Investor Application

Company

Apply online in just 10 minutes

Applying to be an investor gives you obligation free access to our live investment opportunities and unique investor portal.

If you need assistance you can contact us at [email protected] or phone 09 535 2239 during business hours.

NOTE: You must be 18 years or older to complete this form

Before you start it will be helpful to have the following information to hand:

IRD number
RWT tax rate i
Resident withholding tax (RWT) is a tax that is deducted from investment income before the investor receives it. Not sure about your tax rate? see https://www.ird.govt.nz/income-tax/withholding-taxes/resident-withholding-tax-rwt/using-the-right-rwt-tax-rate
Proof of bank account

* indicates a required field

"*" indicates required fields

X/Twitter

This field is for validation purposes and should be left unchanged.

Company Details

Full Company Name*

NZBN*

Business Address*

Street Address Suburb City Postcode Country

IRD Number*

Directors & Shareholders

List all directors, shareholders (25% or greater) and any ultimate beneficial owners.

Name

First Last

Mobile Phone

Country Phone Number

Are you a NZ Citizen or NZ Permanent Resident?

NZ Citizen

NZ Permanent Resident

Neither

If not, what is your country of birth?*

If you are not an NZ Citizen, please provide a copy of your visa*

Please upload a copy of your visa

Max. file size: 16 MB.

Name

First Last

Mobile Phone

Country Phone Number

Are you a NZ Citizen or NZ Permanent Resident?

NZ Citizen

NZ Permanent Resident

Neither

If not, what is your country of birth?*

If you are not an NZ Citizen, please provide a copy of your visa*

Please upload a copy of your visa

Max. file size: 16 MB.

Name

First Last

Mobile Phone

Country Phone Number

Are you a NZ Citizen or NZ Permanent Resident?

NZ Citizen

NZ Permanent Resident

Neither

If not, what is your country of birth?*

If you are not an NZ Citizen, please provide a copy of your visa*

Please upload a copy of your visa

Max. file size: 16 MB.

Contact Person for Company

Name*

First Middle Last

Date of Birth*

Mobile Phone*

Email address*

Address*

Street Address Suburb City Postcode Country

Contact Person - Residency

Are you a NZ Citizen or NZ Permanent Resident?*

NZ Citizen

NZ Permanent Resident

Neither

If not, what is your country of birth?*

If you are not an NZ Citizen, please provide a copy of your visa*

Please upload a copy of your visa

Max. file size: 16 MB.

Tax & Banking Details

Tax Deduction Rate*

28%

33%

Other

Other Tax Deduction Rate*

Is the company a tax resident of another country?*

Yes

If yes, what country is the company a tax resident of?*

Tax Identification Number (TIN):*

Bank Account Name*

Bank Account Number*

Please uses spaces or hyphens as per your proof of bank account

Documents required: Proof of bank account displaying bank logo, bank account number and account name to match applicant name(s). Note: If no tax deduction rate is selected, 28% will be automatically selected.*

Please upload a bank statement, proof of account document or screenshot from internet banking that displays the above information.

Drop files here or

Max. file size: 16 MB.

Financial Declaration

AML/CFT Legislation

Southern Cross Partners is a reporting entity under the Anti-Money Laundering and Countering Financing of Terrorism (AML/CFT) Act 2009. The following questions are designed to assist us with our compliance obligations. More information about the Act can be found at https://www.legislation.govt.nz/act/public/2009/35/en/latest/#DLM2140720

Purpose of Account*

Savings

Investment

Retirement

Other

Other Specified*

Have you participated in this type of investment in the past?*

Yes

Values below are to include the total value of ALL assets held by the investing entity: (Figures can be approximate)

Approx value of all investments/cash*

Approx value of all property

Approx value of all other assets

How has the company mainly acquired these assets?

(tick all that apply)

Salary/Wage

Sale of Investment Property

Sale of home

Interest earned on investments/savings

Business earnings

Dividends from shares

Inheritance

Other

Other Specified

Where did you hear about us?

(tick all that apply)

Internet Search

Social Media

Newspaper

Current SCP Investor

Event

Radio

interest.co.nz

Other

Current SCP Investor

Other Specified

Identity & Address Verification

The AML/CFT Act 2009 came into effect on 30 June 2013. Southern Cross Financial is legally required to confirm the identity of its customers and any person acting on behalf of the customer.

We have your permission to complete verification in relation to your identity and personal information, by whatever manner is most appropriate to our satisfaction. Southern Cross Partners prefers to confirm your identity biometrically via a text to your mobile device.

Please note: ID needs to be a current and original Passport or Drivers Licence (NZ & Australian only).

Directors Signature

By signing this application form I confirm that I have read, understood and agree to be bound by the terms of the Service Disclosure Statement, Investor Agreement and General Terms and Conditions that govern my/our investments through Southern Cross Partners.

Name*

Signature*

Date*

Name

Signature

Date

Further space (if required)

Investor Application

Company Details

Directors & Shareholders

Contact Person for Company

Contact Person - Residency

Company Information

Tax & Banking Details

Financial Declaration

AML/CFT Legislation

Identity & Address Verification

Directors Signature