authority to deduct financial advice fees form

authority to deduct financial advice fees form BOCSUPER You may request the Trustee to debit fees for financial advice related to your super from your BOC Super account. To arrange this, you and your adviser should complete this form and send it with a copy of the invoice to: The Fund administrator BOC Gases Superannuation Fund GPO Box 4303 Melbourne VIC 3001 1. Personal details Please use blue or black pen. Mr Mrs Ms Miss Date of birth BOC Super Member number* Surname Given names Home address Suburb/Town/City state Postcode Telephone (Work) (Home) (Mobile) ( ) ( ) * Financial advice fees will be deducted from this account. 2. Amount to be deducted Insert amount. Show below the amount to be deducted. The maximum amount of financial advice fees that can be deducted from your account is $5,000. Amount (inclusive of GST) $ I understand and agree that the above amount will be deducted from my account and paid to: Adviser name Please complete 3. Invoice Attached is a copy of the invoice from my financial adviser. 4. Proof of identity Attached is a certified photocopy of my proof of identity documentation (see back of form). Page 1 of 3

5. Declaration I confirm that the amount to be deducted from my account is solely for financial advice provided to me in relation to my super benefits. I understand and agree that: z the fee nominated will be deducted from my BOC Super account by the Administrator on receipt of all required information z the value of my BOC Super account will decrease by the amount of the fee deducted in accordance with my request z I am solely responsible for the selection and appointment of my financial adviser. I acknowledge that BOC Super is not responsible for the advice provided and will not accept liability for any loss or claim that may result from or in connection with the advice provided by the financial adviser z the Administrator may not be able to action my request where they have been notified of family law proceedings in relation to my BOC Super account z the information contained in this form will be used by the Trustee to process my request to deduct a personal financial advice fee from my super or pension account, and if necessary, to update my BOC Super member records so BOC Super can contact me in the future about my BOC Super account. For this purpose, personal information may pass between the Trustee of BOC Super and its administrator and other parties as required. I consent to the handling of my personal information in this manner. I can access my information by contacting the Privacy Officer of BOC Super z if I have provided my email address details in this form, the Trustee may, at its discretion, use that email 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 to that address, including the provision of a website link where I can download the information z BOC Super may use my email address as provided by me or any other person on my behalf including my employer to communicate with me in respect of any correspondence z my request will not be processed if I have not completed and signed this form. I understand and consent to my information being collected, disclosed and used in the manner set out on this form. Signature Date Please arrange for your financial adviser to complete the remainder of this form. Your personal information Privacy Collection Statement BOC Super is administered by us along with our service provider, Mercer Outsourcing Australia Pty Ltd (Mercer). 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 call the BOC Super Helpline on 1300 136 829. Our Privacy Policies are available to view at www.bocsuper.com.au or you can obtain a copy by calling the BOC Super Helpline on 1300 136 829. 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. They also provide 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 call the BOC Super Helpline on 1300 136 829 or write to our Privacy Officer, BOC Gases Superannuation Fund, GPO Box 4303, Melbourne VIC 3001. Page 2 of 3

adviser use only Please complete this section and enclose a copy of the invoice to arrange payment for advice. Adviser details Adviser name Company name/authorised representative of AFS Licence number afs Authorised representative number telephone Payment information I wish to be paid by: Cheque OR EFT Company Details Company name/authorised representative of Address Suburb/Town/City state Postcode Daytime telephone fax ( ) ( ) Remittance advice via: Fax OR Post Banking details (EFT payments only) I/We hereby agree for all payments by BOC Super for goods and services supplied to be made by way of direct transfer to the bank account details below. I/We hereby guarantee that the following details are correct, and agree to indemnify BOC Super against any loss or damage suffered if the details provided are incorrect. The information provided will be used solely for financial management and will not be used for any other purpose. Bank name Branch name BSB number account number Account name Approval and declaration Adviser name Adviser s office I confirm that the personal financial advice fee to be deducted from the member s BOC Super account balance is solely in relation to their super benefits. Signature Date Issued by BOC Superannuation Pty Ltd, ABN 83 080 598 821, AFS Licence No. 287131, as Trustee of the BOC Gases Superannuation Fund, ABN 49 620 344 668. Form issued November 2014. Page 3 of 3

COMPLETING proof of identity BOCSUPER Sometimes we need you to provide information and documents to prove your identity. This process is important to keep your super safe. This leaflet explains the proof we require and who is eligible to certify documents. Contact the BOC Super Helpline on 1300 136 829 if you have questions. Proof required Primary photographic identification You will need to provide a copy of one of the following primary identification 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*, or similar document issued for the purpose of international travel* 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 identification*. Identification documents must not be expired (excepting an Australian passport which may be expired within 2 years). OR Alternative identification If you are unable to provide any primary photographic identification, you will need to provide two identification documents, one from each of the following lists: Birth certificate or birth extract* 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). proof OF IDENTITY Name change If you have changed your name, you must provide a certified copy of the relevant name change document*, for example, a Marriage Certificate issued by the Registry of Births Deaths & Marriages, Decree Nisi or Deed Poll (in addition to the above identification). 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; and A certified copy of the appropriate proof of identity for the applicant. * 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. *BOCSC.F01NO1*

How to certify documents After sighting the original and the copy and making sure both documents are identical, the certifier must include on EACH page: Written or stamped certified true copy Signature and printed full name Qualification (such as Justice of the Peace, Australia Post employee, etc) Date (the date of certification must be within the 12 months prior to our receipt). IDENTIFICATION Certified true copy JSample Mr John Sample Justice of the Peace Registration No: 123456789 Date: 01/01/2013 A clear copy of the document that identifies you (i.e. your driver s licence (front & 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 authorisation (within 12 months of receipt) Verification A verification 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 leaflet is a guide only and we may request additional documentation prior to any payment. PROOF OF IDENTITY Who can certify documents in Australia? Australia Post permanent employee or agent (who is currently employed with the post office and has at least two continuous years of service or is in charge of 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 on the roll of the Supreme Court of a State or Territory, or the High Court of Australia 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) 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 Issued by BOC Superannuation Pty Ltd, ABN 83 080 598 821, AFS Licence No. 287131, as Trustee of the BOC Gases Superannuation Fund, ABN 49 620 344 668. July 2014. Member of the Institute of Chartered Accountants in Australia, the Australian Society of Certified Practising Accountants or the National Institute of 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 or Sheriff 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 or patent attorney Veterinary surgeon. Allan Murphy, BOC s Superannuation Manager, at North Ryde can certify documents. 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: http://www.transparency.org. *BOCSC.F01NO2*