Client Consent to Electronic Identity Check

Basic Details
*All fields are mandatory
Given/First Name*
Middle Name*
Family Name/Surname*
Date of Birth
Day*
Month*
Year*
Address
Number and Street*
Suburb*
City/Town*
Post Code*
Document Details
Ensure all names and spelling are exactly per the documents to be checked. For passport, birth certificates and NZ Citizenship Certificate checks, you must include middle names.
Tick the checkbox for any documents to be checked in this section. PLEASE NOTE: Only ONE form of ID is required.*
- NZ Driving License
- NZ Passport
- NZ Birth Certificate
- NZ Citizenship Certificate
- Australian Driving License
- Australian Passport
NZ License Number*
NZ License Version*
NZ Passport Number*
NZ Passport Expiry DD/MM/YYYY*
DD slash MM slash YYYY
NZ Birth Certificate Registration Number*
NZ Citizenship Certificate Number*
NZ Citizenship - Country of Birth*

Must match the details shown on certificate.
Australian Driving License - State of Issue*
Australian Driving License Number*
Australian Passport Number*
Australian Passport Gender*
Vehicle Registration
*This section is optional.
Vehicle Registration Number
PEP and Sanctions
*This section is optional but will improve the accuracy of the search.
Country of Residency
Country of Citizenship
Whitelist
Consent
*This section is mandatory.
I (name as below) confirm that I am authorised to provide the personal details presented and I consent to my information being passed to and checked with the document issuer, official record holder and authorised third parties for the purpose of verifying my identity and address.
Full Name*
Todays Date DD/MM/YYY*
DD slash MM slash YYYY
Signature*
CAPTCHA
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