Benefit Payment Request Form Complete this form if you wish to withdraw part or all of your benefit from the Plan or you wish to begin a pension in the Plan. MEMBER DETAILS Surname: Given Name: Residential Address: Member No: Date of Birth: Telephone: Email TYPE AND METHOD OF PAYMENT I authorise the payment of my benefit in the following manner (please tick appropriate boxes and complete details): 1. All / part of my benefit paid to me in cash*, less applicable taxes (please select an option) Full benefit payment Partial benefit payment (specify amount) $ Total non-preserved portion in cash, with preserved portion to be paid to below nominated rollover institution Cash Payment via Electronic Funds Transfer (EFT) Your Bank Account Name: Your Bank Account Number: BSB: Your Bank Name and Location: 2. All / part of my benefit paid to the below nominated rollover institution (please select an option) Full rollover Partial rollover (specify amount) $ Name of rollover institution: Rollover cheque payable to: Address of rollover institution: ABN of rollover institution: SPIN Number: Member number (if available) : Contact name and number: 3. I would like to utilise part /all of my account balance to commence a Pension from the Plan*. Please send me details. May 2014 Page 1 of 8
4. I was employed in Australia on a temporary visa and I am departing Australia permanently. I would like my benefits paid from the Fund. 5. In requesting a cash payment of any preserved component of my benefit or the commencement of a Pension from the preserved component of my benefit, I declare that I meet one of the following conditions of release (please tick appropriate box ): (a) I am over my preservation age, and am taking out a Transition to Retirement Pension OR (b) I am over my preservation age, and have permanently retired from the workforce* [* I ceased gainful employment on / / (insert date) and do not intend to become gainfully employed again for more than 10 hours per week] OR (c) I am over age 60 and ceased an arrangement of gainful employment after reaching age 60** [** I ceased gainful employment under this arrangement on: / / (insert date)] (d) I am over age 65. OR PROOF OF IDENTITY REQUIRED FOR ALL BENEFIT TRANSFERS AND PAYMENTS 6. In order for your cash benefit to be paid from the Plan, you are required to provide an original or an original certified copy of one of the following Primary Photographic Identification documents (please tick appropriate box and attach document): a driver s licence or permit issued under a law of a State or Territory or equivalent authority of a foreign country that contains a photograph of the person in whose name the document is issued; or a passport issued by the Commonwealth; or a passport or a similar document issued for the purpose of international travel, that: (a) (b) contains a photograph and the signature of the person in whose name the document is issued; is issued by a foreign government, the United Nations or an agency of the United Nations; and (c) if it is written in a language that is not understood by the person carrying out the verification is accompanied by an English translation prepared by an accredited translator; or a card issued under a law of a State or Territory for the purpose of proving the person's age which contains a photograph of the person in whose name the document is issued; or a national identity card issued for the purpose of identification, that: (a) (b) (c) contains a photograph and the signature of the person in whose name the document is issued; is issued by a foreign government, the United Nations or an agency of the United Nations; and if it is written in a language that is not understood by the person carrying out the verification is accompanied by an English translation prepared by an accredited translator. A list of persons that can certify the copy of the above documents is included as an Appendix to this form. May 2014 Page 2 of 8
If you are unable to provide an original or certified copy of one of the Primary Photographic Identification documents listed above, please contact the Fund Administrator on (02) 9335 7852 who can provide you with a list of possible alternative non-photographic and secondary identification documents. TAX FILE NUMBER 7. If you have not previously provided your Tax File Number to the Fund, please complete the Tax File Number Notification form attached. BENEFIT PAYMENT PROCESS 8. On receipt of this completed Benefit Payment Request Form, the Fund Administrator will undertake the following steps in order to facilitate the payment of your benefit: * Consider whether you have met a condition of release under superannuation law; * Carry out proof of identity procedures as required under the Trustee s Anti-Money Laundering / Counter-Terrorism Financing ( AML/CTF ) Program (refer to section 6 above on Proof of Identity ); * Process your benefit payment (i.e. calculate the benefit and produce the relevant member communication material). NOTE: YOUR BENEFIT WILL REMAIN INVESTED IN YOUR PREVIOUSLY CHOSEN INVESTMENT OPTION UNTIL THE ACTUAL DATE OF YOUR PAYMENT You have the option within 60 days of terminating employment with ASC Pty Limited and ASC Shipping Pty Limited to continue any insurance cover you may have in the Plan through an individual insurance policy or continuation option. PLEASE NOTE: You must have applied for cover and been accepted by the insurer within the 60 day period, so do not wait for day 50 before applying. If you wish to continue this insurance, contact the Plan on (02) 9335 7852 for further details. The premiums for this insurance will be deducted from your account. Contact the Fund Administrator for the further details. Member signature: Date: Equity Trustees Limited (ABN 46 004 031 298; AFSL 240975) as Trustee for ASC Superannuation Plan a plan in the Employer Sponsored Members Division of The Executive Superannuation Fund (ABN: 60 998 717 367). Please return forms via mail to the Fund Administrator, KPMG Superannuation Services Pty Limited, Level 4, 10 Shelley Street, Sydney NSW 2000; PO Box 67 Australia Square NSW 1215. Email: AU-FMNATASC@kpmg.com.au Telephone: (02) 9335 7852 Fax: (02) 9335 7001 May 2014 Page 3 of 8
APPENDIX CERTIFIED COPIES The AML / CTF Rules set out who can certify a copied document. The Rules state that a certified copy means a document that has been certified as a true copy of an original document by one of the following persons: 1. a person who is enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a legal practitioner (however described); 2. a judge of a court; 3. a magistrate; 4. a chief executive officer of a Commonwealth court; 5. a registrar or deputy registrar of a court; 6. a Justice of the Peace; 7. a notary public (for the purposes of the Statutory Declaration Regulations 1993); 8. a police officer; 9. an agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public; 10. a permanent employee of the Australian Postal Corporation with two or more years of continuous service who is employed in an office supplying postal services to the public; 11. an Australian consular officer or an Australian diplomatic officer (within the meaning of the Consular Fees Act 1955); 12. an officer with two or more continuous years of service with one or more financial institutions (for the purposes of the Statutory Declaration Regulations 1993); 13. a finance company officer with two or more continuous years of service with one or more finance companies (for the purposes of the Statutory Declaration Regulations 1993); 14. an officer with, or authorised representative of, a holder of an Australian Financial Services Licence (AFSL), having two or more continuous years of service with one or more licensees; 15. a member of the Institute of Chartered Accountants in Australia, CPA Australia or the National Institute of Accountants with two or more years of continuous membership. May 2014 Page 4 of 8
Privacy Statement This privacy statement relates to the collection, use, storage and disclosure of personal information about you in all communications with the Trustee. The Trustee collects personal information about you to: process your enrolment in the Fund (in accordance with the Superannuation Industry (Supervision) Act 1993); administer and manage your participation in the Fund and communicate with you about the Fund; provide you with information about other products or services that may be of assistance to you; and facilitate our internal business operations, including fulfilment of any legal requirements. If you do not provide the personal information sought from time to time, it may mean that your enrolment in the Fund cannot be processed or that services cannot be provided to you. The Trustee may disclose your personal information (as necessary): to its agents, contractors or third party service providers that provide financial, administrative or other services in connection with the operation of the Fund or its business, for example where a fund administrator is appointed; Access Effective 21 December 2001, new privacy laws came into effect. Under these laws, you are entitled to request access to personal information held by the Trustee about you and to ask the Trustee to correct this information where you believe it is incorrect or out of date. No fee will be charged for an access request. You may be charged the reasonable expenses incurred in giving you any information you have requested (eg searching and photocopying costs). To access personal information about you, or to obtain more information about your rights or our privacy policy, please contact the Fund as follows: Fund Administrator KPMG Superannuation Services Pty Limited Level 4, 10 Shelley Street SYDNEY NSW 2000 PO Box 67 Australia Square NSW 1215 Telephone: (02) 9335 7852 Fax: (02) 9335 7001 Email: AU-FMNATASC@kpmg.com.au By completing the attached form you agree to the Trustee collecting, using, storing and disclosing personal information about you in accordance with this privacy statement. to your financial advisor, or sponsoring employer, if any, unless you tell us not to; to an insurer where insurance services are arranged in connection with your enrolment in the Fund; to any new Trustee as may be appointed from time to time; to any party which holds amounts on your behalf which will be transferred to the Fund; and where the law requires or permits us to do so (eg. to law enforcement agencies or other government agencies such as Austrac, the agency responsible for monitoring anti-money laundering and counter-terrorism ) or if you consent. May 2014 Page 5 of 8
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Superannuation Individual Tax File Number Notification Via Fund Trustee or Employer This form may only be used to pass on your tax file number to your superannuation fund. (Please print neatly in BLOCK LETTERS with a black or blue pen only) Fund Name: ASC Superannuation Plan a plan in the Employer Sponsored Members Division of The Executive Superannuation Fund Fund Address: KPMG Superannuation Services Pty Limited, Level 4, 10 Shelley Street Sydney NSW 2000 Fund telephone number: (02) 9335 7852. Employer Name: Telephone Number: (If applicable) Surname: Given Name(s): Date of Birth: / / Membership Number: Sex: Female Male (if known) I agree to provide my Tax File Number: Yes No My Tax File Number is: Signature: Date: / / Collection of tax file numbers is authorised by tax laws, the Superannuation Industry (Supervision) Act 1993 and the Privacy Act 1988. Changes to the tax file number laws require trustees to ask you to provide your tax file number to your superannuation Fund. By completing this form and providing it to Your Fund will allow Your Fund trustee to use your tax file number for the purposes contained in the Superannuation Industry (Supervision) Act 1993 and for the purpose of paying superannuation termination payments. The purposes currently authorised include: taxing superannuation termination payments at concessional rates; accepting non-concessional contributions; not applying excess tax to concessional contributions; finding and amalgamating your superannuation benefits where insufficient information is available; passing your tax file number to the Australian Taxation Office where You receive a benefit or have unclaimed superannuation money after reaching the aged pension age; and allowing the trustee of your superannuation Fund to provide your tax file number to a superannuation Fund receiving any benefits you may transfer. Your trustee won t pass your tax file number to any other Fund if you tell the trustee in writing that you don t want them to pass it on. You are not required to provide your tax file number. Declining to quote your tax file number is not an offence, however giving your TFN to your superannuation fund will have the following advantages (which may not otherwise apply): your 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. The lawful purposes for which your tax file number can be used and the consequences of not quoting your tax file number may change in future, as a result of legislative change. For more information, please contact Your Fund or the ATO Superannuation Helpline (13 10 20).
Page 7 of 8 Superannuation Individual Tax File Number Notification Via Fund Trustee or Employer Important notes to trustees and employers In the interests of your members/employees, you should make this form available to them. Please ensure that the member/employee is aware of your address and telephone number (see the space provided on the front of this form). The member s/employee s tax file number must be kept private and secure. Specific notes for trustees If a member provides you with his or her tax file number for superannuation purposes (e.g. on this form), you must accept it and record it with member s details. Unauthorised use of the tax file number may incur a penalty of 100 penalty units (currently $10,000) and/or 2 years imprisonment. Specific notes for employers If an employee provides you with his or her tax file number for superannuation purposes (e.g. on this form), you are required to pass it on with or before the next superannuation contribution you make for that employee unless you receive it within 14 days (e.g. 2 days) before that contribution in which case you have 14 days from receiving it to pass it onto the employee s superannuation fund. Employers who do not meet the above requirement may be subject to a penalty of up to 10 penalty units (currently $1,000). You may only disclose the tax file number on this form to the employee s superannuation fund. It is against the law to disclose the tax file number quoted on this form to any other fund or person. May 2014 Page 8 of 8