Common use of COMPANY CONTACT DETAILS Clause in Contracts

COMPANY CONTACT DETAILS. In order to comply with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 American Express International (NZ) Inc is required to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customer, this includes the Authorised Signatory, Programme Administrator and the Decision Maker. We will not be able to process your application without this information. Authorising Signatory2 (for future Application authorisation) Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y Additional Authorising Signatory2 (recommended) Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y 4. COMPANY CONTACT DETAILS (CONT) Primary Programme Administrator3 Title First Name Last Name Position Mailing Address (if different from Company Address) 4. COMPANY CONTACT DETAILS (CONT) We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Residential Address City Postcode City Date of birth D D / M M / Y Y Postcode Telephone Number – Fax Number – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) In order to comply with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 American Express International (NZ) Inc is required to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customer, this includes the Authorised Signatory, Programme Administrator and the Decision Maker. We will not be able to process your application without this information. Residential Address City Postcode Date of birth D D / M M / Y Y @ Work Online Program Management4 (except BTA) I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting Do you have an existing @ Work User ID ? YES NO If Yes, please provide your User ID If No, please provide Verification word# @ Work Online Program Management4 (except BTA) I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting Do you have an existing @ Work User ID ? YES NO If Yes, please provide your User ID If No, please provide Verification word# # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Verification PIN (must be 4 numeric characters) Corporate ID5 (please provide the CID to gain access) Note - you must remember both the Verification word and PIN as you will be prompted to enter these as authentication when completing your online registration to American Express @ Work. Credit Control7 (Optional) Title First Name Last Name Position Mailing Address (if different from Company Address) City # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Verification PIN (must be 4 numeric characters) Corporate ID5 (please provide the CID to gain access) Note - you must remember both the Verification word and PIN as you will be prompted to enter these as authentication when completing your online registration to American Express @ Work. Additional Programme Administrator6 (recommended) Title First Name Postcode Telephone Number – Fax Number – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Last Name Position Mailing Address (if different from Company Address) City Postcode Telephone Number – Fax Number –

COMPANY CONTACT DETAILS. In order to comply with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 American Express International (NZ) Inc is required to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customer, this includes the Authorised Signatory, Programme Administrator and the Decision Maker. We will not be able to process your application without this information. Authorising Authorised Signatory2 (for future Application authorisation) Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Authorised Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y Additional Authorising Authorised Signatory2 (recommended) Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Authorised Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y 4. COMPANY CONTACT DETAILS (CONT) Primary Programme Administrator3 Credit Control7 (Optional) Title First Name Last Name Position Mailing Address (if different from Company Address) 4. COMPANY CONTACT DETAILS (CONT) We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Residential Address City Postcode City Date of birth D D / M M / Y Y Postcode Telephone Number – Fax Number Postcode – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) In order to comply with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 American Express International (NZ) Inc is required to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customer, this includes the Authorised Signatory, Programme Administrator and the Decision Maker. We will not be able to process your application without this information. Residential Address City Postcode Date of birth D D / M M / Y Y @ Work Online Program Management4 (except BTA) I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting Do you have an existing @ Work User ID ? YES NO If Yes, please provide your User ID If No, please provide Verification word# @ Work Online Program Management4 (except BTA) I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting Do you have an existing @ Work User ID ? YES NO If Yes, please provide your User ID If No, please provide Verification word# # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Verification PIN (must be 4 numeric characters) Corporate ID5 (please provide the CID to gain access) Note - you must remember both the Verification word and PIN as you will be prompted to enter these as authentication when completing your online registration to American Express @ Work. Credit Control7 (Optional) Title First Name Last Name Position Mailing Address (if different from Company Address) City # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Verification PIN (must be 4 numeric characters) Corporate ID5 (please provide the CID to gain access) Note - you must remember both the Verification word and PIN as you will be prompted to enter these as authentication when completing your online registration to American Express @ Work. Additional Programme Administrator6 (recommended) Title First Name Postcode Telephone Number – Fax Number – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Last Name Position Mailing Address (if different from Company Address) City Postcode Telephone Number – Fax Number –

COMPANY CONTACT DETAILS. In order to comply with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 American Express International (NZ) Inc is required to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customer, this includes the Authorised Signatory, Programme Administrator and the Decision Maker. We will not be able to process your application without this information. Authorising Signatory2 (for future Application authorisation) Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y Additional Authorising Signatory2 (recommended) Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y 4. COMPANY CONTACT DETAILS (CONT) Primary Programme Administrator3 Title First Name Last Name Position Mailing Address (if different from Company Address) 4. COMPANY CONTACT DETAILS (CONT) We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Residential Address City Postcode City Date of birth D D / M M / Y Y Postcode Telephone Number – Fax Number – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) In order to comply with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 American Express International (NZ) Inc is required to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customer, this includes the Authorised Signatory, Programme Administrator and the Decision Maker. We will not be able to process your application without this information. Residential Address City Postcode Date of birth D D / M M / Y Y @ Work Online Program Management4 (except BTA) I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting Do you have an existing @ Work User ID ? YES NO If Yes, please provide your User ID If No, please provide Verification word# @ Work Online Program Management4 (except BTA) I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting Do you have an existing @ Work User ID ? YES NO If Yes, please provide your User ID If No, please provide Verification word# # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Verification PIN (must be 4 numeric characters) Corporate ID5 (please provide the CID to gain access) Note - you must remember both the Verification word and PIN as you will be prompted to enter these as authentication when completing your online registration to American Express @ Work. Credit Control7 (Optional) Date of birth D D / M M / Y Y Postcode Title Last Name First Name Last Name @ Work Online Program Management4 (except BTA) I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting Do you have an existing @ Work User ID ? YES NO If Yes, please provide your User ID If No, please provide Verification word# Position Mailing Address (if different from Company Address) City # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Verification PIN (must be 4 numeric characters) Corporate ID5 (please provide the CID to gain access) Note - you must remember both the Verification word and PIN as you will be prompted to enter these as authentication when completing your online registration to American Express @ Work. Additional Programme Administrator6 (recommended) Title First Name Postcode Telephone Number – Fax Number – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Last Name Position Mailing Address (if different from Company Address) City Postcode Telephone Number – Fax Number –

COMPANY CONTACT DETAILS. In order to comply with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 American Express International (NZ) Inc is required to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customer, this includes the Authorised Signatory, Programme Administrator and the Decision Maker. We will not be able to process your application without this information. Authorising Signatory2 (for future Application authorisation) Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y Additional Authorising Signatory2 (recommended) Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y 4. COMPANY CONTACT DETAILS (CONT) Primary Programme Administrator3 Title First Name Last Name Position Mailing Address (if different from Company Address) 4. COMPANY CONTACT DETAILS (CONT) We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Residential Address City Postcode City Date of birth D D / M M / Y Y Postcode Telephone Number – Fax Number – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) In order to comply with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 American Express International (NZ) Inc is required to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customer, this includes the Authorised Signatory, Programme Administrator and the Decision Maker. We will not be able to process your application without this information. Residential Address City Postcode Date of birth D D / M M / Y Y @ Work Online Program Management4 (except BTA) I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting Do you have an existing @ Work User ID ? YES NO If Yes, please provide your User ID If No, please provide Verification word# @ Work Online Program Management4 (except BTA) I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting Do you have an existing @ Work User ID ? YES NO If Yes, please provide your User ID If No, please provide Verification word# # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Verification PIN Pin (must be 4 numeric characters) Corporate ID5 (please provide the CID to gain access) Note - you must remember both the Verification word and PIN Pin as you will be prompted to enter these as authentication when completing your online registration to American Express @ Work. Credit Control7 (Optional) Date of birth D D / M M / Y Y Postcode Title Last Name First Name Last Name @ Work Online Program Management4 (except BTA) I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting Do you have an existing @ Work User ID ? YES NO If Yes, please provide your User ID If No, please provide Verification word# Position Mailing Address (if different from Company Address) City # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Verification PIN Pin (must be 4 numeric characters) Corporate ID5 (please provide the CID to gain access) Note - you must remember both the Verification word and PIN Pin as you will be prompted to enter these as authentication when completing your online registration to American Express @ Work. Additional Programme Administrator6 (recommended) Title First Name Postcode Telephone Number – Fax Number – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) Last Name Position Mailing Address (if different from Company Address) City Postcode Telephone Number – Fax Number –