AMP KiwiSaver Scheme Permanent emigration to Australia Transfer application form

Transcription

1 AMP KiwiSaver Scheme Permanent emigration to Australia Transfer application form Please send this completed form and supporting documents to: AMP KiwiSaver Scheme Freepost 170, PO Box 55 Shortland Street, Auckland 1140 Please call us on or if you have any queries. Use this form to apply for a transfer of your KiwiSaver savings for the reason of permanent emigration to Australia. Under the KiwiSaver Scheme rules, you can apply to transfer your savings from the AMP KiwiSaver Scheme to an Australian complying superannuation fund. Important note: You will be eligible to transfer your KiwiSaver savings if you have left New Zealand to live permanently in Australia and the Australian complying superannuation fund you are applying to transfer to is approved to accept your transfer. Steps you need to complete: 1. Complete your details in sections (a) (d) and (e). Please note: we can t process your withdrawal if you haven t verified your identity, so please make sure you complete sections (f) and (g). 2. Please send this application and supporting documentation to your Australian complying superannuation fund provider. 3. Ask your Australian complying superannuation fund provider to complete sections (b) and (c). They will then need to send the form and your supporting documents back to us by , post or fax to the address above. The decision to transfer your KiwiSaver savings to an Australian complying superannuation fund is an important decision and we recommend you obtain financial advice. This form can be completed on-screen by typing content directly into the PDF document. Please use block letters if you re not completing this form online. Once you have completed and signed this form please send it and any supporting documents to the address above. *These fields must be completed (a) Your personal details *Member number K Title: Mr Mrs Ms Miss Dr Other *First names *Date of birth *Surname *IRD number * *Residential address Postcode *Postal address Postcode *Please provide at least one contact number Home phone Work phone Mobile phone ( ) ( ) ( ) *PIE tax rate % 17.5% 28% Australian superannuation fund membership number We deduct PIE tax from your withdrawal using the information we have at the time your withdrawal is paid. If you re unsure of your PIE tax rate, please go to for help or contact your Adviser or Inland Revenue. If you are a non-resident for NZ tax purposes the 28% PIE tax rate should be used. *Australian Tax File Number (TFN) 1 Also referred to as a Prescribed Investor Rate (PIR). 1 of 5

2 (b) Australian complying superannuation fund details - provider to complete *Australian complying superannuation fund name Superannuation Product Identification Number (SPIN) *Postal address *Phone number ( ) Australian Business Number (ABN) The fund is an Australian complying superannuation fund regulated by the Australian Prudential Regulation Authority (APRA) and can accept New Zealand-sourced retirement savings from a KiwiSaver scheme. Yes No (c) Payment instructions - provider to complete For the purposes of transferring AMP KiwiSaver Scheme savings, please tell us the Australian complying superannuation fund bank account details. Your Australian provider will also need to confirm in writing on their letterhead that they can accept funds from the AMP KiwiSaver Scheme and their banking details. *Bank name *Account name *Account number *Swift code (d) Evidence of permanent emigration *Date of departure from New Zealand: *The following documentation is required before your request can be assessed: (Please check you have enclosed evidence of the following (if appropriate), then tick the relevant boxes to confirm) Evidence of your permanent residence at an Australian address, for example: - a copy of a property sale and purchase agreement; or - tenancy/leasing agreement for an Australian property; or - a recent electricity or rates bill. Evidence of your departure from New Zealand, for example: - evidence of confirmed travel arrangements; or - copy of your passport page showing arrival stamp; or - international movements record or evidence of any necessary visas; or - evidence of Australian employment, i.e. a copy of a contract or letter from your Australian employer; or - evidence of your Australian tax status issued by the relevant Australian tax authority. If you re unsure about whether your evidence will be satisfactory, us at kiwisaver@amp.co.nz and we ll confirm for you. (e) Statutory declaration I FULL NAME OCCUPATION of CITY OF RESIDENCE solemnly and sincerely declare that all the information provided in or with this application is true and correct and that: - I have permanently emigrated from New Zealand to Australia and request my AMP KiwiSaver Scheme balance be transferred to the account in section (c). - I have been a member of a KiwiSaver scheme and my principal place of residence was New Zealand for the period(s): From To From To From To - I understand that any information I give to AMP or the Supervisor of the AMP KiwiSaver Scheme may be passed on to my chosen Australian complying superannuation fund provider as reasonably required and I authorise AMP to give such information in relation to this transfer as requested by my chosen Australian complying superannuation fund provider. - All the information I have supplied in this application (and any attachments to this application) is true and correct. - I understand that acceptance of this application is at the discretion of AMP, that fees may be charged by my Australian complying superannuation fund provider to process the transfer, and that telegraphic transfer fees will apply. 2 of 5

3 - I acknowledge that the Privacy Act 1993 provides me with the right to request access to and/or correction of any of my personal information held by AMP (AMP in this context includes all members of the AMP Group of Companies and their subsidiaries, associated companies and agents) or the Supervisor of the AMP KiwiSaver Scheme. I understand that the information supplied by me with this application will be used to process this application and to administer my membership of the AMP KiwiSaver Scheme (and may be disclosed for these purposes to third parties where relevant, including the Inland Revenue, my Adviser, my employer s Adviser, my Australian complying superannuation fund provider or other intermediary or distributor). I authorise AMP and/or the Supervisor to obtain additional information in relation to this application from any third party/entity. - I acknowledge that there may be tax consequences when transferring my AMP KiwiSaver Scheme savings to an Australian complying superannuation fund, and that I am liable for any such tax consequences. - I understand that any annual Member Tax Credit contribution entitlement I have received during my membership period whilst residing outside of New Zealand will be deducted from my withdrawal amount and returned to Inland Revenue. - I understand that my AMP KiwiSaver Scheme account will be closed upon my AMP KiwiSaver Scheme savings being transferred to my chosen Australian complying superannuation fund. - I understand that following a transfer of my AMP KiwiSaver Scheme savings to an Australian complying superannuation fund, I will not be able to transfer them to a third country. - I understand my chosen Australian complying superannuation fund provider may request additional information to support this application. - I indemnify the Supervisor of the AMP KiwiSaver Scheme, AMP, and any of their related companies against all claims, actions, demands, proceedings, costs or expenses, damages or liability arising and discharge them from any liability in respect of my membership of the AMP KiwiSaver Scheme and/ or any transfer made to an Australian complying superannuation fund. - I understand that the New Zealand-sourced KiwiSaver savings in my Australian superannuation fund will not generally be able to be accessed until I reach the age of eligibility for New Zealand Superannuation (currently age 65). - I understand that once my AMP KiwiSaver Scheme savings has been transferred to Australia, it will become (with a few exceptions) subject to the rules and regulation governing the Australian complying superannuation fund. - I understand that AMP has recommended I obtain financial advice before requesting this transfer. AND I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act *Declared at PLACE *this (date) *Member s signature Before me: (Signature, name, occupation and address of the person in front of whom the declaration is made. We have provided a list of people below who can make this statutory declaration in Australia). *Full name, title/office of person taking declaration of city (where signing) *Occupation *Signature of person authorised to take declaration *Date OFFICIAL MARK People authorised to take a statutory declaration in Australia Below is a list of people who are authorised to take a statutory declaration in Australia. Australia All of Australia Also, if in the Northern Territory Judge Commissioner for Oaths (by personal appointment) Notary Public Member of the Legislative Assembly Justice of the Peace Member of House of the Parliament of the Commonwealth elected to represent the Territory or a constituency in the Territory Solicitor of the High Court of New Zealand Member of the Police Force who has attained the age of 18 years Australian legal practitioner Also, if in South Australia Court clerk or registrar who certifies his or her authority to take an oath Commissioner for Affidavits for a judicial proceeding Commonwealth Representative Also, if in Western Australia Also, if in Queensland Commissioner for Affidavits Commissioner for Declarations A mining registrar appointed under the Mining Act 1978 Conveyancer Also, if in Victoria Australian police are not authorised to take this statutory declaration, Pharmacist unless you are in the Northern Territory 3 of 5

4 (f) Provide your identification to verify your identity and address Please complete option 1 in the table below and attach copies of the requested document (please tick which document you are providing). If you cannot provide a document from option 1, then complete option 2 or 3. If you are under 18 years of age, your parent/s or guardian should complete a separate Acting on behalf of identity verification form. This form can be found on amp.co.nz within the documents and downloads section, or you can request a copy of this form by ing kiwisaver@amp.co.nz or calling or Option 1: ONE document from this section NZ passport (Identity page) Overseas passport (Identity page) and Proof of NZ residency NZ firearms licence NZ certificate of Identity If you have provided an overseas passport, please provide proof of NZ residency (e.g. copy of NZ passport or copy of residency visa/ stamp on your passport) Option 2: NZ Driver s Licence PLUS (ONE of the documents from this section) Super Gold card NZ citizenship certificate/citizenship certificate issued by foreign government NZ full birth certificate/birth certificate issued by foreign government Bank statement or Inland Revenue statement issued in your name in the last 6 months Option 3: 18+ identity card PLUS (ONE of the documents from this section) NZ full birth certificate/birth certificate issued by foreign government NZ citizenship certificate/citizenship certificate issued by foreign government IMPORTANT: If you are providing previously certified identity documents, please ensure the documents have been certified not more than 3 months prior. Please attach only the certified photocopies of the original documents to this application. Proof of address As well as providing your identity documents you must also supply proof of your address. Tick one document option from this section. The document you supply needs to be addressed to you at the residential address detailed in section (a) and dated within the last 6 months. Letter or invoice from utility company Bank statement Letter from government agency (e.g. Inland Revenue, rates bill) (g) Certify or verify your identity and address documents Your identity and address documents can be certified by a trusted referee (use the first box below), or verified by an Adviser/AMP employee acting as agent of AMP (use the second box below). DECLARATION BY TRUSTED REFEREE I, FULL NAME OF TRUSTED REFEREE/AMP EMPLOYEE confirm that 1. I have sighted today the original of each document identified with a tick in section (f) above verifying the identity and address of the person named in section (a) of this form, and attached to this statement are true copies of those documents initialled and dated by me. 2. The documents that have been provided represent the identity of the person named in section (a) of this form. 3. I am a (tick one of the following) New Zealand Lawyer Justice of the Peace Notary Public Registered Medical Doctor Chartered Accountant Police Constable Registered Teacher Kaumãtua Member of Parliament Minister of Religion Commonwealth Representative NZ Honorary Consul 4. I am not related to and do not live at the same address as the person named in section (a) of this form. Signature of trusted referee Dated OR DECLARATION BY ADVISER/AMP EMPLOYEE (AS AGENT OF AMP) I, FULL NAME OF ADVISER/AMP EMPLOYEE ADVISER CODE (if applicable) confirm that 1. I have sighted today the original of each document identified with a tick in section (f) above verifying the identity and address of the person named in section (a) of this form, and attached to this statement, are true copies of those documents initialled and dated by me. 2. I have no reason to believe that this person is not who he/she claims to be. 3. AMP has authorised me to be its agent to conduct customer due diligence procedures and obtain any information required for customer due diligence under the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 and I acknowledge that AMP is relying on me to perform those functions for it. Signature of Adviser Dated 4 of 5

5 (h) Checklist and next steps *Checklist Please check you have completed the form correctly Have you completed all fields with an *? Have you attached copies of the supporting evidence as detailed in section (d)? Have you completed the statutory declaration in section (e)? Have you verified your identity and attached copies of the supporting evidence as detailed in section (f) (if you have not already done this when you joined the AMP KiwiSaver Scheme)? Have you attached a letter from your Australian provider confirming they will accept KiwiSaver funds and their bank account details? Next steps: If the request is approved we ll process your withdrawal request within 8 working days. We ll process your withdrawal at the unit prices effective on the day of your withdrawal. We ll direct credit the bank account for your chosen Australian complying superannuation fund and send you confirmation of the payment made. If your request is not approved we will advise you. It s important that ALL supporting documentation is provided with this application. Failing to do so will delay the application process or could result in your application being declined. We will contact you if we require further information. (i) For Adviser use only AMP Adviser name (if applicable) B L O C K L E T T E R S AMP Adviser number FSPN (please use your QFE s FSPN if you are a QFE Adviser) I confirm that I am a: AFA (entitled to sell Category 1 Product) AMP QFE Category 1 Adviser Other And I certify that the information provided in this Adviser use only section is correct and that I have complied with the requirements of the Financial Advisers Act 2008 and all other applicable laws. Signature of Adviser Date WEL (03/16) 5 of 5