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1 Option 3 Membership Shell Australia Superannuation Fund Application for membership About this form We need you to fill out this form to let us know: your details how much you d like to contribute if anything which investment options you d like your money invested in if you d like extra death and disability cover who you d prefer to receive your super if you die while you re a member of the Shell Australia Superannuation Fund your tax file number To find the information you need to complete this form just look in the section of the Product Disclosure Statement (PDS) that relates to the section you re up to. Once you ve finished the form, don t forget to sign it and return it to your Payroll Department (Melbourne office). If you re unsure of your decisions, we recommend that you see a licensed financial adviser. Step 1 Complete your personal details Title Mr Mrs Ms Miss Other Date of birth / / Given names Surname Postal address Suburb State Postcode Daytime Telephone Fax see note below Providing your address In the future the Trustee anticipates providing information such as annual reports, member statements, exit statements and notices of any material changes or occurrence of significant events electronically, rather than in written form as we do at the moment. If this format becomes available and you d like to receive this information electronically please advise your address. Issued by SASF Pty Ltd ABN RSE Licence No. L as Trustee of Shell Australia Superannuation Fund ABN Registration R *SHELF.N01HI1* Page 1
2 Step 2 Make a contribution Your employer contributes to your super but if you d like to build wealth faster you can contribute too Only complete this section if you want to contribute. I would like to contribute % of my salary or $, per pay period I d like to contribute from (select an option ) After-tax salary Before-tax salary* *subject to employer approval Before making any decision about your contributions, or for help on the Government contribution cap levels you should seek independent financial advice from a licensed financial advisor. A list of some advisors in your state can be obtained from the Financial Planners Associate of Australia Limited. The Association maintains a website: Step 3 Choose your investment options Take control of how your super is invested You can choose one or more investment options or a mix of up to a total of 5 options. Please ensure the total adds to 100% otherwise the default investment option will apply until it s corrected. If you don t make a selection you ll automatically be invested in the default investment option which is the Balanced Growth Option. I d like to invest in the following investment option(s): Percentage to be invested Option 1 Aggressive Growth Australian Shares % Option 2 Aggressive Growth - Global Shares % Option 3 Balanced Growth (default) % Option 4 Cautious % Option 5 Cash % TOTAL 1 % This investment strategy will apply from commencement of membership where the form is received by the Fund Administrator within two weeks of joining the Fund, or, where the form is not received by the Administrator within two weeks of joining the Fund, from the first day of the month following receipt of this form by the Fund Administrator. Step 4 Additional Cover (optional) Upon joining Option 3, you will automatically be provided with basic cover for death, total & permanent disablement and ill health at no cost to you. Please refer to the Fund s Product Disclosure Statement Part 1 for Option 3 members for more information. However, you can choose to take out additional cover for death and total & permanent disablement. If you choose to take out additional cover, the cost for this will be deducted from your account. This cost is set by the Trustee, in consultation with the Fund s Actuary, and is reviewed regularly. Please refer to Information Booklet 3 Insurance for the current cost. For more information or to apply for additional insurance, please contact the Shell Australia Superannuation Fund on or if calling from overseas for a Personal Statement for Additional Insurance form. *SHELF.N01HI2* Page 2
3 Step 5 Nominate your beneficiaries Who ll get your super if you die while you re in the Shell Australia Superannuation Fund? Should I die while a member of the Shell Australia Superannuation Fund, I d prefer my death payout to be paid to the following people in the proportions shown. The Trustee of the Shell Australia Superannuation Fund is not legally bound by your wishes but will take them into account. TOTAL % * must be a dependant or be your legal personal representative (or the executor of your will). A dependant is defined as: your spouse (including de-facto but not same-sex partner) your children including step-children and adopted children, and any other person who the Trustee considers is wholly or partially dependent on you at the time of death, and any person you have an interdependency relationship with. Two people have an interdependency relationship if: 1. they have a close personal relationship; 2. they live together; 3. one or each of them provides the other with financial support; and 4. one or each of them provides the other with domestic support and personal care. An interdependency relationship will also exist between two people if they have a close personal relationship but do not meet the other criteria as listed above (2, 3 & 4) because either or both of them suffer from a physical, intellectual or psychiatric disability. If you would like to nominate more beneficiaries, please attach a separate piece of paper which includes your additional beneficiaries signed and dated by yourself. *SHELF.N01HI3* Page 3
4 Step 6 Provide your tax file number Don t pay more tax than you have to let us know your tax file number. Your tax file number is confidential and you don t have to give it to the Shell Australia Superannuation Fund. It is not an offence to not provide your tax file number. However, you may pay more tax than you have to if you don t supply it. My tax file number is: - - Special note: The Trustee is required by law to ask for your tax file number. By providing your tax file number, you re allowing the Trustee to use it to: find or identify your super when there s no other way work out any tax payable pass your tax file number to the tax office when you receive your super payout or have unclaimed super money after reaching pension age pass your tax file number to any other super fund or account to which your super is transferred in the future, unless you tell the Trustee in writing not to do so report details of contributions to the tax office for working out whether any tax is applicable if contributions for you exceed certain limits, and where required by law, pass your tax file number to other Government agencies. If you don t provide your tax file number, now or later: you may pay more tax on contributions made by your employer and certain other contributions made by or for you. In some circumstances, you may be able to claim this back, however time limits and other rules may apply the Trustee will only be able to accept contributions made for you by your employer. No other contributions, for example, after-tax contributions, can be accepted you may pay more tax on your super benefit that you would otherwise (although you can claim this back when you lodge your tax return) it may be more difficult to find your super in the future if your change your address without notifying the Trustee or if you rollover any other super accounts you may have. The legal purposes for which the Trustee can use your tax file number and the consequences for not quoting your tax file number may change in the future. Your name Date of birth / / Your employer s name *SHELF.N01HI4* Page 4
5 Step 7 Sign the form Don t forget to return this form to your employer. You may like to make a copy for your records. By signing this form I: 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 the provisions of the trust deed and rules which govern the operation of the Shell Australia Superannuation Fund. understand that my personal information will be handled by the Trustee to provide and manage my super. Without this information it may not be able to provide my super and choices. For this purpose, my personal information may pass between the Trustee of the Shell Australia Superannuation Fund and its administrator, professional advisers, insurers, government bodies, my employer and other parties as required, including the trustee of any other super fund that my super is transferred to. I consent to the handling of my personal information in this manner. I can access my information by contacting the Privacy Officer of the Shell Australia Superannuation Fund. acknowledge that if I ve provided my address details in this application form, the Trustee may, at its discretion, use that address to send information, including any annual reports, member and exit statements and notices of any material changes or the occurrence of significant events, by electronic means. authorise my employer to deduct from my pay, any contributions that I have indicated I d like to make to my super. acknowledge that I have read and understood the attached Product Disclosure Statement consisting of Part 1, Part 2 and Part 3 and agree to be bound by it. Signature / / Date Employer use only section (If you use Mercer Spectrum you only need to sign the form below, other details are provided through Mercer Spectrum). Employer name Category of membership Date member joined employer / / Date member joined the Fund Annual Superannuation Salary on joining Payroll number / / $,, Employment status Perm. full time Perm. part time (working hours per week) Casual (please tick one option) I certify that the above named member was at work OR not at work performing their normal duties on the date they joined the Fund (If not at work please provide details) Employer s Eligibility Certificate (Select applicable option) This employee has joined the Fund at the first available opportunity (ie had not previously elected an alternative super fund under Choice of Fund). Yes OR No Authorised signatory Date / / Issued by SASF Pty Ltd ABN RSE Licence No. L as Trustee of Shell Australia Superannuation Fund ABN Registration R *SHELF.N01HI5* Page 5
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