confirm that you are 18 or over
• Confirm that you have received and accepted this offer in Australia
or New Zealand
• Acknowledge that if you have received the PDS from the internet
or other electronic means, you have received it personally, or a
paper print out of it, accompanied by or attached to this application
form
• Acknowledge that investments in the BT Premium Cash Fund are
not deposits or other liabilities of Westpac Banking Corporation
or any other company in the Westpac Group of companies and
that investments in the Fund are subject to investment risks,
including possible delays in repayment and loss of income and
principal invested
• Acknowledge that none of Westpac Banking Corporation or any
of its related entities stands behind or otherwise guarantees the
capital value or the investment performance of any fund offered
in this PDS
• Consent to us continuing to act as Responsible Entity notwithstanding
a conflict of interest arising from circumstances referred to in the
‘Related party transactions and conflicts of interests’ section in
the Product Disclosure Statement or any other circumstances
• Acknowledge that you have read the section titled ‘Protecting
your privacy’ in the PDS and that we, our agents and related
companies may exchange with each other information about you,
and use that information for the purposes described in that section
• Consent to us passing on information in relation to your investment
to your Financial adviser
• Acknowledge and agree that you must not initiate, engage in or
effect a transaction that may be in breach of Australian law, or
the law of any other country
• Acknowledge that you have the legal power to enter into the
investment – agree that future transactions will be made on the
terms of the then current PDS and the relevant constitution (each
as amended from time to time)
• Acknowledge that if a transaction request is invalid, it will not be
processed until valid documentation is received
• Direct us to deduct any government fee, duty, bank charge,
dishonour fee or any other fees payable from time to time, from
your withdrawal proceeds or any other amounts payable by us to
you
• Direct us to deduct from your investment any amount owed by
you to us
• Agree that if we make an incorrect payment to you, we are entitled
to deduct the amount incorrectly paid from any holding you may
have with us or a related body corporate
• Acknowledge that if we reasonably believe a signature on a
document, such as a withdrawal request, to be genuine we are
entitled to rely on that signature and will not be liable for any loss
you may suffer if it is later found that the signature was fraudulent
• Acknowledge that if we reasonably believe an email or facsimile
communication we receive from you, your Financial adviser or
representative is genuine, we are entitled to rely on that email or
Page 4 of 8
8.payment/distribution account details
facsimile communication and will not be liable for any loss you
may suffer if it is later found the email or facsimile communication
was fraudulent
• Agree that any email sent to [email protected]
including the details required to withdraw your investment will
be taken to be by you and, further, you acknowledge that we may
act on those instructions and will not be liable for any loss you
may suffer if it is later found that the email was fraudulent.
• Consent to telephone conversations being recorded and listened
to for training purposes or to provide security for transactions
• Acknowledge that information, reports and other communication
to you may be delivered electronically.
If Section 9 (Authorised Representative) is completed, by
signing below you:
• Acknowledge that the appointment of an authorised representative
is governed by the terms set out in this PDS.
Anti-Money Laundering and Counter-Terrorism Financing
obligations
We are bound by laws about the prevention of money laundering and
the financing of terrorism, including the Anti-Money Laundering and
Counter-Terrorism Financing Act 2006 (AML/CTF Laws).
By completing the application form, you agree that:
• you do not apply for a BT Premium Cash Fund under an assumed
name
• any money used by you in connection with your BT Premium Cash
Fund is not derived from or related to any criminal activities
• any proceeds will not be used in relation to any criminal activities
• if we ask, you will provide us with additional information we reasonably
require for the purposes of AML/CTF Laws (including information
about a holder of a beneficial interest in a parcel or the source of
funds used in connection with the BT Premium Cash Fund)
• we may obtain information about you or any beneficial owner of
an interest in a parcel from third parties if we believe this is
necessary to comply with AML/CTF Law
• in order to comply with AML/CTF Laws we may be required to
take action, including delaying or refusing the processing of any
application, the sale or transfer of a security at maturity or disclosing
information that we hold about you or any beneficial owner of an
interest in a parcel to our related bodies corporate or service
providers, or relevant regulators of AML/CTF Laws (whether in or
outside of Australia).
your request cannot proceed
if this section is not signed
Joint applicants must all sign unless we have received prior instructions
from all investors that any can sign solely.
If signing under a Power of Attorney (POA), you verify that at the time
of signing, you have not received notice of revocation of that power.
Please provide an originally certified copy of the POA including the
appointed POA’s signature. If the POA’s signature is not included,
please attach two originally certified copies of identification. In the
case of company signatories, two directors, or a director and a
company secretary must sign unless you are the sole director
and sole secretary.
Signature of Investor A or company officer A
Date (dd/mm/yy)
Signatory name (please print)
/
Company signatories must indicate their company title.
Director
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/
Clubs/Associations/Unincorporated bodies Signatories must
indicate their office title.
Signature of Investor B or company officer B
Date (dd/mm/yy)
Signatory name (please print)
/
/
Company signatories must indicate their company title.
Director
  Company Secretary
Clubs/Associations/Unincorporated bodies Signatories must
indicate their office title.
Individual or sole trader
Sign as Investor A. If a sole trader,
indicate by crossing applicable box
above.
Company
Two directors or a director and
company secretary must sign unless
the company has only a sole director
and sole secretary. All signatories
must state their capacity within the
company by crossing the applicable
box(es) above.
Superannuation fund
or Trust
Individual Trustee – Sign as Investor A.
Joint Trustees – Sign Investors A and B
Corporate Trustee – see company
requirements above.
Adult(s) investing on
behalf of a child
under 18
Adult(s) to sign in their own name.
Joint Investor
All investors must sign unless
previously indicated; otherwise
we will be unable to accept your
application. If more than two
investors, please photocopy
blank form.
Club, association or
unincorporated body
Office bearer(s) must sign and state
their appropriate office title in the
fields above.
Partnership
All partners to sign. If more than two
partners, please photocopy this page
and attach with signatures for all
partners.
Deceased estate
All executors to sign. If more than two
executors, please photocopy this page
and attach with signatures of all
executors.
11.privacy consent preference
Please cross [✘] the box if you would not like the benefit of receiving
information about products and services (which may be
supplied by us, any member of the Westpac Group or
preferred providers) that we consider may be of value or
interest to you.
No
   Sole Director and Sole Company Secretary
Page 5 of 8
adviser must sign and date this form
If I am not a Westpac Financial Planner, I:
• declare that I am authorised to provide advice in relation to the
investor’s BT account under an Australian Financial Services
Licence; and
If I am a Westpac Financial Planner, I declare that:
• I am a representative of Westpac Banking Corporation (AFSL
233714); and
• I am authorised to provide advice in relation to the member’s BT
account.
BT Adviser number
a
Title
Mr
Mrs
Miss
Ms
Other
Given name(s)
Surname
Phone number
(
)
Mobile phone number
Signature of Financial adviser
Date (dd/mm/yy)
/
Fax number
(
)
Office postcode
Please mail your completed application form, together with any
cheque(s) (if applicable) to:
BT Financial Group
GPO Box 2675
SYDNEY NSW 2001
Email address
Investment Link ILCN (Client No.)
ILGN Group Number
Financial adviser stamp (please use black ink only)
New financial adviser information
New advisers please attach copies of the following documents.
Authorised Representatives
• Letter/Fax from head agent confirming AFSL number and that
the adviser is an Authorised Representative, and
• Copy of the written notice from head agent authorising the
adviser to provide financial services on their behalf
Head Agent
• Copy of AFSL issued by ASIC
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/
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12.adviser use only
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