GoEscrow Forms

Financial Disclosure

Source of Funds and Wealth

This form helps GoEscrow understand the general sources of funds and wealth that may support your escrow payments. GoEscrow may reference this information to meet licensing and regulatory obligations required by government.

Form Number: GOE-SOF-001

Publish Date: 1st Feb 2026

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

If you are completing this for a company, trust, sole trader, partnership or other ABN holder, choose ABN Entity.

Individual ABN Entity

A. Your details

First Name *

Last Name *

Mobile

B. Expected GoEscrow use

What types of transactions do you expect to use GoEscrow for?

Used Goods Registered Vehicle Resale Machinery/equipment Tradie Style Services Renovation/building Projects Major Construction Professional services Business sale Marine/aviation Domain/digital asset Intellectual Property Transfer High-value goods Executed Contract Facility Warranty and Guarantee Leins Property Sale Deposits Property Liens Replacement of Lawyer Trust Functions Other

Please specify other

Typical transaction value range

C. Source of Funds

Where are the funds you expect to use with GoEscrow generally expected to come from?

Select where the money generally expected to be used with GoEscrow comes from, such as wages, savings, business income, asset sales or finance.

Salary / wages Personal savings Business income Sale of property Sale of vehicle, goods, equipment or other asset Sale of shares or investments Loan or finance Gift from family or another person Inheritance Superannuation / pension Insurance payout Legal settlement Digital asset / cryptocurrency sale Overseas transfer Cash savings or cash deposit Other

Please specify other

Will any third party provide funds?

Select Yes if third parties other than the GoEscrow account holder or named transaction parties may make direct payments into the escrow transaction accounts on your behalf.

What is the third party’s relationship to you or the entity?

Please briefly describe the relationship

Are any funds expected to come from outside Australia?

Select Yes or Unsure if any money may come from outside Australia. This helps GoEscrow understand whether escrow payments may have an overseas source.

Please list potential countries

List any countries where funds may originate from, be held, or be transferred through before reaching GoEscrow. Approximate countries are acceptable if not yet final. Do not enter bank account numbers or sensitive login details.

Are any funds expected to come from cash deposits or digital assets / cryptocurrency?

Select Yes or Unsure if the funds may originate from cash deposits, digital assets or cryptocurrency. This helps describe the type of funds that may be used with GoEscrow.

D. Source of Wealth

How have you mainly accumulated your overall wealth or financial position?

Select how you have generally built your overall wealth or financial position over time.

Employment income Business ownership Property ownership or property sales Investment income or investment growth Inheritance or family wealth Superannuation Professional practice income Farming / agricultural income Other

Please specify other

Approximate annual income band

E. Other declarations

Are you acting for another person or entity?

Select Yes if you are completing this information for, or acting on instructions from, another person or entity.

Any bankruptcy, insolvency, freezing order or similar restriction?

Select Yes or Unsure if there is any bankruptcy, insolvency, freezing order, court order or similar restriction that may affect funds or authority to transact.

Are you a wholesale client or sophisticated investor?

In Australia, some people may be treated as wholesale clients or sophisticated investors if they hold a current certificate from a qualified accountant confirming they meet certain income or asset thresholds.

Anything unusual about the source of funds or wealth GoEscrow should know?

Use this optional field for anything GoEscrow should know about the source of funds or wealth that may not be obvious from the answers above.

F. Declaration

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. Entity details

ABN *

ABR organisation name

Representative email

Representative mobile

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

B. Expected GoEscrow use

What types of transactions do you expect to use GoEscrow for?

Please specify other

Typical transaction value range

C. Source of Funds

Where are the funds you expect to use with GoEscrow generally expected to come from?

Select where the entity generally expects the money used in GoEscrow transactions to come from, such as trading revenue, retained earnings, finance or capital contributions.

Trading revenue Business savings / retained earnings Sale of business asset Customer or client receipts Loan or finance facility Director or shareholder loan Investor capital Related entity transfer Trust distribution Government grant or funding Insurance or legal settlement Overseas related-party transfer Cash deposits Digital asset / cryptocurrency sale Other

Please specify other

Will any third party provide funds?

Select Yes if third parties other than the GoEscrow account holder or named transaction parties may make direct payments into the escrow transaction accounts on your behalf.

What is the third party’s relationship to you or the entity?

Please briefly describe the relationship

Are any funds expected to come from outside Australia?

Select Yes or Unsure if any money may come from outside Australia. This helps GoEscrow understand whether escrow payments may have an overseas source.

Please list potential countries

Are any funds expected to come from cash deposits or digital assets / cryptocurrency?

Select Yes or Unsure if the funds may originate from cash deposits, digital assets or cryptocurrency. This helps describe the type of funds that may be used with GoEscrow.

D. Source of Wealth

How has the entity generally built its financial position or business capital?

Select how the entity has generally built its financial position or business capital over time.

Trading profits Capital contributions Asset ownership or asset sales Investment income Loans / finance Related entity support Trust distributions Other

Please specify other

Approximate annual turnover band

E. Other declarations

Are you acting for another person or entity?

Select Yes if you are completing this information for, or acting on instructions from, another person or entity.

Any bankruptcy, insolvency, freezing order or similar restriction?

Select Yes or Unsure if there is any bankruptcy, insolvency, freezing order, court order or similar restriction that may affect funds or authority to transact.

Anything unusual about the source of funds or wealth GoEscrow should know?

Use this optional field for anything GoEscrow should know about the source of funds or wealth that may not be obvious from the answers above.

F. Declaration

Declared on behalf of:

Organisation Name

ABN

By:

First Name *

Last Name *

I confirm I am the declarant. Digital signature acknowledgement.