Customer Customer Due Diligence ID form

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07 5524 3655
4 Minjungbal Dr, Tweed Heads South

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Please fill out the form below for customer due diligence ID

Please remember to upload a photo of the customers ID

Gaming customer ID verification (CDD) form advanced

"*" indicates required fields

Step 1 of 11

Please notify a supervior and let them know you are completing this form

Time

Hours

Minutes

Date*

DD slash MM slash YYYY

Staff Member Name who is lodging the form:*

Transaction context (reason for CDD)*

Gaming machine winnings over $5000 threshold

Multiple gaming winnings just under threshold / structuring

TAB

Keno

Unusual behaviour

Multiple transactions

Machine hopping

Minimal play before cashing out

Third party involvment / smurfing

Staff concern

Other

If other give more details

If unusual behaviour please give details

Transaction amount

$5,000-$9,999

$10,000 +

Other

Exact transaction amount

Is the customer a politicaly exposed person (PEP)? Are they a politician or business leader in the community. (see risk matrix)

No (answer will be mostly no)

Yes

Unsure

Is the customer acting suspicious or behaving in an unusal manner

Yes

Unsure

Customer risk rating (see risk matrix)

Low (known customer either a member or visitor who has signed in)

Med (limited history - visitor who cannot produce sign in slip)

High (unknown/suspicious behaviour)

Please contact a supervisor immediatley for enhanced customer due dilegence and/or a SMR (continue with the rest of the form - NEXT)

Please contact a supervisor as a Transaction Threshold Report may need to be completed as well as this CDD form - continue with this form - NEXT

Customer Details

Is the customer a member?*

Customer name*

ID type...*

Drivers Licence

Australian Passport

International Passport

Pension card

Other (not membership card)

Other details*

Drivers licence state of issue

Document number

Expiry date

DD slash MM slash YYYY

Member number*

Customer name*

First Last

Does the visitor have a sign in slip? (do you have access to the sign in slip ID number)*

Customer ID details

ID type..*

Drivers Licence

Australian Passport

International Passport

Pension card

Other

Other details*

Drivers licence state of issue

Document number*

Expiry date

DD slash MM slash YYYY

Please record either a phone number or an email

Phone Number

Detailed ID details

Date of birth

DD slash MM slash YYYY

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Ocupation

Customer verification

Primary ID*

Drivers licence

Australian passport

International passport

Pension card

Other

Other details*

Document Number*

Drivers licence state of issue

Expiry Date

DD slash MM slash YYYY

Please take a photo of the ID

Drop files here or

Max. file size: 2 MB.

Secondary ID if required

Credit card

Utility bill

Rates notice

Phone bill

Other

if other please describe

Secondary ID reference number

If unable to ID the customer please give a detailed description of them

Staff verification

Verification*

I confirm the ID documents sighted are original and valid

Details match the customer present

Any discrepancies have been escalated (leave blank if no discrepancies)

Verified by*

First Last

Submit the form

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07 5524 3655

4 Minjungbal Dr, Tweed Heads South

Mon: 9:30 AM - 10:00 PM
Tue: 9:30 AM - Midnight
Wed: 9:30 AM - Midnight
Thur: 9:30 AM - Midnight
Fri: 9:30 AM - Midnight
Sat: 10 AM - Midnight
Sun: 10 AM - 10:00 PM

Opening and closing times may vary on public holidays

South Tweed Sports

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Home Page
Bar & Dining
- Restaurant
- The Cafe
What’s On
- Entertainment
- What’s On
Sports
- Bowls
- Sports
- Game On
Functions
Membership
- Membership Sign Up
- Membership Renewal
Our Club
Courtesy Bus
- Courtesy Bus

07 5524 3655
4 Minjungbal Dr, Tweed Heads South

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