Client Information Form

Thank you for your enquiry to Indue for payment services. As an authorised deposit taking institution regulated by the Australian Prudential Regulation Authority, Indue is required to ensure certain obligations are met in its dealings with clients. The information provided by you will help us to understand the nature of your enquiry and to make an initial assessment on our readiness to support your business requirements. Please complete as much as you are able to assist us in your enquiry.

Full name of Legal Entity ABN

Registered Business Address AFSL number (if applicable)

Key Management/Contacts (who can be contacted in relation to the information provided in this form)

Full Name Position

Email(Required)

Telephone(Required)

Please check boxes for the solutions you're interested in(Required)

Prepaid Card

Debit Card

Direct Entry

BPAY

NPP/PayTo

Financial Crimes

Other

Provide information that may assist us in determining your business requirements and your anticipated launch date/s?

Provide information on the forecasted number of transactions per annum Y1-3 for each of the products

Business Description

Is the entity a new or existing business? If existing business please provide details of how long the business has been in operation and the products/services currently offered

What is the target market / customer profile for the Indue Product(s)? For example will the product be marketed to Australian residents or is its primary market international citizens?

What is the proposed distribution method for the Indue Product(s)? Please explain how the products will purchased or applied for by customers (for example will they be purchased online, in-store with mail delivery, direct, white label or other third party distribution etc.).

Financial Information

How will the establishment of a program be funded?

If the entity is a new business please provide details of how growth and expenses will be funded over the next 24 months.