BANK CONFIRMATION—AUDIT REQUEST
Instructions
Auditor
(a)	Complete all known details in the shaded areas of this form before forwarding to the bank, including all known account names and the corresponding BSB and account numbers.
(b)	If the space provided on the form is inadequate, attach a separate request giving full details of the information required.

Please delete this sentence and the above Auditor’s instructions on printing
Bank
(a)	Confirm that the details provided in the shaded areas are correct as at the confirmation date shown below, and highlight any variation/s.  Also add any relevant information that may have been omitted by the customer/auditor.
(b)	Complete the unshaded areas in sections 1-10.
(c)	Sign the completed form and return the original direct to the auditor, and a duplicate to the customer, in the stamped addressed envelopes provided.  A copy may be retained by the bank.  

Bank (Name & Address)

	<<Entity_Name>> 
<<Entity_Address>>

<<Auditor_Name>>
<<Auditor_Address>> 

Contact Name: <<Auditor_Name>>
Telephone Number: <<Auditor_Contact_No>>
Fax Number: <<Auditor_Fax_Number>>
Email Address: <<Auditor_Email>>	Confirmation Date 30/06/<<Audit_Year>>  	
	Authority to Disclose Information attached		Yes/No	
	Third Party Authority attached			Yes/No/ Not applicable	
Date of Audit Request : <<DD/MM/YYYY>>	Request for Acknowledgement attached 	Yes/No	

1. CREDIT ACCOUNT BALANCES
Provide details of all account balances in favour of the bank customer as at the confirmation date, in respect of current accounts, interest bearing deposits, foreign currency accounts, convertible certificates of deposit, money market deposits, cash management trusts and any other credit balances.  Provide details for the accounts listed below and for any other accounts not listed.
Provide details of any account or balance that is subject to any restriction(s) whatsoever and indicate the nature and extent of the restriction e.g. garnishee order.
Account Name	BSB Number	Account Number	Currency	Balance	
Auditor/customer to complete known details in shaded areas	<<Auditor’s comments>>	Bank to complete unshaded areas	

<<Auditor’s comments>>	<<Auditor’s comments>>		
<<Bank’s comments>>	
<<Bank’s comments>>	
Bank to provide information on other accounts not identified by auditor/customer	
<<Bank’s comments>>	

<<Bank’s comments>>	

<<Bank’s comments>>	

<<Bank’s comments>>	
<<Bank’s comments>>				
2.	
BALANCES OF ACCOUNTS (DEPOSIT& ADVANCES), SECURITIES HELD 

(a)	Please confirm details of all account balances as at the confirmation date. 

(b)	Include details of interest bearing deposits, foreign currency accounts, convertible certificates of deposit, money market deposits, etc.

Account	Account	Balance			Interest		Other	Maturity	Collateral	
Name	Number	DR/CR	Currency	Interest Rate	Accrued	Date Paid	Charges	Date	Lodged	
Auditor/customer to complete	Bank to complete unshaded areas							
<<Auditor’s comments>>		<<Auditor’s comments>>	<<Auditor’s comments>>	<<Auditor’s comments>>	<<Auditor’s comments>>	<<Auditor’s comments>>	<<Auditor’s comments>>	<<Auditor’s comments>>	<<Auditor’s comments>>	
Bank to provide information on other accounts not identified by auditor/customer							
<<Bank’s comments>>	<<Bank’s comments>>	<<Bank’s comments>>	<<Bank’s comments>>	<<Bank’s comments>>	<<Bank’s comments>>	<<Bank’s comments>>	<<Bank’s comments>>	<<Bank’s comments>>	<<Bank’s comments>>	

3. DEBIT ACCOUNT BALANCES
Provide details of all account balances owed to the bank by the bank customer as at the confirmation date, in respect of overdraft accounts, bank loans, term loans, credit cards and any other debit balances.  
Provide details of any account or balance that is subject to any restriction(s) whatsoever and indicate the nature and extent of the restriction, e.g. garnishee order.
Account Name	BSB Number	Account Number	Currency	Balance	
Auditor/customer to complete known details in shaded areas	
<<Auditor’s comments>>	Bank to complete unshaded areas	
<<Auditor’s comments>>	<<Auditor’s comments>>		<<Bank’s comments>>	<<Bank’s comments>>	
Bank to provide information on other accounts not identified by auditor/customer	<<Bank’s comments>>	<<Bank’s comments>>	<<Bank’s comments>>	
<<Bank’s comments>>	<<Bank’s comments>>				

4. ITEMS HELD AS SECURITY FOR CUSTOMER’S LIABILITIES TO THE BANK  (Bank to complete)
With respect to items held as security for customer’s liabilities to the bank indicate whether the security:
(a)	relates to particular borrowings or liabilities to the bank and whether it is lodged in the customer’s name or by a third party.  (If lodged by a third party, that party’s authority to disclose details must be attached).
(b)	is formally charged (provide details of date, ownership and type of charge);
(c)	supports facilities granted by the bank to the customer or to another party.  
(d)	is limited in amount or to a specific borrowing or, if to your knowledge, there is a prior, equal or subordinate charge;
Provide details of any arrangements for set-off of balances or compensating balances e.g., back to back loans.  Include details of date, type of document and account covered, any acknowledgement of set-off, whether given by specific letter of set-off or incorporated in some other document;
Provide details of any negative pledge arrangements that exist. 

Provide details here	

<<Auditor’s comments>>

 

5. ACCOUNTS OPENED/CLOSED (Bank to complete)
List details of any accounts opened or closed during the twelve months prior to confirmation date. 
Account Name	BSB Number	Account Number	Open or Closed?	Date opened/closed	

<<Bank’s comments>>
	<<Bank’s comments>>	<<Bank’s comments>>	<<Bank’s comments>>	<<Bank’s comments>>	

6. OTHER INFORMATION
Please confirm (see shaded area below) and/or provide any other details (unshaded area below) relating to any financial relationships not dealt with under sections 1-4 above.

Auditor/customer to complete known details in shaded area

<<Auditor’s comments>>
	
Bank to provide other information not identified by customer

<<Bank’s comments>>

7. BANK AUTHORISATION (Bank to complete)
This certificate has been completed from our records at  <<Bank’s comments                                                                       	(bank details).  The Bank and its staff are unable to warrant the correctness of that information and accordingly hereby disclaim all liability in respect of the same.  The information contained herein is confidential and provided for private use in confirmation of our customer accounts for audit purposes only.  It may not be used for any other purpose or by any other persons.  In particular this is not a credit reference.

AUTHORISED BY: 	Other authorisation details (where applicable)	

Signature:	
<<Bank’s Signature  >>		

Name (print name)  	
<<Bank’s comments>>		

Title  	
<<Bank’s comments>>		

Telephone Number	
<<Bank’s comments>>		

Email Address	
<<Bank’s comments>>		

Date Completed 	
<<Bank’s comments>>		

Trustees are to sign this authority and it is to be sent with the bank confirmation to the bank (Please delete this sentence on printing).

<<Insert Date>> 

The Manager
<<Name of Bank>>
<<Address of Bank							>>

Dear Sir/Madam,

<<SMSF_Name>>— Bank Confirmation Request and Authority to Disclose Information

I/We authorise you, <<Name of Bank>>			, including all branches and subsidiaries of the bank, to provide to our auditor <<Auditor_Name>>			, any information that the auditor may request from you regarding all and any of our accounts and dealings with you.

More specifically, it would be appreciated if you would complete and return, for audit purposes, the information requested in the attached form(s) within 7 days of receipt:

Bank Confirmation—Audit Request

Please mail the original of the completed form(s) direct to our auditor as named in the form(s) and the duplicate(s) to us in the stamped, addressed envelopes enclosed for this purpose.

Any charge for providing this information is to be debited to the following account: [insert account details]

Yours faithfully

<<Trustee1 Signature>>						<<Trustee2 Signature>>

<<Trustee1 Name>>							<<Trustee1 Name>>