个人账户申请书.pdfVIP

Bacera Co Pty Ltd INDIVIDUAL ACCOUNT APPLICATION 个人账戶申请书 ACN: 130 877 137 AFS 执照编号: 328794 发行者: BACERA CO PTY LIMITED 发行日期: 2010 年6 月1 日 Please answer all questions fully. 请完整地回答所有问题。 Please select a PASSWORD (can only contain alphanumeric characters (az,AZ,0-9) and must be between 4-10 characters) 请选择一个密码（仅能包含字母和数位（az, AZ, 0-9），必须在4-10 个字元之间）__________________________________________ Email Address (Required) 电邮地址（必填）: ____________________________________________ Security Question 安全问题: □What is your Mothers maiden name? 您母亲的婚前姓名是什么？ □What is your pets name? 您宠物的名字是什么？ □What is your nickname? 您的昵称是什么？ Security Answer 安全答案: ____________________________ General Information 一般资讯 Last Name 姓: ______________________ First Name 名:________________________ Middle Name 中名: _____________ Gender 性别: □Male 男 □Female 女 Marital Status 婚姻状况: □Single 单身 □Married 已婚 Tax File Number, Social Security Number, Passport, Drivers License or Reason for Exemption (Please attach a copy) 税务档案号码，社会安全号码，护照，驾驶执照或豁免原因(请附上影本) :________________________________ Date of birth (MM/DD/YY) 出生日期（月/ 日/年）: _____________________Citizenship 国籍:___________________ Residential Address 居住地址: ________________________________________________________________________ City 城市: _________________________________ State/Province 州/省: _________________________ Post/Zip Code 邮递区号: ____________________ Country of Residence 居住国家: ________________ Home Telephone No.家庭电话: _______________ Home Fax No.家庭传真: _______________________ Mobile Phone No.手机号码: _________________ Employment Details 就业状况 □Employed 受雇 □Self-employed 自雇 □Retired 退休 □Unemployed 失业 Name of Current Employer 现任雇主: ______________________ Nature of Business 业务属性: ___________________ Occupation 职位: ________________________________