Identity Verification Form *2987 A 5775603868541710 31
Your Identity Document Requirements
Does your primary document contain Primary Identification Documents
BOTH a photo AND your date of birth? . Australian Driver’s Licence or Learner’s Permit (current)
. Australian Passport (current or expired within the last 2 years)
Yes > Choose ONE primary identification . International Passport (current)
document from the list . Proof of Age Card/NSW Photo Card (current and government issued)
. Centrelink Pension Card (current)
No > Choose ONE primary identification . Australian Birth Certificate (not an extract)
document from the list and ONE . Australian Citizenship Certificate
secondary identification document that Secondary Identification Documents with Residential Address
displays your current residential . Utility bill (issued within the last three months)
address . Notice of Council Rates (issued within the last three months)
The document(s) will need to be presented . Tax assessment from Australian Taxation Office (issued within the last twelve months)
with this form. . Centrelink Statement (recording paid benefit issued within the last twelve months)
How to lodge your Application at Australia Post
1. Lodge your form at any participating post office. To find the nearest participating outlet, please call 13 13 18 or go to auspost.com.au/pol
and select Bank@Post.
2. DO NOT complete section C, your signature must be witnessed by the Australia Post verifier.
3. Identification documents MUST be presented and be original.
4. DO NOT make any changes to the information printed on this form, including the bar code. Any changes will cause the form to be rejected.
A. Details of Applicant
Family name/surname Date of birth
Bahba 07/11/1984
Given Name (full name, no initials) Contact phone number
Abdelhakim +61 405107801
B. Current Residential Address of Applicant (must be an Australian residential address not a PO Box)
Unit number/street number/street name
unit 4, 63 Crawford rd
Suburb/locality State Postcode
maylands Western Australia 6051
C. Declaration by Applicant
DO NOT SIGN UNTIL YOU LODGE THIS FORM AT AUSTRALIA POST
Your signature must be witnessed by the Australia Post verifier.
I acknowledge that the information on this form is true and correct. The details on this form have been completed by me and not another person.
Applicant to sign at Australia Post
Please Disclaimer and Privacy Notice - Australia Post is acting as an agent for PayPal
sign in and collects your information to identify you in accordance with requirements
black ink under Australian Law. Your details will be forwarded to PayPal and may also be
disclosed to government agencies such as AUSTRAC. Subject to certain exceptions
Date (DD/MM/YYYY) you may request access to your personal information. If access is denied, the law says
we must tell you why.
D. Australia Post use only
I confirm that I have sighted original documentation that verifies the Applicant’s name, date of birth and residential address as required
Verifier’s name Verifier’s Signature
Comments
Date (DD/MM/YYYY)
Work centre code
