Open an Account - Argonaut

Client Application Form

* Asterisk = required field.

Account Type*

Select your account type

How Many Individuals?*

How Many Directors?*

Individual 1 Details

Please provide details for your account.

* Asterisk = required field.

Title*

Date of Birth*

DD

MM

YYYY

Name*

First Name Surname

Country of Birth*

Country of Citizenship or lawful permanent residency*

Individual 2 Details

Please provide details for your account.

* Asterisk = required field.

Title*

Date of Birth*

DD

MM

YYYY

Name*

First Name Surname

Country of Birth*

Country of Citizenship or lawful permanent residency*

Individual 3 Details

Please provide details for your account.

* Asterisk = required field.

Title*

Date of Birth*

DD

MM

YYYY

Name*

First Name Surname

Country of Birth*

Country of Citizenship or lawful permanent residency*

Company Details

Please provide your company details.

* Asterisk = required field.

Company Name*

ABN / ACN*

Country of Incorporation*

Company Type*

Number of Directors*

ARBN or foreign registration number*

Place of Incorporation

Director 1 Details

* Asterisk = required field.

Title*

Date of Birth*

DD

MM

YYYY

Name*

First Name Surname

Country of Birth*

Country of Citizenship or lawful permanent residency*

Director 2 Details

* Asterisk = required field.

Title*

Date of Birth*

DD

MM

YYYY

Name*

First Name Surname

Country of Birth*

Country of Citizenship or lawful permanent residency*

Director 3 Details

* Asterisk = required field.

Title*

Date of Birth*

DD

MM

YYYY

Name*

First Name Surname

Country of Birth*

Country of Citizenship or lawful permanent residency*

Trust / Superannuation Fund Details

Please provide details.

* Asterisk = required field.

Name of Trust*

ABN / ARBN*

Country of Establishment*

Type of Trust*

Name of the Trustee*

Account Designation

Trust name, Superannuation Fund Name, Minor (child). Must not be more than 28 characters.

* Asterisk = required field.

Designation*

Authorised Agent

If you wish to authorise a third party to operate your account, please complete the below details. Until you notify us in writing that the authority has been revoked, the following person is authorised to act on your behalf, including giving dealing and other instructions, information and requests and/or receive account information.

* Asterisk = required field.

Are You Authorised?*

Title*

Date of Birth*

DD

MM

YYYY

Name*

First Name Surname

Address*

Street Address Address Line 2 City ZIP / Postal Code

Country of Birth*

Country of Citizenship or lawful permanent residency*

Position Held*

Phone Number*

Do you have Power of Attorney or signatory authority to a person with a U.S. address?*

Yes
No

Address

This cannot be a PO Box.

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Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Details

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Mobile Phone*

Note: Provide at least one contact phone number.

Home Phone

Work Phone

Fax Number

Email*

Confirm Email*

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