FINANCIAL DISCLOSURE

Path Of Funds into Escrow

Please use this form to detail why the name shown on a payment into escrow differs from your GoEscrow account name. GoEscrow may additionally request supporting documents before clearing payments and any payment that cannot be accepted will be returned to the originating bank account. This form is presented by Globalclouds, a GoEscrow referral partner.

Form Number: GOE-POF-001

Publish Date: 17 July 2026

Are you completing this declaration as an Individual or for an ABN Entity?

Choose ABN Entity for a company, trust, sole trader, partnership or other ABN holder.

Individual ABN Entity

A. GoEscrow account

Enter your details as recorded on your GoEscrow individual account.

First Name *

Last Name *

Mobile

B. Funding Pathway

GoEscrow has received, or may receive, a payment from this account:

Incoming Account Name *

Incoming BSB (optional)

Incoming Bank Account (optional)

C. Account Relationship

Please tell us how this bank account is related to you.

Maiden, married or former legal nameJoint accountSpouse or family member accountHousehold member accountEmployer, workplace or business colleague accountSole trader or trading nameRelated companyDirector or shareholder personal accountTrust or trustee accountLawyer, accountant, settlement agent or other intermediarySettlement or conveyancing service accountMarketplace or payment providerSuperannuation accountCommercial refundOther

Please explain how this incoming bank account is related to you or your organisation.

D. Supporting documents

Supporting documents are optional. GoEscrow may ask you to provide documents that help confirm the relationship between you and the incoming bank account. Uploading relevant documents now may help expedite the review process. Examples include: marriage certificate; change of name certificate; joint bank account statement.

Supporting document 1 (optional)

Accepted file types: PDF, Word, JPG and PNG. You may add up to eight documents. Uploads are not required to submit this declaration.

E. Declaration

This form is presented by Globalclouds, a GoEscrow referral partner. The escrow payment service is provided and administered by GoEscrow Pty Ltd. Information submitted through this form is provided directly to GoEscrow, with a summary of the submission also provided to Globalclouds. Globalclouds does not provide the escrow service, hold or control escrow funds, bind GoEscrow, or determine transaction, settlement, refund or dispute outcomes.

I declare that the information provided is true, accurate and complete to the best of my knowledge. I understand that GoEscrow Pty Ltd may request additional information or supporting documentation where required for operational, compliance or risk review purposes. I have read, understood and agree to the Terms Of Use and have read and understood the Product Disclosure Statement and Financial Services Guide.

First Name *

Last Name *

I confirm I am the declarant. Digital signature acknowledgement.

A. ABN account

Enter the ABN and representative contact details recorded with GoEscrow.

ABN *

ABR organisation name

Representative email

Representative mobile

Enter at least one registered contact detail for the representative acting for this ABN account.

For ABN accounts, the ABR legal name and registered business names should already be recognised as expected names. You do not need to declare names GoEscrow already holds from ABR unless the incoming bank information formats them differently.

B. Funding Pathway

GoEscrow has received, or may receive, a payment from this account:

Incoming Account Name *

Incoming BSB (optional)

Incoming Bank Account (optional)

C. Account Relationship

Please tell us how this bank account is related to you.

Please explain how this incoming bank account is related to you or your organisation.

D. Supporting documents

Supporting document 1 (optional)

Accepted file types: PDF, Word, JPG and PNG. You may add up to eight documents. Uploads are not required to submit this declaration.

E. Declaration

Declared on behalf of:

Organisation Name

ABN

By:

First Name *

Last Name *

I confirm I am the declarant. Digital signature acknowledgement.