Application for an RBF Account Based Pension

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1 Pension RBF Tasmanian Accumulation Scheme Application for an RBF Account Based Pension About this form Complete this form to advise: your personal details how much you d like to invest which Member Investment Choice options you d like your money invested in your pension amount your payment frequency who you d prefer to receive your pension if you die while you re a member of RBF NOTE: If you are using funds held in another RBF account to purchase your RBF Account Based Pension you will also need to complete the relevant Payment instructions form for your scheme. The form is available by contacting the RBF Enquiry Line on or from the RBF website at If this form is not completed in full, a further written election may be required. We cannot commence your pension based on verbal instructions. This may delay the commencement of your pension. If you re unsure of your decisions, we recommend that you consult a licensed financial advisor. Please sign and return your completed form to RBF. If you need help For assistance call the RBF Enquiry Line on Step 1 Complete your personal details Please print in black or blue pen, in uppercase, one character per box. A Title Mr Mrs Ms Miss Other Date of birth / / Given names Surname Residential address (must be provided) Suburb State Postcode Postal address (if different to above) Suburb State Postcode Daytime telephone Mobile - After hours telephone - Please tick the box if you require a Centrelink Schedule to be sent to you Issued by Retirement Benefits Fund Board ABN as Trustee for Retirement Benefits Fund (RBF) ABN *SA DI1*

2 Step 2 Nominate the type of RBF Account Based Pension RBF Account Based Pension Reversionary (see note) Non-reversionary RBF Transition to Retirement Account Based Pension (restrictions apply) Reversionary (see note) Non-reversionary NOTE: Before your pension starts, you can nominate your surviving spouse as a reversionary beneficiary. This means that if you die with money in your account, your surviving spouse will continue to receive your pension (or have the option of cashing out your account as a lump sum), as long as he or she is your surviving spouse at the time of your death. You cannot change your reversionary beneficiary once your pension starts. If you wish to nominate a reversionary beneficiary please provide details below. Surname Given names Date of birth / / Step 3 Complete your preservation status (not applicable for RBF Transition to Retirement Account Based Pension) Your benefit may be subject to preservation. If the preservation portion of your benefit is over $200, legislation requires that this amount be retained in an approved superannuation fund until: You are at least 65 years of age or over; OR You are at least 60 years of age and have ceased employment since attaining age 60; OR You have reached your preservation age *, have ceased employment and have permanently retired # from the workforce. * Your preservation age depends on your date of birth see the table below: Date of birth Preservation age Before 1 July July 1960 to 30 June July 1961 to 30 June July 1962 to 30 June July 1963 to 30 June July 1964 or after 60 # Permanently retired is defined as never being gainfully employed again for more than 10 hours per week. Gainful employment means employed or self-employed for gain or reward in any business, trade, profession, calling, occupation or employment. If you are eligible, please complete one of the following declarations and attach proof of age to allow your benefit payment to be processed e.g. photocopy of your driver s licence, passport or birth certificate). Yes, I have reached preservation age, ceased employment and permanently retired from the workforce. Yes, I am at least 60 years of age and I have ceased employment since attaining age 60. Yes, I am at least 65 years of age. Step 4 Confirm your initial investment I wish to invest the following amount(s): Amount to be invested 1. Transfer from an existing RBF account $,,. 2. Transfer from another superannuation fund* $,,. (Approximate amount) *Complete the RBF Tasmanian Accumulation Scheme Rollover form to action this request. Total initial investment $,,. Note: Your pension will not commence until all of your listed transfers have been received. *SA DI2*

3 Step 5 Choose your Member Investment Choice (MIC) options for your pension account balance You can choose to invest in one or more MIC options. RBF will not be able to implement your choice if you provide percentages with decimal places or if your percentages do not equal 100. Diversified options: RBF Growth RBF Balanced (Default) RBF Socially Responsible Investments RBF Moderate RBF Conservative Asset class options: RBF Australian Shares RBF International Shares RBF Property RBF Fixed Interest RBF Cash Percentage to be invested Total (must equal 100) Step 6 Choose your MIC options for your pension payments You can choose either Option 1 or Option 2, but not both. If you do not complete this section of the form, each pension payment will be drawn proportionately from each of your investment options. Option 1: Nominated percentage () drawdown You can choose to have your pension payments made from one or more of the MIC options you have chosen above for your account balance. For example, if your account is invested 80 RBF Growth and 20 RBF Socially Responsible Investments, you could choose to have 100 of your payments made from the RBF Socially Responsible Investments option only. Once there s no longer enough money in your chosen MIC option(s), payments will automatically be deducted from the remaining MIC options in which your account balance is invested. You ll be notified at the time, and can adjust your investment choice if desired. Diversified options: RBF Growth RBF Balanced (Default) RBF Socially Responsible Investments RBF Moderate RBF Conservative Asset Class options: RBF Australian Shares RBF International Shares RBF Property RBF Fixed Interest RBF Cash Drawdown percentage Total (must equal 100) Continued over *SA DI3*

4 Step 6 Choose your MIC options for your pension payments (continued) Option 2: Priority drawdown You can choose to change the MIC options from which each pension payment is drawn by electing a drawdown order. Pension payments will only be drawn from one MIC option at a time. RBF will draw from your first nominated MIC option until this is depleted continuing down your nominated drawdown order. For example, if your account balance is invested in 50 RBF Balanced, 25 RBF Cash and 25 RBF Fixed Interest you could choose to have your pension payments drawdown in the order of 1. RBF Cash, 2. RBF Fixed Interest and 3. RBF Balanced. Diversified options: RBF Growth RBF Balanced (Default) RBF Socially Responsible Investments RBF Moderate RBF Conservative Asset class options: RBF Australian Shares RBF International Shares RBF Property RBF Fixed Interest RBF Cash Drawdown order (number 1 to 10 as required) Step 7 Nominate your pension payment details 1. Select your payment frequency Fortnightly Monthly Quarterly Six monthly Annually Please nominate the first month in which your payment is to commence. M M / Y Y 2. Select your payment amount (Select one option only) Minimum amount permitted Nominated amount* of $, per annum Maximum amount permitted (Only for RBF Transition to Retirement Account Based Pension. If you begin your pension after the financial year this is calculated on a pro-rata basis to take into account the number of days remaining in the financial year) * This amount must be at least the minimum amount permitted and will be gross of tax (where applicable). If you re applying for a RBF Transition to Retirement Account Based Pension the nominated amount must not exceed the maximum pension allowable (gross of tax). Please note: If you have not selected a payment amount, payments will be made at the minimum amount permitted Your first pension payment will be paid on the first available pay period after your pension account has been established. NOTE: The ability to pay a pension (and the rate of any applicable tax) may depend upon your residency or citizenship status. Please indicate your current status by ticking the appropriate box below: Are you an Australian or New Zealand citizen or an Australian Permanent Resident? YES NO Holder (past or present) of visa sub-class 405 or 410 YES NO If your payment request is affected by your residency / citizenship status, you will be advised accordingly. *SA DI4*

5 Step 8 Provide your bank account details My bank account details are as follows: Name of institution Branch name BSB Account number Account name Step 9 Make a Death benefit election (Please tick one and nominate percentage if required) Who ll get your pension if you die while you re an RBF member? You can elect to have the remaining balance of your pension account paid to your estate in the event of your death. If you have nominated a reversionary beneficiary at Step 2, your pension will be paid to the reversionary beneficiary in the event of your death (if they are still your surviving spouse at the time of your death). In the event of my death, I hereby elect: To have 100 of my Death benefit paid to my estate To have part of my Death benefit paid to my estate (nominate percentage) To ensure your Death benefit is paid in accordance with your current wishes, you should review your Will regularly. You should also review your Will if your domestic and/or financial circumstances change. For more information you should refer to the Fact sheet: How super works available by contacting the RBF Enquiry Line on or from the RBF website at Step 10 Providing proof of your identity You will need to provide certified proof of your identity. The easiest way to do this is as follows: photocopy both sides of your current drivers licence or passport take the photocopies of your ID and the original of the partly completed statutory declaration to Australia Post * or your local Police station ** ask them to certify your ID. * to be able to certify your documents, the Australia Post employee must be a permanent employee of the Australian Postal Corporation with 2 or more years of continuous service in an office supplying postal services to the public. Australia Post will charge a small fee for each photocopy you need to get certified. ** a police officer, sheriff or sheriff s officer can certify your ID. The person certifying your ID documents will include the following details on the copy: IDENTIFICATION Certified true copy J. Sample Mr John Sample Justice of Peace Registration No Date: 01/03/2015 A clear copy of the document that identifies you (i.e. your driver s licence (front and back) or passport) Write or stamp certified true copy of the original document The authorised person s signature Full name, qualification and registration number (if applicable) of the authorised person Date of certification (within 12 months of receipt) Alternatively, you can refer to the Completing Proof of Identity fact sheet on the RBF website at for a list of other people who can certify your ID document(s) and witness your statutory declaration. Continued over *SA DI5*

6 Step 10 Providing proof of your identity (continued) If you don t have a driver s licence or passport You will need to provide a certified copy of one document from each of the following groups: Birth certificate or birth extract 1 Citizenship certificate issued by the Commonwealth Pension card issued by the Department of Human Services (Centrelink) that entitles the person to financial benefits AND Letter from the Department of Human Services (Centrelink) or other Government body in the last 12 months regarding a Government assistance payment Tax Office Notice of Assessment issued in the last 12 months Rates notice from local council issued in the last 3 months Electricity, gas or water bill issued in the last 3 months Landline phone bill issued in the last 3 months (mobile phone bills will not be accepted) Name change If you have changed your name, you must provide a certified copy of the relevant name change document 1, for example, a marriage certificate, deed poll, decree nisi/divorce order or change of name certificate issued by the Births Deaths and Marriages Registration office. Signing on behalf of another person If you are signing on behalf of the applicant you will need to provide the following: A certified copy of the Guardianship papers or Power of Attorney; and A certified copy of the appropriate proof of identity for the holder of the Guardianship or Power of Attorney; and A certified copy of the appropriate proof of identity of the applicant. 1 Translation If your identification is written in a language other than English, the identification must be accompanied by an English translation prepared by a translator accredited by the National Accreditation Authority for Translators and Interpreters Ltd. (NAATI) at the level of Professional Translator or higher (or an equivalent accreditation), to translate from a language other than English into English. Step 11 Complete a Tax file number declaration I am under age 60 and I have completed and attached the Tax file number declaration from the Australian Taxation Office. Note: If you are aged 60 or more you are not required to complete a Tax file number declaration. Your Privacy The fund is administered by us along with our service provider, Mercer Outsourcing (Australia) Pty Ltd. We collect, use and disclose personal information about you in order to manage your superannuation benefits and give you information about your super. We may also use it to supply you with information about the other products and services offered by us and our related companies. If you do not wish to receive marketing material, please contact us on Our Privacy Policies are available to view at or you can obtain a copy by contacting us on If you do not provide the personal information requested, we may not be able to manage your superannuation. We may sometimes collect information about you from third parties such as your employer, a previous super fund, your financial adviser, our related entities and publicly available sources. We may disclose your information to various organisations in order to manage your super, including your employer, our professional advisors, insurers, our related companies which provide services or products relevant to the provision of your super, any relevant government authority that requires your personal information to be disclosed, and our other service providers used to assist with managing your super. In managing your super your personal information will be disclosed to service providers in another country, most likely to Mercer s processing centre in India. Our Privacy Policies list all other relevant offshore locations. Our Privacy Policies set out in more detail how we deal with your personal information and who you can talk to if you wish to access and seek correction of the information we hold about you. It also provides detail about how you may lodge a complaint about the way we have dealt with your information and how that complaint will be handled. If you have any other queries in relation to privacy issues, you may contact us on or write to our Privacy Officer, Reply Paid 446, Hobart Tasmania *SA DI6*

7 Step 12 Sign the form By signing this form I: am applying for an RBF Account Based Pension or RBF Transition to Retirement Account Based Pension acknowledge that I have received all information I require in order to exercise the choices I have made accept that I will be bound by RBF s governing legislation understand that the information contained in this form will be relied upon by the RBF Board to provide and manage my pension. understand and consent to my information being collected, disclosed and used in the manner set out in this form acknowledge that if I ve provided my address details in this form, the RBF Board may, at its discretion, use that address to send information, including any member and exit statements and notices of any material changes or the occurrence of significant events, by electronic means. Signature / / Please return your completed form together with your proof of identity and Tax file number declaration and RBF Tasmanian Accumulation Scheme Rollover forms (if applicable) to RBF, Reply Paid 446, Hobart TAS Date *SA DI6*

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