Roll other super money into the Equip Rio Tinto fund. If you need help

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1 Roll other super money into the Equip Rio Tinto fund About this form You must be a member of the Equip Rio Tinto fund in order for the Fund to accept your transfer/rollover. If you re unsure of your membership status or member number, please call the Fund Member Helpline on If you have super with more than one other superannuation fund that you want to rollover to the Equip Rio Tinto fund, you ll need to complete a separate for each amount and forward it to each fund. You can photocopy this form for this purpose. Once your other super money has been received and credited to your superannuation account in the Equip Rio Tinto fund you will receive a written confirmation. Important note You should check with your other fund to see what fees they may apply if you withdraw your money and consider the impact on any insurance cover you may have with the other fund. You should discuss the benefits of rollovers with a licensed or appropriately authorised financial adviser before rolling your money into the Fund. You may also need to read the material provided to you on joining the Equip Rio Tinto fund for more information on how your rollover will be treated. You can obtain a copy of the Product Disclosure Statement relevant to your membership category by calling the Fund Member Helpline or visiting the Fund website Please ensure that all details on this form are completed and then send it to the super fund where your money is currently held not the Equip Rio Tinto fund. If you need help For assistance please call the Fund Member Helpline 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 name(s) Surname Residential address Suburb State Postcode Postal address (if different for above) Suburb State Postcode Daytime telephone - Equip Rio Tinto fund membership number Mobile see below Sign up for electronic communications By providing your address and mobile number not only will it be easier for the Fund to keep in touch with you but it allows you to receive information electronically if that s your preference. You can tell the Fund how you d like to receive various types of communications by signing into your account on the website and updating your preferences in the Personal details section. Issued by Equipsuper Pty Ltd (ABN , AFSL ) as trustee for Equipsuper Superannuation Fund (ABN , SPIN EPL0100AU) for persons in the Rio Tinto Staff Superannuation Fund (Equip Rio Tinto fund) July 2017 RT0011

2 Step 2 Attach documentation if your personal details have changed If you have changed your name you will need to provide a certified linking document - a linking document is a document that proves a relationship exists between two (or more) names. See the Completing proof of identity section for details of what to provide and how and who can certify documents. If you have changed your address you will need to attach a copy of a recent bill, mail item or drivers licence that displays your new residential address. Step 3 Provide details of your other super fund Name of other fund Approximate value $,, Fund ABN Unique Superannuation Identifier (USI) Membership or Account number* * If you have more than one membership or account number in the other fund, you will need to complete a separate form for each membership or account. If you do not provide the above details, there may be delays in processing your transfer. Step 4 Instructions to other super fund I request that you transfer the total value or the value of $,, held in respect of me in the superannuation fund and/or account nominated in Step 3 to the Equip Rio Tinto fund and: I approve the deduction of any appropriate exit fees from the amount to be transferred subject to legislative restrictions. If I have requested the transfer of my total value, I approve any further amount resulting from extra contributions received after the payment of the first amount be transferred to the Equip Rio Tinto fund. Notes for other superannuation provider Name of Fund: Equip Rio Tinto fund USI: ABN: When transferring money into the Equip Rio Tinto fund please note: The Equip Rio Tinto fund is a regulated super fund under the Superannuation Industry (Supervision) Act Accordingly the Equip Rio Tinto fund can accept the rollover of both preserved and non-preserved benefits in accordance with the Superannuation Industry (Supervision) Act. Cheques (if necessary) should be made payable to Equip Rio Tinto fund Account of [member s name] Please forward this authority, the cheque, a rollover benefits statement, and other associated documentation to: Equip Rio Tinto fund, GPO Box 4303, Melbourne VIC 3001 Phone: Providing your tax file number Under the Superannuation Industry (Supervision) Act 1993, your superannuation provider is authorised to collect your tax file number (TFN) and will only use it for lawful purposes. These purposes may change in the future as a result of legislative change. Your superannuation provider also needs to comply with the requirements of the Privacy Act Your TFN may be disclosed to another superannuation provider, when your benefits are being transferred, unless you request in writing that your TFN not be disclosed to any other superannuation provider. It is not an offence not to quote your TFN. However giving your superannuation provider your TFN will have the following advantages (which may not otherwise apply): the superannuation fund will be able to accept all types of contributions to your account/s; the tax on contributions to your superannuation account/s will not increase; other than the tax that may ordinarily apply, no additional tax will be deducted when you start drawing down your superannuation benefits; and it will make it much easier to trace different superannuation accounts in your name so that you receive all your superannuation benefits when you retire. 2 of 5

3 Protecting your privacy We collect, use and disclose personal information about you in order to manage your superannuation benefits and give you information about your super. Our Privacy Policy is 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, professional advisors, health service providers, insurers, government bodies (for example the Australian Taxation Office and tribunals), investigation organisations, previous super funds, our related entities and publicly available sources. We may disclose your information to various organisations in order to manage your super, including our service provider, Mercer Outsourcing Australia Pty Ltd (Mercer), the entities mentioned above, 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 Policy lists all other relevant offshore locations. Our Privacy Policy sets 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 the Fund Member Helpline on or write to our Privacy Officer, GPO Box 4303 Melbourne VIC Step 5 Sign the form By signing this form: I declare that I have fully read this form and the information completed is true and correct. I request and consent to the transfer of superannuation as described in this form and authorise the superannuation provider of each fund to give effect to this transfer. I acknowledge that I have read the applicable Equip Rio Tinto fund Product Disclosure Statement (PDS) including the important information in the guides that form part of the PDS and I understand that I cannot access the preserved and restricted non-preserved amounts rolled over until I satisfy a relevant condition of release. I am aware I may ask the superannuation provider nominated in Step 3 for information about any fees or charges that may apply, or any other information about the effect this transfer may have on my benefits, and have obtained or do not require such information. I understand that all amounts transferred into the Equip Rio Tinto fund will be credited to an account in my name and accumulate with net investment returns (both positive and negative) based on my chosen investment option, or the Growth option, if I have not made a choice. I consent to my tax file number being disclosed for the purposes as set out in this form. I understand that my information will be collected, disclosed and used in the manner set out in this form and I consent to this. I discharge the trustee of the fund nominated in Step 3 of all further liability in respect of the benefits paid and transferred to the Equip Rio Tinto fund. Signature Date / / Please send this form to your other super fund, not the Equip Rio Tinto fund. Step 6 Attach documentation if you are signing on behalf of the applicant If you are signing on behalf of the applicant you will need to provide a certified linking document - a linking document is a document that proves a relationship exists between two (or more) names. See the Completing proof of identity section for details of what to provide and how and who can certify documents. 3 of

4 Complete your personal details Primary photographic identifi cation You will need to provide a copy of one of the following primary identifi cation documents: Current Australian or foreign driver s licence (including the back of the driver s licence if your address has changed) Australian passport Current foreign passport 1, or similar document issued for the purpose of international travel 1 Current card issued under a State or Territory for the purpose of proving a person s age Current national identity card issued by a foreign government for the purpose of identifi cation 1 Identifi cation documents must not be expired (excepting an Australian passport which may be expired within 2 years). Alternative identifi cation If you are unable to provide any primary photographic identifi cation, you will need to provide two identifi cation documents, one from each of the following lists: Birth certifi cate or birth extract 1 Citizenship certifi cate issued by the Commonwealth Pension card issued by the Department of Human Services (Centrelink) that entitles the person to fi nancial benefi ts AND Letter from the Department of Human Services (Centrelink) or other Government body in the last 12 months regarding a Government assistance payment Tax Offi ce 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 certifi ed copy of the relevant name change document 1, for example, a Marriage Certifi cate issued by the Registry of Births Deaths & Marriages, Decree Nisi or Deed Poll (in addition to the above identifi cation). If your legal name or date of birth does not match exactly to our records (excluding aforementioned name changes), please contact us for further instructions. 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. Note: Certifi ed ID is also required for the member 1 Translation If your identifi cation is written in a language other than English, the identifi cation 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. How to certify documents After sighting the original and the copy and making sure both documents are identical, the certifi er must include on EACH page: Written or stamped certifi ed true copy Signature and printed full name Qualifi cation (such as Justice of the Peace, Australia Post employee, etc) Date (the date of certifi cation must be within the 12 months prior to our receipt) IDENTIFICATION Certifi ed true copy J. Sample Mr John Sample Justice of Peace Registration No Date: 01/02/2012 A clear copy of the document that identifi es you (i.e. your driver s licence (front and back) or passport) Write or stamp certifi ed true copy of the original document The authorised person s signature Full name, qualifi cation and registration number (if applicable) of the authorised person Date of certifi cation (within 12 months of receipt) Verification A verifi cation of the certifying party may be performed. If a discrepancy arises, you may be requested to re-certify documentation. Important Note The information in this document is a guide only and we may request additional documentation prior to any payment. 4 of 5 V7.1

5 Complete your personal details Who can certify documents in Australia? Permanent employee of the Australian Postal Corporation with 2 or more years of continuous service who is employed in an offi ce supplying postal services to the public Agent of the Australian Postal Commission who is in charge of an offi ce 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, building society officer or credit union officer (with two or more continuous years of service) Commissioner for Affidavits or Declarations Court Officer, Registrar or Deputy Registrar of a Court, Judge, Clerk, Magistrate, Master of a Court, Chief Executive Officer of a Commonwealth Court Fellow of the National Tax Accountant s Association Finance Company Officer (with two or more continuous years of service with one or more finance companies) Justice of the Peace Legal practitioner Marriage celebrant (registered under Subdivision C of Division 1 of Part IV of the Marriage Act 1961) Medical practitioner, chiropractor, dentist, nurse, optometrist, physiotherapist, psychologist 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 Australasian Institute of Mining and Metallurgy Member of the Australian Defence Force (who is an officer; or a non-commissioned officer within the meaning of the Defence Force Discipline Act 1982 with two or more years of continuous service or 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 Member of the Institute of Public Accountants Member of Commonwealth Parliament, State Parliament, Territory Legislature or a Local Government Authority (State or Territory) Minister of Religion (under Subdivision A of Division 1 of Part IV of the Marriage Act 1961) Notary Public Officer with, or Authorised Representative of an Australian Financial Services Licensee (who has had at least two years of continuous service with one or more licensees) Officer with, or a credit representative of, a holder of an Australian credit licence (who has had at least two years of continuous service with one or more licensees). Permanent employee of the Commonwealth (or Commonwealth Authority) or a State or Territory (or State or Territory Authority) or a Local Government Authority with two or more years of continuous service Person before whom a statutory declaration may be made under the law of the State or Territory in which the declaration is made Pharmacist Police Officer, Sheriff or Sheriff s Officer Senior Executive Service Employee of the Commonwealth (or Commonwealth Authority) or a State or Territory (or State or Territory Authority) Teacher employed on a full-time basis at a school or tertiary education institution Trade marks attorney Veterinary surgeon Who can certify documents outside of Australia an authorised staff member of an Australian Embassy, High Commission or Consulate an authorised employee of the Australian Trade Commission who is in a country or place outside Australia an authorised employee of the Commonwealth of Australia who is in a country or place outside Australia a Member of the Australian Defence Force who is an officer or a non-commissioned officer with 5 or more years of continuous service a Notary Public from a country ranked 129 or below in the latest Transparency International Corruptions Perception Index: V7.1 5 of 5