New Zealand Merchant Application

Business Information

Merchant Trading Name

Legal Name

Business Email Address

Business Contact Number

Business Website / Online Presence

Please write N/A if not applicable

Date Business Registered

Annual Revenue

Sales Model

Industry

Address

Street Address

City

Country

Postcode

Primary Contact Details

First Name

Last Name

Contact's Email

Contact's Phone Number

Contact Assignment

Please contact me above for all enquiriesI do not manage the finacials and wish to assign another contact personI wish to assign another contact person for order/customer support queries

Finance Name

Finance First Name

Finance Last Name

Finance Email

Finance Phone

Support Name

Support Email

Support Phone

Beneficial Owner Details

We require a copy of a Drivers Licence or passport for all ‘beneficial owners’ as part of our obligations under the Anti-Money Laundering & Countering Financing of Terrorism Act 2009.

A summary of the beneficial ownership requirements can be found here on the Department of the Internal Affairs website.

A beneficial owner is a natural person who meets any one of the following criteria:

Owns more than 25% of your business
Has effective control of your business (e.g. by way of voting rights, or is a key decision maker)

Please select number of beneficial owners

Director Details #1

Director Name Director Email	Director Phone Director Date of Birth
Driving Licence or Passport Number	Driving License Version Number
Driving Licence or Passport Picture Please make sure attachment is less than 25KB

Director Details #2

Director Name Director Email	Director Phone Director Date of Birth
Driving Licence or Passport Number	Driver License Version Number
Driving Licence or Passport Picture Please make sure attachment is less than 25KB

Director Details #3

Director Name Director Email	Director Phone Director Date of Birth
Driving Licence or Passport Number	Driving License Version Number
Driving Licence or Passport Picture Please make sure attachment is less than 25KB

Director Details #4

Director Name Director Email	Director Phone Director Date of Birth
Driving Licence or Passport Number	Driving License Version Number
Driving Licence or Passport Picture Please make sure attachment is less than 25KB

Nominee Directors / Shareholders / Nominee Partners

We are required to confirm the existence of any nominee directors / nominee shareholders for a company or nominee partners for a limited partnership. These are person(s) who follow the instructions or directions of another person who is not a director, shareholder or general partner of your business when carrying out their role.

Do you have any nominee directors / nominee shareholders / nominee general partners?

Please provide the full names of any nominee directors / nominee shareholders / nominee general partners

Please provide the reason for the nominee arrangements

Please provide the full names of the directors / nominee shareholders / nominee general partners they are acting on behalf of as the capacity as a director or shareholder or partner

Powers that Bind and Regulate

We are required under the Anti-Money Laundering & Countering Financing of Terrorism (Requirements and Compliance) Regulations 2011 section 11 and 11A to collect information on any powers that bind and regulate your business.

This is anything that may govern the management of your business, including but not limited to the rights of shareholders and share classes; and the appointment, powers and removal of key persons (e.g., partner, director).

Please select your Entity Type

Other than the Companies Act 1993, are there any other powers that bind and regulate your business? E.g., company constitution, shareholders agreement

Is your entity a Limited Partnership?

Do you have a partnership agreement?

Please attach a copy of your partnership agreement

Other than a partnership agreement, are there any other powers that bind and regulate your business? (e.g., Deed of Accession, Deed of Amendment)

Please attach a copy of your trust deed

Other than the trust deed, are there any other powers that bind and regulate your business? E.g., Deed of appointment, deed of amendment

Please provide a copy of your rules/charter/constitution

Other than your rules/charter/constitution, are there any other powers that bind and regulate your business? E.g., Deed of appointment, deed of amendment

Please detail any powers that bind and regulate your business

Please attach a copy of the document(s) that include the powers that bind and regulate your business

Please provide a statutory declaration confirming the following:

Full name of partnership;

Each partner associated with the partnership;

Percentage ownership of assets/distributions for each partner;

Voting rights for each partner;

The reason why a partnership agreement cannot be provided;

Whether there are any powers that bind and regulate the business

Financial Details

Bank Name

Eg: ANZ Bank

Bank Account Name

E.g. The Business Limited

Bank Account Number

Banks typically display the suffix as two digits. Please pad this with a leading zero e.g. 50 -> 050

Bank Statement Attachment

NZBN/GST

New Zealand Business Number (NZBN)

E.g. 987654321234

GST Number

E.g. 123-456-789

Agreement

Please read through Zip's Standard Service Agreement before submitting this application

I agree to Zip's Standard Service Agreement