Individual foreign tax residency ING &) self-certification form ‘About this form Please return to Individuals banking with us must complete this form to ensure we hold accurate and curent information | cent documentation au@ing com ‘about your foreign tax residency. This form is for personal banking customers, sole waders, uarantors ‘and controling persons of an entity, ‘Why this form must be completed ‘Australia has enacted laws committing to glabal standards onthe automatic exchange of financial account information - commonly known asthe ‘Common Reporting Standard (CRS) and Foreign Account Tox Complance Act (FATCA Under these laws, financial institutions must identity where on account holder is a resident for tax purposes, and report information about financial ‘accounts of foreign tx residents to the Australian Taxation Office (ATO). Tax authorities in participating countries may then exchange this information with each other ‘The purpose of the standards is to give participating notions transparency about the financial assets that their residents hold offshore. we don't receive your form ‘As we're bound by legislation, we may be requted to treat you as a tx resident in a county outside of Australia (even if you rent) and report the relevant details to the ATO. If you intend to open a new account, we wort be able to do this for you. Where to find more information + Vist the ATO website—ategov.aulers + Speak witha professional tax adviser + See the CRS and FATCA FAQs and glossary-—ing.com.ou cE Existing customer Your ING client number: General information If you are new to ING or you nee to provide a new self-cetifcation, please complete the folowing: Residential address Given nome stret access (SESSA ae RT BRAVA PE SEAC PAT VAN PRAIR PARK Family name Subub TONER 2, 216 _ Coes | (COLopné = idle narete) state Country Pesta code tN NON ae ] MACE Potzof birth (Donen Postal address if diferent rom above) OS ],[25), 22°) Street adress (or PO 80x) Place of birth = Ton or ety af bith Sibu (AIT IAMS TOWN aes Country of ith ste County Festal code (AGSTRAL IR eee) ees zens) Employers Name AUSIEALAAN. cmp 1 ill Occupation STUDENT & Page of 0575, INGis business name ofING Bank Australi Limited | ABN 24 000893282 | AFSL ond Austraton Credit Licence 229828,art 2: Please declare your What's the difference? Source of Funds i where you generate funds or ongoingifrequent transfers of funds into your account, which aso determines your consistent source of income. Source of Weotth refers to the orgin of your wealth, in which where you generated your total net worth or total value ofall your cecount. For ‘more information on Source of Funds, please refer tothe Hyper For more information on Source of Wealth, please refer tothe Hyperlink Please only select ONE entry for Source of wealth and ONE entry for Source of funds, If multiple categories are applicable please choose the largest contributor or the most relevant cotegory to your ING accounts Source of wealth Source of funds solary’Woges Dbivdends or income from business OO Income from Business Fomiytrstinnertonce Oo Donation/Git Gront/Subsidy Insurance /Setiement proceeds Investment income LotteryGambing Pension/Secial benefits payments) Royeltes O00000 Sale of property or investments SpouselPortner Oo Divorce Settlement Other (please specify) [Livi ALLOWANCE FROM PARENT | x x 1s Australia your sole country of tox residence? ‘Are you a US. Person for tox purposes? In general your taxresidence is the county/uredction in which you AUS. Person generellyrcudes cizen or resident ofthe United States lve, however in some special cases, you canbe ataxresidentofmore of America than one county, [ves Eo ves [X]n0 You need to compete this Part f Australia isnot your sole country aftax residence or you ore @ US Person fo tax purposes. Otherwise, proceed to Pat 3, Pease complete the toble below indicating = each country of tax residency forthe account helder (other than Australia) + the account holder's TIN or equivalent, such as your Socal Security Number for each countryjurscction indicated. country 1 Note: ATINisolways required (unless inthe rae case the country does not issue TINS). Poge2 of 3/05/23, & Nee a business nome ofING Bank (Austral Limited | ABN 24 000655292 | AFSL on ustalion Cet Licence 225023,| understand thatthe information supplied by me is covered by the plicable Terms and Conditions governing the account holder's relationship With ING, Ths includes the relevant product terms and conditions and our Privacy Policy (avalabe at ing.cornay) which sets out how ING may collect, use and disclose the information supplied by me. | confirm that am the individual identied in Part 1 ofthis form, or am authorised to sign on thetr behalf | cert that where | have provided information on behalf of or regarding any other person (such os an Authorised Representative) that wil, within '30 days of signing this for, notify those persons that + Uhave provided the information toING, and =the information may be provided tothe ATO and later disclosed by the ATO to tox authorities of another country or counties in which the person may be tax resident pursuant ta intergoverrmental ogreerents to exchange financial account information. | declare that ll the statements made and information provided inthis form are tothe best of my knowledge end belie, corect and complete. | undertake to advise ING within 50 days of any change in circumstances which offects the foreign tax residency status ofthe indivduolidentiied in Port 1 of this form or causes the information provided inthis form to become incorrect, and to promptly provide ING with osutably updates self-certifcation. Fullname [FEAIA SHANNON TITIES Signature Dote (oom) TS },[0% |, 20d} Note: f you arent the indivgual specifed in Part 1 or you are completing this form for an Authorised Representative, please indicate the capacty in ‘whieh you'e signing the form (including the name of the Customer signing under authority, please aso attach supporting informatio. opacity Mobile phone EmailQuestionnaire ING SD ‘About this form In order meet our regulatory obligations we need to ask a few extra questions so that we can better understand your business. Question Please confirm if your current country of residence is China? If no, please advise what your current country of residence is. MacAU SAR, CHINA ‘Question2 What is the Date you have left Australia? ‘answer Ape 23% 2023, Question 3 What is the reason for residing overseas? Ifthe reason is due to work, what is your Occupation and Employer? devas! STUDYING aVERSEAS Question 4 What is the planned return date (If Any)? Arowr DECEMBER IS®, 20244 Question What s the reason for needing ING accounts? ‘Answer RECEIVING FUNDS FROM FAMILYCTM LITTLEY JESSICA SHANNON ESTRADA DE SEAC PAI VAN BL.2FL.21F PRAIA PARK COLOANE (68) RASRARAA Companhia de Telecomunicages de WAR Private & confidential Macau S.A.R.L. ‘Account No. 15653652.5 Deposit MOP 500.00 Issue Date: 71270172024 Payment Due Date 1102/2024 Total Amount Due: _ | MOP 0.00 Page 1/1 Reference: 129483283 Warm reminder that simply show your CTM bil /ebill at any 7-11 (Macau) / Circle K (Macau for bill payment enjoy $0 handling fee! The maximum amount is $5,000 per transaction. "RECOUNT SUMMARY Mabie No: 6807175 Transacon Date __Deserpion ‘Amount (MOP) Last Month Balance 100 coxov2024 Payment Received - Thankyou 429.00 2800 tator2024-11022024 569-Destnaions Unlined Plan 3 429.00 THIS IS A TRUE COPY OF THE “Pecnoset 428.00 ‘ Sion DOCUMENT PRESENTED TO. Remorsed Cone Beploye, ag Nisin Consulte-General Hong Aue Hasbess Centre, 25 Harbour Road Total Amount Due 0.00 DATED. = \\Wan Cl #852 i, Hong Kong 221-8881 (GTM Bonus Points Scheme @ ‘Available Bonus Points Used Bonus Points Expiry Date Total Mobile Points 6.394 8,000 ssioaizo24 Local Data Daily Usage Summary (Volume Base) Date. Usage(M6) Date [Usage(™6) Date [__Usage(iBy Date | _Usege(W) 71212023 206.13 | 20rtav2023 (0.00 ‘20/t212023 1,407.33 | 06/01/2024 415.72 13/1212023, 21es7 | 21/12/2023 0.00 2ort2i2023 898.77 | o6/0tr2024 1,000.85 say1212023 0428 | 2avta2023 0.00 s0rt2i2023 256.80 o7iovr2024 41,770.33 1s/1212023, 38032 ‘| 23/2/2023 0.00 3irt2r2023 452.37 osorr2024 2.793.78 16/12/2023, 1,263.56 | 24/2/2023, 333.31 ‘oworiz0z4 1,390,458 | oaor/e026 2,053.96 s7/1212023, 367.94 | 25/12/2023 639.24 | 02/01/2024 396.26 ovor2024 e11.99 1a/1212023, zorcos | 26r12/2023 696.06 | 0301/2024 332 tor2024 1,338.91 19/12/2023, 0.00 27/12/2023 47479 | oa/otizo24 73.00 Payment Advice LITTLEY JESSICA SHANNON ‘Account No.: 15653662-5 ‘Current Amount 7 Previous Amount - Payment Due Date Total Amount Due MOP ~428.00 ‘MOP 428.00 ‘MOP 0.00 o1vo2r2024\e VICTORIA AUSTRALIA [7 REGISTRATION NOMBER emer | mats. onermn av aan meng Ac pa | BIRTH CERTIFICATE acme surnane | LITTLEY siven Nane(s) | Jessica Shannon sex | Female oate of sirth | 15 September 2001 Place of sirth | Williamstown 2 MOTHER surnene | LITTLEY Maiden surnane | LYNCH | Given wanes) | Beverly Rosanne cecupation | Home Helper | ace | 39 years | Place of girth | Koilupitiva, Sri Lanka ) ee surnase | LITTLEY civen Nanecs) | Steven John | ozewetion | Supply Chain Manager ase | 41 years | Plece of sirth | London, England | 5 | AMRENIS Date of Marriage | 11 July 1998 Place of Marriage Parramatta, New South Wales ‘5 PREVIOUS CHILDREN OF RELATIONSHIP Shana Erin 2. years Owen James i2 months @ INFORMANTS) REGISTRY OF BIRTHS DEATHS AND MARRIAGES: ‘MELBOURNE none |B. LITTLEY adéress | 14 Alma Doepel Dr Altona Bay 3028 Mother S. LITTLEY 14 Alma Doepel Dr 4 Altona Bay 3028 Father 7 REGISTRATION OFFICER = fw mie THIS IS A TRUE COPY OF THB vote | 18 October 2001 DOCUMENT PRESENTED TO ME. & ENDORSEMENTS) z | oe DATED... ‘SIGNATURE... Bernadette Sinn ‘Asthorised Consular Employee “<2 ‘Australian Consulate-General Hong Retg 23/F Harbour Centre, 25 Harbour Road ‘Wan Chai, Hone Kong ‘7.#852 2827-8881 ‘THE BACK OF THIS DOCUMENT CONTAINS A HISTORY OF CHANGES OF NAME AND CORRECTIONS. Before acepting copes, sight unaltered original. The original has a coloured background Uereby cerfy that this a tue copy of pantculars recorded in a epister inthe State of Victoria, inthe Commonygalth of Australia, 16 Oct 2001 OoOur Ref: 353853 Melbourne CuINaNT SNIVINOD LNIN HISTORY CERTIFICAT! This certificate contains a history of changes of name registered at the Registry of Births, Deaths and Marriages since 31 October 1986 and corrections made since 26 June 2000 relating to the person named on the front of this certificate. saunuva4 ALlunoas in900 SIAL No changes of No corrections ‘name |. Jason Grave, Vice Consul ofthe Australian Consulate General, Guanganow, aving been duly authorised bythe ‘Secretary ofthe Department of Foreign Atfalis and Trade, OO HEREBY CERTIFY that the signature of Mr. Androw [Levens sppesring onthe document on the rverse hereto isthe tue signature of Mi, Andrew Levens, Register of Birthe,Desths and Mariages, Vitoria, Ino certifying, neither nor the Consulate General andor, very or make any statement as tothe accuracy, truth, logalty or otherwise of th contents ofthe dacument or the purposes for which the document may be used, Neither | nor the Consulate General acept laity for any loss, damage or injury arising out of the use of, o ellance on, the document or its contents. provide no undertaking that have read the contents of the document. (GIVEN under my hand and the seat of he Australian Consulate General, Gusngehou, this Twenty-eighth day of Jog sand and Ten, THIS IS A TRUE COPY OF THE DOCUMENT PRESENTED TO. Jason Grave DATED 9 JAN 2024-08" Wee Consul SIGNATURE Bemadette Sinn ‘Authorised Consular Employee ‘Australian Consulate-General Hong Kong 23/F Harbcur Centre, 25 Harbour Road ‘Wan Chai, Hong Kong 7.4852 2627-8881 REGISTRY OF BIRTHS hereby certify ha hie i rue copy of particulars recorded in a DEATHS AND MARRIAGES Register in the State of Vitoria, inthe Commonygalt of Austaia MELBOURNE 16 Oct 2001 Regisrar2010) SB FH 0001293 SEAT SC TLR PLEIN BD OBESE & A BG] SIA Be Ab OL at NG) FAYE SST BSE feo LES A1370980° 2010 SF 07 H.07 Fl THIS IS A TRUE COPY OF THB ‘Bernadette Sinn ‘Authorised Consular Employee ‘Australian Consulate-General Hong Kong i Centre, 25 Harbour Road, Wan Chai, Hong Koos ‘7.4852 2827-8881THIS 1S A TRUE COPY OP THR DOCUMENT PRESENTED TO MB.THIS IS ATRUE COPY OF THE DOCUMENT PRESENTED TO MB DATED .. SIGNATURE. “Bemadete Sinn ‘Authorised Consular Employee ‘Wan Chai, Hong Kong. 17. +852 2827-8881