Step 1 of 4 25% INTRODUCTION From 1 July 2026, real estate agencies providing certain designated services are required to comply with the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (Cth) (AML/CTF Act) and the associated obligations regulated by AUSTRAC. As your real estate agent, we are legally required to collect, verify, and retain specific information about you before we can provide these designated services. This form collects the information we need to meet our customer due diligence obligations under the AML/CTF Act. Your personal information provided to us may be required by easyAML to process your selling or buying property transaction (if applicable) in accordance with the requirements of the easyAML Representative Subscriber Participation Agreement. Your information will be stored in easyAML's electronic database and protected by physical and technical security processes. For further information on how your personal information is handled, visit easyAML's privacy policy on https://easyaml.com/privacy-policy/. client's detailsFull Name(Required)Date of Birth(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email(Required) Mobile(Required)Address(Required) Street Address City State Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Note: Kindly confirm that all information is accurate and consistent as on the Government Identity Card.Upload Your ID(Required) Drop files here or Select files Accepted file types: jpg, gif, png, pdf, tiff, Max. file size: 25 MB, Max. files: 2. Property Sales Consultant(Required)Select Your Consultant:Alain WarisadiAlisha LinAndrew TomingBruce OliverEndru YaoIin IrawatiIvan TandyoJunius TjetjeJoyce VellaKey TseKial JarredNovi GouwLisa SuryawanRebekah SinghSapta NugrahaWilliam ColemanWilliam WangYosie Alansa SOURCE OF FUNDS DECLARATION To comply with anti-money laundering requirements, please provide evidence and details of the source of funding for the purchase of the property.Will you be obtaining finance for the purchase or using your own funds?(Required) Own Funds; Mortgage Lending; Others: Will you be obtaining finance for the purchase or using your own funds?(Required)How the funds were obtained?(Required) Employment Salary; Business Activities; Shares and Investments; Gifts; Investments; Refinance; Other: How the funds were obtained?(Required)Mortgage Lending(Required)If you are using any borrowed funds from bank/lender for the property purchase, please provide us a pre-approval letter and your broker details. No – Provide 3 Months Bank Statements Yes – From Whom: From:(Required) CONFIRMATION(Required) By ticking this box, I declare that: All information provided in this form is true, accurate, and complete to the best of my knowledge and belief.I understand that Xynergy Realty is required to collect this information under the AML/CTF Act and will retain it for a minimum of 7 years.I consent to Xynergy Realty verifying my identity using electronic verification services or other reliable and independent sources.I consent to Xynergy Realty conducting sanctions and PEP screening.I will notify Xynergy Realty promptly if any of the information provided in this form changes.I am aware that providing false or misleading information may result in serious legal consequences, including but not limited to legal penalties (Civil and/or Criminal) under Australian law.I understand that Xynergy Realty may be required to report suspicious matters to AUSTRAC and is prohibited from informing me if such a report is made (tipping off prohibition under section 123 of the AML/CTF Act).I understand that failure to provide satisfactory identification or source of funds information may result in Xynergy Realty being unable to act on my behalf. Any false or incomplete details may delay your property purchase process and/or result in penalties under Australian law.Xynergy Realty is committed to handling all provided information with the utmost care and confidentiality. For further details, please review the Xynergy Realty Privacy Policy and Terms and Conditions . By submitting this form, you acknowledge that you have read and agreed that your information may be processed in accordance with these terms. Δ