Application for Payment of a Benefit Form.

Transcription

1 What s this form for? You should use this form if you wish to withdraw all or part of your superannuation benefit and either, transfer it to another superannuation fund or receive the payment in cash. This form should not be used if you wish to apply for your funds to be released under the following grounds: For reasons of severe financial hardship* As a result of Total & Permanent Disablement, Death or Terminal Illness* Because your temporary Australian residency has expired (please apply directly online at This is a free service). * To receive a copy of this form, call our Customer Care Team on between 8am and 6pm, weekdays. A few tips for you. Use blue or black pen Print within the boxes in clear BLOCK LETTERS Faxed or ed copies are not valid Please use not Make sure you complete all relevant sections before sending us this application, otherwise we may not be able to process it Don t forget to include your autograph where required 1 YOUR VIRGIN SUPER DETAILS Member Number ABN: , SFN: , SPIN: TCS005AU 2 BENEFIT AMOUNT Full withdrawal Partial withdrawal $ (Please note that the minimum account balance of $1200 must be retained for partial withdrawals) My balance minus $1200 (This is the maximum partial withdrawal you can make from your Virgin Super account) I would like to transfer my benefit to another super fund (complete section 8) VITAL STATISTICS 3 * This section must be completed in full. Name First Last Address Unit Street No. Street Name Date of birth / / Age Gender Telephone Home ( ) Work ( ) Mobile Postal address 4 YOUR TAX FILE NUMBER Check out the Virgin Super Product Disclosure Statement (PDS) and Member Guide for details on why you should include it and how we are allowed to use it. TFN continued overleaf... VS0612 Payment Benefit Form Page 1

2 5 CONDITIONS OF RELEASE Not applicable for tansfers. Retirement I declare that I am between the ages of 55-59, I have retired from the workforce and to the best of my knowledge and belief will not be returning to work. Retirement I declare that I am between the ages of and have left gainful employment. Retirement Over 65 I declare that I have reached the age of 65. My benefit contains an unrestricted non-preserved amount and I wish to make a withdrawal of some or all of this amount. I wish to apply under specified compassionate grounds (see section 9). Under $200: I declare that I have left gainful employment and my super balance is less than $ PAYMENT METHOD Cheque (Please Note: Cheques may be sent to a postal address however you must provide a residential address for a benefit payment to be processed) Electronic Funds Transfer to bank account (complete section 7) (Please note: Payments by EFT cannot be made to joint bank accounts the account must be solely in your name) 7 BANK ACCOUNT Financial Institution Branch Account Name BSB Number Account Number Please note: If applying for funds to be rolled over to your Self Managed Super Fund (SMSF) and you require the payment to be electronically transferred to a bank account, a copy of the SMSF s bank account statement must be supplied (we cannot accept personal banking statements). Please also complete section 8 with the SMSF details. 8 NEW FUND DETAILS Please complete if you re rolling into another fund including a Self Managed Super Fund (SMSF). Fund Name Postal Address Membership Number Fund Phone Number ( ) ABN SPIN NOTE for transfers to Self Managed Superannuation Funds: Before processing a rollover to a SMSF, we are required to confirm with the Australian Taxation Office (ATO) that the fund to which the payment is being made to is registered as a complying superannuation fund. We will also confirm with the ATO that you are a member of the fund to which the payment is being made. You will be notified in writing if there are any issues with your transfer. Cheques will be issued to the address listed with the ATO. If you would like an alternative address to be used this must be updated with the ATO before payment can be made. If the fund has recently been registered with the ATO and the status is yet to be determined, in order to process your rollover request we will require you to provide one of the following certified documents: A certified copy of the SMSF s Trust Deed, or A certified copy of the SMSF s New Trustee Letter, or A certified copy of the SMSF s latest annual return lodged with the ATO Please note: If applying for funds to be rolled over to your SMSF and you require the payment to be electronically transferred to a bank account, a copy of the SMSF s bank account statement must be supplied (we cannot accept personal banking statements). Please also complete section 7, bank account details. Page 2

3 9 COMPASSIONATE GROUNDS If applying under specified compassionate grounds: This form can be used to arrange a payment from your Virgin Super account if Medicare, an agency of The Department of Human Services (DHS), has approved the early release of your benefit on specified compassionate grounds. DHS is responsible for assessing all requests for early release of benefits on specified compassionate grounds. Virgin Super is responsible for the payment of the benefit from the fund. The specified grounds for the early release of benefits and the relevant application form are available on the DHS website or by calling DHS on DHS will assess your application and write to you with their decision. If DHS approves the early release of your benefit, please send the following documents to Virgin: 1. DHS letter of approval of the early release of your benefits 2. This Benefit Application Form (completed) 3. Proof of your Identity (e.g. Driver s Licence, passport etc). Please see below for further information on acceptable identification documents and eligible certifiers. 10 MEMBERS FEEDBACK We re sorry to see you leave. Tick a box below to let us know why you re leaving - or tell us in your own words below. Changed employer/employer s default fund Transferring to SMSF Investment Options Financial Advisor Performance Fees Insurance Service Other Or let us know why in your own words YOUR DECLARATION Proof of ID Please attach a certified copy of proof of identification (e.g. Driver s Licence, passport etc). Please see below for further information on acceptable identification documents and eligible certifiers. Employer Contributions If you have employer contributions being paid into your Virgin Super account, you will need to notify them of the change. This is not the responsibility of Virgin Superannuation. Once you re account is closed, we cannot receive payments for your void account. Applicant declaration and information acknowledgement Please consider your superannuation decisions carefully. By signing this form, you are making the following statements: I have fully read this form and the information provided is true and correct; and I am aware that I may ask Virgin Super for any information about the effect of my benefits, and do not require any further information; and I discharge Virgin Super of all liability in respect of the benefits paid and transferred into my new super choice account; and I consent to the transfer of benefits as provided and authorise each fund to give effect to this transfer. Signature Date / / Name Please post completed form to: Customer Care Team Virgin Super, PO Box 1489 Wollongong NSW am 6pm (EST) Monday Friday if you need any help. Prepared by Virgin Money Financial Services Pty Ltd ABN , AFSL for The Trust Company (Superannuation) Limited ABN , AFSL , RSE L as Trustee for Virgin Super ABN Page 3

4 Identity documents that can be provided A certified copy of the following documents can be provided to satisfy the proof of identity requirements. EITHER One of the Group A documents below (only ONE document is required if a Group A document is provided): Group A documents a licence or permit issued under a law of a State or Territory or equivalent authority of a foreign country for the purpose of driving a vehicle that contains a photograph of the person in whose name the document is issued; a passport issued by the Commonwealth; a passport or a similar document issued for the purpose of international travel, that: contains a photograph and the signature of the person in whose name the document is issued; is issued by a foreign government, the United Nations or an agency of the United Nations; and if it is written in a language that is not understood by the person carrying out the verification is accompanied by an English translation prepared by an accredited translator. a card issued under a law of a State or Territory for the purpose of proving the person s age which contains a photograph of the person in whose name the document is issued. a national identity card issued for the purpose of identification, that: contains a photograph and the signature of the person in whose name the document is issued; is issued by a foreign government, the United Nations or an agency of the United Nations; and if it is written in a language that is not understood by the person carrying out the verification is accompanied by an English translation prepared by an accredited translator. Change of Name The name on the document is to be the same as the name currently recorded on your account. If the name on the document differs to that on your account, in addition to the above documents you will be required to submit a certified copy of one of the following documents to confirm the name change: Marriage Certificate Deed Poll Document Change of Name Certificate OR One document from the Group B AND one document from the Group C documents below (TWO documents in total are required): Group B documents birth certificate or birth extract issued by a State or Territory; citizenship certificate issued by the Commonwealth; citizenship certificate issued by a foreign government that, if it is written in a language that is not understood by the person carrying out the verification, is accompanied by an English translation prepared by an accredited translator; birth certificate issued by a foreign government, the United Nations or an agency of the United Nations that, if it is written in a language that is not understood by the person carrying out the verification, is accompanied by an English translation prepared by an accredited translator; pension card issued by Centrelink that entitles the person in whose name the card is issued, to financial benefits. Group C documents was issued to an individual by the Commonwealth, a State or Territory within the preceding twelve months; records the provision of financial benefits to the individual under a law of the Commonwealth, State or Territory (as the case may be); was issued to an individual by the Australian Taxation Office within the preceding 12 months; records a debt payable to or by the individual by or to (respectively) the Commonwealth under a Commonwealth law relating to taxation; was issued to an individual by a local government body or utilities provider within the preceding three months; records the provision of services by that local government body or utilities provider to that address or to that person. Page 4

5 Eligible persons who can certify a document What is a certified copy? Persons eligible to certify documents (see below) must sight the original document and the copy and make sure both documents are identical, then certify all pages as true copies by writing or stamping certified true copy followed by their signature, printed name, qualification (eg. Justice of the Peace, Australia Post employee, etc) and the date. Please note that certified documents remitted via facsimile are not acceptable. Chiropractor Dentist Legal practitioner Medical practitioner Nurse Optometrist Patent attorney Pharmacist Physiotherapist Psychologist Trade marks attorney Veterinary surgeon a person who is enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a legal practitioner (however described); Agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public Australian Consular Officer or Australian Diplomatic Officer (within the meaning of the Consular Fees Act 1955) Bailiff Bank officer with 5 or more continuous years of service Building society officer with 5 or more years of continuous service Chief executive officer of a Commonwealth court Clerk of a court Commissioner for Affidavits Commissioner for Declarations Credit union officer with 5 or more years of continuous service Employee of the Australian Trade Commission who is: (a) in a country or place outside Australia; and (b) authorised under paragraph 3(d) of the Consular Fees Act 1955; and (c) exercising his or her function in that place Employee of the Commonwealth who is: (a) in a country or place outside Australia; and (b) authorised under paragraph 3(c) of the Consular Fees Act 1955; and (c) exercising his or her function in that place Fellow of the National Tax Accountants Association Finance company officer with 5 or more years of continuous service Holder of a statutory office not specified in another item in this list Judge of a court Justice of the Peace Magistrate Marriage celebrant registered under Subdivision C of Division 1 of Part IV of the Marriage Act 1961 Master of a court Member of Chartered Secretaries Australia Member of Engineers Australia, other than at the grade of student Member of the Association of Taxation and Management Accountants Member of the Australian Defence Force who is: (a) an officer; or (b) a non-commissioned officer within the meaning of the Defence Force Discipline Act 1982 with 5 or more years of continuous service; or (c) a warrant officer within the meaning of that Act Member of the Institute of Chartered Accountants in Australia, the Australian Society of Certified Practising Accountants or the National Institute of Accountants Member of: (a) the Parliament of the Commonwealth; or (b) the Parliament of a State; or (c) a Territory legislature; or (d) a local government authority of a State or Territory Minister of religion registered under Subdivision A of Division 1 of Part IV of the Marriage Act 1961 Notary public Permanent employee of the Australian Postal Corporation with 5 or more years of continuous service who is employed in an office supplying postal services to the public Permanent employee of: (a) the Commonwealth or a Commonwealth authority; or (b) a State or Territory or a State or Territory authority; or (c) a local government authority; with 5 or more years of continuous service who is not specified in another item in this list Person before whom a statutory declaration may be made under the law of the State or Territory in which the declaration is made Police officer Registrar, or Deputy Registrar, of a court Senior Executive Service employee of: (a) the Commonwealth or a Commonwealth authority; or (b) a State or Territory or a State or Territory authority Sheriff Sheriff s officer Teacher employed on a full-time basis at a school or tertiary education institution Member of the Australian Institute of Mining and Metallurgy An officer with, or authorised representative of, a holder of an Australian financial services licence, having 2 or more years of continuous service with one or more licensees Prepared by Virgin Money Financial Services Pty Ltd ABN , AFSL for The Trust Company (Superannuation) Limited ABN , AFSL , RSE L as Trustee for Virgin Super ABN Page 5