Social Club Change of Signatories Form

SOCIAL CLUB CHANGE OF SIGNATORIES

Please ensure all current and any new signatories have completed and signed this form in full. Failure to obtain all required details and signatures will result in the need to resubmit the entire application form, which may delay processing.

This form can be saved and completed at a later time if needed.

SOCIAL CLUB DETAILS

Name of Social Club *

Account number *

CURRENT SIGNATORIES

Who are the current signatories on this Social Club account?

Name

Member number

Remove this signatory from this Social Club account.

Name

Member number

Remove this signatory from this Social Club account.

Name

Member number

Remove this signatory from this Social Club account.

Name

Member number

Remove this signatory from this Social Club account.

Do you want to add new signatories to this account? *

YesNo

NEW SIGNATORIES

Who do you want to add to the Social Club account?

1st New Signatory

Membership number (if applicable)

Title *

First name *

Middle name(s) (if any)

Last name *

Gender *

Date of birth *

Email *

Mobile number *

Address *

Street address *

City *

State *

Postcode *

Signature *

Clear

Please upload proof of identity *

Browse

Please upload either: Driver’s Licence (front and back), Medicare card or passport

2nd New Signatory

Membership number (if applicable)

Title *

First name *

Middle name(s) (if any)

Last name *

Gender *

Date of birth *

Email *

Mobile number *

Address *

Street address *

City *

State *

Postcode *

Signature *

Clear

Please upload proof of identity *

Browse

Please upload either: Driver’s Licence (front and back), Medicare card or passport

Do you want to add another new signatory? *

YesNo

3rd Signatory

Membership number (if applicable)

Title *

First name *

Middle name(s) (if any)

Last name *

Gender *

Date of birth *

Email *

Mobile number *

Address *

Street address *

City *

State *

Postcode *

Signature *

Clear

Please upload proof of identity *

Browse

Please upload either: Driver’s Licence (front and back), Medicare card or passport

Do you want to add another new signatory? *

YesNo

4th Signatory

Membership number (if applicable)

Title *

First name *

Middle name(s) (if any)

Last name *

Gender *

Date of birth *

Email *

Mobile number *

Address *

Street address *

City *

State *

Postcode *

Signature *

Clear

Please upload proof of identity *

Browse

Please upload either: Driver’s Licence (front and back), Medicare card or passport

Please make sure that FRONT and BACK of driver's licences are attached.

ACCOUNT OPERATION METHOD

A Visa Debit card is available for accounts that operate as one to sign.

How do you want the account to operate? *

One to sign (any of the signatories)Two to sign (any two signatories)All to sign (all signatories)

Do you want a Visa debit card? *

YesNo

Is this a new or replacement debit card? *

NewReplacement

Was your card lost, stolen or damaged? *

LostStolenDamaged

Which signatory do you want this debit card nominated to? *

What address do you want it sent to? *

Street address *

City *

State *

Postcode *

We agree to be bound by the ‘Visa Conditions of Use’ and all other terms and conditions applicable to the selected Accounts and Access facilities. We acknowledge that our Cards and Personal Identification Numbers will be mailed to the nominatedsignatory and postal address provided above. *

Social Club Signatories will take responsibility to protect card against any unauthorised use and for its safe storage. *

DECLARATION

The members of the Social Club will continue to indemnify the Woolworths Team Bank for any account which may be overdrawn.

A copy of our privacy notification and policy is available at www.woolworthsteambank.com.au/privacy-policy/.

A copy of our Account & Access Facility Conditions of Use is available at www.woolworthsteambank.com.au/disclosure-statements/.

We have read the above and agree to the terms and conditions and privacy notification and policy as outlined. *

All signatories need to sign. Existing and new signatories need to sign.

1st Signatory Signature

Clear

2nd Signatory Signature

Clear

3rd Signatory Signature

Clear

4th Signatory Signature

Clear

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