Credit Card Application
* You will be a US citizen if you were born in the US or have acquired US citizenship, unless you have formally renounced your US citizenship
** The country listed will determine the tax rate applied to your products. Please contact your tax advisor if you are unsure
*** If you are a US citizen or tax resident, the FIN section must be completed with your social security number or individual tax identification number
Are you a US citizen?* Yes No
Main country of tax
residency** THIS IS THE MAIN COUNTRY WHICH HAS THE RIGHT TO TAX YOUR WORLDWIDE INCOME Additional country(s) of tax
residency (if any) LIST THE ADDITIONAL COUNTRY(S) OF WHICH YOU ARE A TAX RESIDENT Foreign Tax Identification
Number*** (FIN) YOUR IDENTIFICATION NUMBER FOR TAX PURPOSES IN A PARTICULAR COUNTRY
A: Type of Westpac credit card account
Please select
one card type and one reward programme per application.
The Low Rate MasterCard
®does not include a reward programme.
Westpac Low Rate MasterCard®
Westpac MasterCard®
Westpac Platinum MasterCard®
Westpac World MasterCard®
Westpac Airpoints Business MasterCard®
Westpac BusinessPLUS MasterCard®
If you select, but do not meet Westpac’s current lending criteria for a
hotpoints or Airpoints Platinum MasterCard account, a hotpoints or
Airpoints MasterCard
®account will be issued instead (provided you
meet the relevant criteria for that card).
If you are applying for an Airpoints credit card and already have an
Airpoints number, please enter it below. If you are not currently an
Airpoints member, we’ll arrange an Airpoints membership for you free of
charge. Your Airpoints number will be printed on your credit card and all
Airpoints Dollars earned will be credited to your Airpoints account.
Airpoints™ Membership Number
B: Principal applicant details
Title
(please tick one)Mr
Mrs
Miss
Ms
Dr
Other
(please specify)Given name(s)
FIRST MIDDLESurname
Date of birth
DATE/
MONTH/
YEARNZ Resident
Yes
No
How would you like your name to appear on your card
This must be your given name(s), or initial(s) and surnameIf you already have a Westpac bank account, please provide the
account no. below
Home address
STREET NO. STREET NAME/BOX NUMBERSUBURB TOWN / CITY
Time at current address
YEARS / MONTHSPostal address
(if different from home address given above)STREET NO. STREET NAME/BOX NUMBER
SUBURB
Best description of your living arrangements
(Please tick one)Home owner
Rent
Live with parents/guardian
Board
Home phone
( )
Mobile phone
( )
Work phone
( )
Email address
NZ driver’s licence
number (5a)
Version
no. (5b)
Identification word
YOU WILL NEED THIS WORD IF YOU CALL US TO DISCUSS YOUR CARD IN THE FUTUREClose friend or relative
FULL NAME (MUST BE LIVING IN NEW ZEALAND AND NOT LIVING AT THE SAME ADDRESS)
Their phone
number
( )
Joint application
On a joint credit card account, both cardholders are jointly and severally liable for any balance owed on the account. A joint cardholder must be at least 18 years old.
Additional cardholder
The principal cardholder is liable for all transactions on the credit card account which are made by an additional cardholder as though they had personally made the additional cardholder transactions. An additional cardholder must be at least 16 years of age.
There is a $15 charge for each joint and additional card on all cards except the World MasterCard where a $100 charge applies. When a hotpoints World MasterCard is selected there is no charge for the first joint/additional card.
Title
(please tick one)Mr
Mrs
Miss
Ms
Dr
Other
(please specify)Given name(s)
FIRST MIDDLESurname
Date of birth
DATE/
MONTH/
YEARHow would they like their name to appear on their card
This must be their given name(s), or initial(s) and surname
Home address
STREET NO. STREET NAME/BOX NUMBERSUBURB TOWN / CITY
Contact phone
( )
Email address
How to apply
1) Apply online at westpac.co.nz/credit-cards/apply-now/ This is the fastest way to apply for a card.
2) Complete this form and take it together with identification and proof of income to your nearest Westpac branch, or
3) Complete this form and mail to Westpac, Private Bag 92503, Wellesley Street, Auckland.
If you have any questions or need help to complete this form, please call 0800 888 111.
C: Joint/Additional applicant’s details
For joint applicant only
Are you a US citizen?* Yes No
Main country of tax
residency** THIS IS THE MAIN COUNTRY WHICH HAS THE RIGHT TO TAX YOUR WORLDWIDE INCOME Additional country(s) of tax
residency (if any) LIST THE ADDITIONAL COUNTRY(S) OF WHICH YOU ARE A TAX RESIDENT Foreign Tax Identification
Number*** (FIN) YOUR IDENTIFICATION NUMBER FOR TAX PURPOSES IN A PARTICULAR COUNTRY hotpoints® Airpoints™ Westpac PayTag™
(optional)
Credit Card Application
F: Acknowledgement
I/we certify that all information supplied in this application is true, correct and complete.
In applying for this credit card, I/we acknowledge that my/our declared income is correct and sufficient to service the credit limit provided.
I/we agree that as soon as I/we sign or use my/our card or use any other payment instrument (such as PayTag® if requested), to access my/our account I/we
will be deemed to have agreed to be bound by:
• the Credit Card Conditions of Use for the applicable card;
• the Air New Zealand Airpoints™ programme terms and conditions (where applicable);
• the hotpoint terms and conditions (where applicable); and
• the Westpac PayTag terms and conditions (where a Westpac PayTag has been requested).
I/we acknowledge and agree that:
• I/we are personally responsible for all credit extended by Westpac to me/us, including credit extended under a BusinessPLUS MasterCard or Airpoints
Business MasterCard, irrespective of whether a business name appears on the card;
• where applicable, I must be a member of Air New Zealand’s Airpoints programme to be eligible to earn Airpoints and that I can access the Airpoints
terms and conditions at airnewzealand.co.nz/aripoints-terms-and-conditions;
• for a joint credit card account, a notice Westpac sends to one of us will count as a notice to all of us;
• fees and charges will apply to the use of the card. Details of fees and charges are provided in the Transaction and Service Fees brochure, which will be
sent to me; and
• the Credit Card Conditions of Use for the applicable card, the Westpac PayTag terms and conditions (where applicable), and the hotpoints terms and
conditions (where applicable) will be sent to me.
Copies of the Credit Card Conditions of Use for the applicable card, the Westpac PayTag terms and conditions, the hotpoints terms and conditions (which
are incorporated in the Credit Card Conditions of Use for the applicable cards) and the Transaction and Service Fees brochure are available at any Westpac
branch or online at westpac.co.nz.
Personal information
I/we consent to and authorise the collection, use and disclosure of my/our personal information by Westpac New Zealand Limited and its related
companies (Westpac) in the following ways:
•
Westpac may make all necessary enquiries (now or in the future) concerning my/our credit record, residence, employment, financial status, and any
information provided by me/us in this application for the purposes related to provision of credit to me/us, from whatever source Westpac considers
appropriate, including any credit reporting agency that Westpac has a subscriber agreement with, and any party approached may provide such
information to Westpac.
• Westpac may use all the information that they hold about me/us to make available to me/us the full range of financial services provided by Westpac and
to provide me/us with details of products and services that may be purchased with the card.
• Westpac may provide Credit Information (as defined in the Credit Reporting Privacy Code 2004) about me to credit reporting agencies, who will use
that information to update their credit reporting database and who may disclose any information they hold about me/us to their own customers for the
purpose of providing credit reporting services.
This optional insurance can help you pay your credit card balance should
you or any cardholder on your account die or experience total disability,
redundancy or bankruptcy before age 66.
E: Card Repayment Cover
PRINCIPAL SIGNATURE
DATE
/
MONTH/
YEARI/we agree to be covered by Card Repayment Cover (please sign:)
Do you want to be covered by
Card Repayment Cover?
You will be covered on the terms, conditions and exclusions of the Card
Replacement Cover policy wording from the date that this application is
received by Westpac. A sample copy of the Card Replacement Cover
policy wording is attached.
Yes
No
Note: You must be aged between 18 and 65 years.
Cost of the insurance is 79 cents a month for each $100 of the outstanding balance on your Westpac credit card statement. If you choose Card Repayment Cover, then each month we will charge your premium to your credit card account. We will let you know if the cost of the insurance changes 30 days beforehand. The premiums are collected on behalf of the underwriter Westpac Life-NZ-Limited.
Westpac Life-NZ-Limited has an AA- Insurer Financial Strength rating given by Standard & Poors (Australia) Pty Limited on 6 August 2013. The rating scale is: AAA Extremely Strong, AA Very Strong, A Strong, BBB Good, BB Marginal, B Weak, CCC Very Weak, CC Extremely Weak, SD or D Default, R Regulatory Supervision, NR Not Rated. Plus (+) or Minus (-) following ratings from ‘AA’ to ‘CCC’ show relative standings within the major rating categories. For a full description of the ratings scale go to standardandpoors.com
D: Employment and financial details
Occupation of principal applicant
INSERT YOUR OCCUPATION HERE
Current employer of principal applicant
Time in current job
years
months
Principal applicant’s annual income from all sources
(before tax) is
$
ANNUALLYJoint applicant’s annual income from all sources
(before tax) is
$
ANNUALLYIf you’re applying for a joint credit card account please combine your financial details for the following questions
Total savings and investments with Westpac
add up to
$
TOTALTotal savings and investments not with Westpac
add up to
$
TOTALMonthly home loan, rent or board payments
$
MONTHLY TOTALMonthly repayments for any bank loans, other
than home loans (e.g. car & personal) add up to
$
MONTHLY TOTALMonthly repayments for non-bank loans (e.g.
finance companies, student loans or
hire-purchase agreements) add up to
$
MONTHLY TOTAL
Credit Card Application
Westpac use only
Card number CRS number
Application
number Card account number
Package type
Card Repayment Cover is underwritten by Westpac Life-NZ-Limited, a wholly owned subsidiary of Westpac Financial Services Group-NZ-Limited, which is a wholly owned subsidiary of Westpac Banking Corporation ABN 33 007 457 141, incorporated in Australia. Neither Westpac Banking Corporation, Westpac New Zealand Limited (“Westpac”), nor any other member of the Westpac Group guarantees the obligations of, or any products issued by, Westpac Life-NZ-Limited. Westpac employs salaried employees whose remuneration is influenced in the long term by the arrangement of Westpac Life-NZ-Limited insurance policies. Westpac will receive commission payments as a result of the arrangement of Westpac-Life-NZ-Limited policies. hotpoints® is a registered trademark of Westpac Banking Corporation. MasterCard is a registered trademark of MasterCard International Incorporated.
Credit cards are both a convenient means of payment and a flexible form of borrowing. Although paying only the minimum monthly payment can help you
manage your cash flow from time to time, If you make only the minimum payment each month, you will pay more interest and it will take you longer to pay off
your balance.
Bank stamp
FTR stamp Special delivery instructions
Branch/split code
Staff number
Courier cost
Branch
Customer
X X X X
X X X X
Credit Card Account Number
72273WP-21 11-15
PRINCIPAL SIGNATURE
DATE
/
MONTH/
YEARJOINT / ADDITIONAL SIGNATURE
DATE
/
MONTH/
YEAR• Westpac may disclose my personal information (including default information) to any person Westpac may appoint to collect any outstanding debt.
• Westpac may use credit reporting agencies monitoring service to receive updates, if any, of the information they hold about me/us.
• Westpac and its related companies may obtain, use and/or disclose information held about me/us to enable Westpac and its related companies to
comply with any laws, rules or regulations in New Zealand or any other country including any laws, rules or regulations reasonably expected to be
implemented (including to enable the government of New Zealand to comply with any agreement between it and any other country).
• Westpac may disclose and exchange any information held about me/us now or in the future to any party associated with a Westpac credit card rewards
programme for the purposes of administration of the applicable rewards programme, provision of related services and for marketing and research
purposes.
I/we confirm that I/we have the permission of the person named as ‘close friend or relative’ in this application to disclose their personal details.
If I/we have indicated that I/we wish to be covered by Card Repayment Cover (“the Cover”), I/we authorise Westpac to disclose all relevant information
held about me/us now or in the future to the underwriters of the Cover for purposes of administrating the Cover.
I/we understand that I/we have the right to access and correct my/our personal information held by Westpac subject to the provisions of the Privacy Act
1993.
I/we acknowledge that I/we have read and accepted the disclosures, terms and conditions set out above.
G: Signature(s)
I /we also certify that:
• I/we are New Zealand citizens or have permanent New Zealand residency status
and reside in New Zealand.
• I/we are over 18 years of age (and any additional applicant is over 16 years of age).
Please note that you will be required to verify your identity and income as part of the
application process or prior to activating your credit card account. All cardholders
(principal, joint or additional) are required to verify identification. Suitable forms of ID
include one of the following
• New Zealand drivers licence
• Current passport
Claims Procedure
If you wish to make a claim, you must notify Westpac Life-NZ-Limited within 30 days of the event that prompted the claim. You must also provide us with medical reports or other information that we may ask for, at your expense. All proceeds of approved claims will be paid to your credit card account.
Notices
Any notices may be made by ordinary post (to the last postal address notified by you to us) or by facsimile or electronic means (to the facsimile/email address provided by you to us).
You are responsible for promptly informing us of any change to your personal details (including your name, address, telephone, mobile or facsimile numbers and email address).
Underwriter
Westpac Card Repayment Cover is underwritten by Westpac Life-NZ-Limited, a wholly owned subsidiary of Westpac Financial Services Group-NZ-Limited. Westpac Financial Services Group-NZ-Limited is a wholly owned subsidiary of Westpac Banking Corporation ABN 33 007 457 141, incorporated in Australia. Westpac New Zealand Limited (“Westpac”) does not guarantee the obligations of, or any products issued by Westpac Life-NZ-Limited.
Westpac will receive commission payments as a result of the arrangement of Westpac Life insurance policies.
Your policy will be included in the Westpac Life-NZ-Limited Statutory Fund No.1. We will pay your benefits from this fund. Statutory Funds are regulated pursuant to the Insurance (Prudential Supervision) Act 2010.
Definitions
Commencement date – means the date on which your cover under the
Master Policy commenced which is the date that your application for Card Repayment Cover was received by Westpac.
Outstanding balance – means the amount of debt on your Westpac credit
card account at the date of any event for which a claim is made under this policy. The amount of debt will exclude:
• any amounts shown as Past Due on your credit card statement together with accompanying interest, or
• any purchases or cash advances you made when you knew of the likelihood of the event giving rise to a claim, which, in our opinion, are outside the normal conduct of your credit card account.
We/our/us/Westpac Life – means Westpac Life-NZ-Limited. You/your – means the cardholder (including any joint cardholder and
additional cardholders) who is the holder of a credit card issued by Westpac and obtained for private use, who has made an application and has paid the required premium each month.
The terms and conditions for Westpac Card Repayment Cover may vary from time to time. Westpac New Zealand Limited
72540WP-3 06-15
Card
Repayment Cover
This is your Card Repayment Cover Policy Wording.
Please read this wording and then keep this
document in a safe place.
Policy Enquiries and Complaints
If at any time you have an enquiry or complaint about Card Repayment Cover, please contact Westpac Life in writing at PO Box 27031, Wellington or call Westpac Life on 0800 738 641. Westpac Life is a member of the Banking Ombudsman Dispute Resolution Scheme. If you are not satisfied with the way we resolve the enquiry or complaint, we can let you know how to refer the matter to the Banking Ombudsman.
Insurer Financial Strength Rating
Westpac Card Repayment Cover is underwritten by Westpac Life-NZ-Limited which has a AA- Insurer Financial Strength Rating given by Standard & Poor’s (Australia) Pty. Limited. The rating scale is:
AAA Extremely Strong BBB Good CCC Very Weak R Regulatory Supervision AA Very Strong BB Marginal CC Extremely Weak NR Not Rated A Strong B Weak SD or D Default
Plus (+) or minus (-) signs following ratings “AA” to “CCC” show relative standings within the major rating categories. For a full description of the rating scale go to: www.standardandpoors.com
Westpac Life-NZ-Limited PO Box 934, Shortland Street Auckland 1140
The Policy
Westpac New Zealand Limited, has been appointed by Westpac Life-NZ-Limited to provide Westpac Card Repayment Cover. Westpac Life-NZ-Life-NZ-Limited is referred to as the Company in the Master Policy.
This document sets out in full the terms of the insurance cover provided by Master Policy NZWP1037 for your protection in the event of:
• death; • total disability;
• unemployment arising from redundancy; • bankruptcy.
At the date of any event for which a claim is made, you must be between the following ages to be eligible for the protection:
• 18 and 65 years (inclusive) for the Total Disability, Redundancy and Bankruptcy benefits
• 18 and 79 years (inclusive) for the Life Insurance benefit.
Life Insurance
What you’re covered for:
We will pay the outstanding balance on your credit card account as at the date of death, up to $50,000.
What is not covered:
You are not covered under this policy for death arising from: • suicide, within 13 months of the commencement date, or
• any injury, sickness or disease which existed at the commencement date whether diagnosed or not, or
• the exclusions detailed under the ‘Exclusions applying to all cover’ heading.
Total Disability
This is any disability resulting from bodily injury, sickness or disease which directly and independently of any other cause, totally prevents you from engaging in your normal or usual business, occupation or work (including normal household duties if that is your primary occupation).
What you’re covered for:
Where total disability continues beyond 30 consecutive days, we will make monthly payments of 10% of the outstanding balance as at the date that you stopped work or sought medical advice, whichever is the earlier.
The maximum payment period is 24 months. The amount paid will not exceed $50,000.
Payment will be calculated on the number of days from the date you stopped work or sought medical advice, whichever is the earlier, until the date of your recovery, but in no event will payments continue beyond 24 months. If your disability becomes permanent we may pay the remainder of the 24 month total disability benefit as a lump sum. Such payment will be in full settlement of the total disability claim. Cover under the policy will then cease for this cardholder for total disability recurring from the same accident or illness. What is not covered:
1. Absence from work due to pregnancy, childbirth or abortion, or 2. Disability caused or resulting from:
• any injury, sickness, disease or degenerative condition which existed at the commencement date, or sickness, disease or degenerative condition which first made itself known within 28 days of the commencement date, or
• a deliberately self-inflicted injury or attempted suicide, or
• travel by air other than as a passenger on a licensed commercial or chartered aircraft, or
• you being addicted to alcohol or a drug, or
• you being under the influence of alcohol, poison or drugs, other than a drug taken on the advice of a legally qualified medical practitioner, or • the exclusions detailed under the ‘Exclusions applying to all cover’ heading.
Redundancy
This is loss of employment resulting from your position becoming superfluous to the needs of your employer. Loss of employment as a result of resignation, dismissal or voluntary redundancy is not covered by the Master Policy. What you’re covered for:
Where unemployment resulting from redundancy continues beyond 30 consecutive days, we will make monthly payments of 10% of the outstanding balance, as at the date you were first notified that you would be made redundant.
The maximum payment period is six months. The amount paid will not exceed $50,000.
Payments will be calculated on the number of days from the date you became unemployed, until the date of your new employment commencing, but in no event will payments continue beyond six months.
What is not covered:
• Cardholders who are self-employed or in seasonal or casual work or contract work, or
• loss of employment as a result of resignation, dismissal or voluntary redundancy, or
• unemployment which was in existence at the commencement date or occurred within 28 days of the commencement date, or
• if you knew or ought to have known, at the commencement date, that it was likely or possible that you would be made redundant, or
• if you have just completed a specific task or specific period of employment, or
• if you were made redundant from employment outside New Zealand, or • if you were a director where you had control over your employees or if you
were employed by a direct member of family (spouse, parents or children), or • the exclusions detailed under the ‘Exclusions applying to all cover’ heading.
Bankruptcy
This is when you have been declared bankrupt as a result of your creditors applying to a New Zealand Court to do so.
What you’re covered for:
If you are a self-employed cardholder and you become bankrupt more than six months after applying for cover, we will pay the outstanding balance, as at the date you were first notified that your creditors had applied to the Court to start bankruptcy proceedings.
The amount paid will not exceed $10,000. What is not covered:
• Cardholders who are not self-employed, or • voluntary bankruptcy, or
• the exclusions detailed under the ‘Exclusions applying to all cover’ heading.
Exclusions applying to all cover (life insurance, total
disability, redundancy & bankruptcy)
Any claim resulting from:
• riot or civil commotion, strike, lockout, war, civil war, rebellion, revolution, insurrection, the use of military or usurped power or if you were committing a materially unlawful act, or
• injury, sickness or disease you sustained outside New Zealand if you have been outside New Zealand for over six months immediately preceding the date of the event which resulted in a claim.
Premiums
The premium payable by you for this insurance is 79 cents per $100 of your outstanding monthly credit card account balance as at the date of your monthly statement. This will cover all cardholders on your account aged between 18 and 65 years (inclusive) for the Total Disability, Redundancy and Bankruptcy benefits, and all cardholders on your account aged between 18 and 79 years (inclusive) for the Life Insurance benefit. The premium is charged to your credit card account each month. If there is a nil balance on your credit card account as at billing date, no premium will be payable for that month. We can amend the premium by giving you not less than 30 days notice.
Policy and benefits
Only one benefit is payable for total disability or redundancy during the same period or for the same event. The rights and benefits you receive under the Master Policy cannot be assigned or charged to another person. The policy does not have a surrender value.
