Customer Declaration

WEX Australia Pty Ltd, the issuer of WEX Accident Assist (“WEX”)

Customer declarations (please read this section carefully)

By submitting this application I declare that:

  • I am authorised to complete this application on behalf of the organisation, trust and/or partnership noted in the application as Customer (Applicant);
  • the information provided to WEX for the purpose of this application is true, correct and complete and I authorise WEX to verify that information including, where necessary, by verifying that information with third parties;
  • I understand that WEX relies on this information to consider this application;
  • the Applicant has read, understood and agrees to the WEX Accident Assist Terms and Conditions (including the Privacy Authorisations), available here: wexaustralia.com/wex-accident-assist/terms-and-conditions/;
  • I understand that by making this application (on behalf of the Applicant) I am providing WEX with personal
    information to enable WEX to assess this application. By submitting this application, I agree that WEX may
    use this personal information in accordance with the Privacy Authorisations set out in the WEX Accident
    Assist Terms and Conditions;
  • if this application is successful, I authorise WEX to open an account in the name of the Applicant and to provide the account to the Applicant on the WEX Terms and Conditions including any terms of payment;
  • the directors of the Applicant have never been declared bankrupt or assigned their estate for the benefit of
    creditors;
  • there are no outstanding judgements against any director of the Applicant which they are unable to satisfy;
  • the directors of the Applicant are not in arrears with any current creditor;
  • the Applicant is currently able to meet all of its financial commitments as and when they fall due;
  • I do not know of any other factors that have not already been disclosed to WEX which may impact the Applicant’s ability to meet its financial commitments over the next 12 months;
  • I acknowledge that, by signing this authority, using or attempting to use the Account I (on behalf of the
    Applicant) will be taken as having unconditionally accepted the WEX Accident Assist Terms and Conditions governing the Account.

Effective: 01 March 2019 | Version: 1

GPO Box 5342 Melbourne VIC 3001
WEX Australia Pty Ltd ABN 68 005 970 570