About this form If you are still employed with one of the Rio Tinto group employers you are eligible to withdraw part or all of any unrestricted non-preserved amounts you have in the Fund at any time. If you are a Personal Member in the Accumulation Division you can roll all or part of your super out of the Equip Rio Tinto fund at any time. Alternatively you may decide to receive your non-preserved super or, if you are eligible, your entire super as a cash payment. To request payment of any of these amounts, complete the details below. If you close your Equip Rio Tinto account before we receive your final contributions, on your behalf we will establish a new account upon receipt of these contributions. Tax components of your super payout Your payout will be made up of a tax-free and taxable component. You cannot nominate to take a payment from just one component (e.g. from just the tax-free component). If you need help For assistance, please call the Fund Member Helpline on 1800 687 134. Step 1 Complete your personal details Please print in black or blue pen, in uppercase, one character per box. A Date of birth (must be advised): Gender: Mr Mrs Ms Miss Other / / Male Female Given name(s) Surname Previous name (if applicable) Residential address (must be advised) Suburb State Postcode Postal address (if different from above) Suburb State Postcode Daytime telephone - Membership number Mobile If you do not provide the above details there may be delays in processing your payment and/or rollover. Email see below Sign up for electronic communications By providing your email 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 www.equipsuper.com.au/riotinto and updating your preferences in the Personal details section. Issued by Equipsuper Pty Ltd (ABN 64 006 964 049, AFSL 246383) as trustee for Equipsuper Superannuation Fund (ABN 33 813 823 017, SPIN EPL0100AU) for persons in the (Equip Rio Tinto fund). July 2017 RT107
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 your date of birth does not match the Fund's records call the Fund Member Helpline for further instruction. If you have changed your address you will need to attach a copy of a recent bill, mail item or driver's licence that displays your new residential address. If the required supporting documentation is not provided, the payment of your benefit will be delayed. Step 3 Provide payment or transfer instructions Please pay my super as follows: Option 1 Pay as cash: (select an option) Maximum amount available in cash (the unrestricted non-preserved portion) or A partial withdrawal of $,. net of tax or The total of my super Note: Tax may be payable on cash payments. Residency or citizenship status The ability to pay as cash (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 resident? Yes No If your payment request is affected by your residency / citizenship status, you will be advised accordingly. Failure to respond to the above question may result in delays in the processing of your payment(s). Electronic Funds Transfer request All payments will be paid by cheque (in the name of the account holder only) and sent to the postal address shown in Step 1 unless you specify details below for an Electronic Funds Transfer. Bank account details for deposit via Electronic Funds Transfer (EFT) Name of account holder(s) Bank BSB number (6 digit number) Bank address Account number Note: the account nominated above must be in your name and must be an account for which you can sign to withdraw, either solely, or with another person. If you do not provide the above details there may be delays in processing your payment. Preservation declaration A portion of your super benefit may be preserved. If the preserved amount is over $200, legislation requires that it be retained in a complying super fund, unless one of the circumstances below applies to you. You have reached your preservation age*, have ceased employment and permanently retired from the workforce. You are at least 60 years of age and have ceased employment since attaining age 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, call, occupation or employment. If you are eligible, please complete one of the following declarations to allow your benefit payment to be processed. (Select an option) Yes, I have reached my preservation age, have ceased employment and permanently retired from the workforce Yes, I am 60 years of age or over and have ceased employment with an employer on or after my 60th birthday * Your preservation age depends on your date of birth as shown in the table below. Date of birth Preservation age Date of birth Preservation age Before 1 July 1960 55 1 July 1962 to 30 June 1963 58 1 July 1960 to 30 June 1961 56 1 July 1963 to 30 June 1964 59 1 July 1961 to 30 June 1962 57 1 July 1964 or after 60 Continued over
Step 3 Provide payment or transfer instructions (continued) Option 2 Rollover to another fund: (select an option) A partial rollover of $,. The total super account balance (remaining after cash payment if applicable) (If you wish to transfer your super to more than one fund, copy this section of the form and complete it for each fund, inputting the amount to be transferred to each fund). Name of fund Fund ABN* - - - Unique Superannuation Identifier (USI)* Membership or account number If exempt from an ABN, tick the reason for exemption: Exempt Public Sector Super Scheme Retirement Savings Account * A rollover to another fund may not be able to occur without the ABN, USI and membership/account number of the fund you are transferring to. If your nominated fund does not have an ABN you will need to contact the fund directly to request evidence of their complying status, such as their notice of compliance. If you do not provide the above details there may be delays in processing your rollover. Is this a Self Managed Super Fund (SMSF)? Yes No If no, proceed to Step 4. If yes, please provide the following information and note that all payments to an SMSF will be paid by EFT. Please ensure the fund address is up-to-date on the ATO s website www.superfundlookup.gov.au and please provide a copy of the SMSF bank account statement. If you do not provide these details, there may be delays in processing your rollover. If we are unable to verify the SMSF or your status as a member, trustee or director of a corporate trustee of the SMSF, we may need to obtain further documentation from you. Fund address Suburb State Postcode Name of Financial Institution BSB Account number Account name Fund contact number -
Step 4 Providing your tax file number Under the Superannuation Industry (Supervision) Act 1993, the Fund's Trustee 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. The Trustee must also comply with the requirements of the Privacy Act 1988. 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 the Trustee your TFN will have the following advantages (which may not otherwise apply): the Fund will be able to accept all types of contributions to your account/s; an additional tax on contributions to your superannuation account/s will not be applied; 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 easier to trace lost superannuation accounts in your name. Should you choose not to provide your Tax File Number additional tax may be deducted, please refer to the Tax File Number Notification form for details. 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 Equip Rio Tinto 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: - - or, if you don't want to provide your TFN, tick below. I will not provide my TFN Step 5 Providing proof of identity We require you to provide proof of identity if you are: requesting a cash payment; rolling over your super to a self managed super fund (SMSF); rolling over your total super balance to another complying super fund (not an SMSF) and we don't have your Tax File Number and you don't wish to provide it for this purpose; rolling over your total super balance to another complying fund and the TFN we hold for you cannot be validated through the online facility provided by the Australian Taxation Office. For identification purposes, you MUST attach a copy of either your Driver's Licence or Passport (or acceptable alternatives). If you have chosen to have any amount paid as cash or rolled over to an SMSF, you MUST provide a certified copy of this document. See the Completing proof of identity section for details of what to provide and how and who can certify documents. Failure to provide appropriate proof of identification may result in delays to the processing of your transfer or payment. We may need to ask you for further identification or verification documents in certain circumstances. We will contact you if this is required. 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 www.equipsuper.com.au/riotinto or you can obtain a copy by contacting us on 1800 687 134. 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 employers, 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 1800 687 134 or write to our Privacy Officer, GPO Box 4303 Melbourne VIC 3001.
Step 6 Sign the form By signing this form: I acknowledge that I have read and understood this form and that the information completed is true and correct. 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 approve the deduction of any appropriate exit fees from the amount paid subject to legal restrictions. I understand that under Tax Office regulations, I must keep a copy of this form for five (5) years from the date completed. I request and consent to the transfer and/or payment of superannuation as described in this form and authorise the superannuation provider of each fund to give effect to these transactions. I understand that the value of my super in the Equip Rio Tinto fund will decrease by the amount paid or transferred from the Equip Rio Tinto fund in accordance with my request. If I have requested a partial rollover, I understand that: a partial withdrawal fee of $75 will be deducted from my Equip Rio Tinto fund account when the transfer is processed; and the Equip Rio Tinto fund may not be able to action my request where the Trustee has been notified of Family Law proceedings in relation to my super, or in other circumstances required or permitted by legislation. If the fund nominated in Step 3 is an SMSF - I declare that I am a member, trustee or director of the corporate trustee of the SMSF. I am aware I may ask the superannuation provider of each fund 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. If the trustee of the Equip Rio Tinto fund holds my tax file number (TFN): I understand this will be passed on to the trustee of the fund nominated in Step 3 (if applicable), unless I have requested in writing to the Equip Rio Tinto fund that my TFN is not to be disclosed to another trustee; and I consent to my tax file number being disclosed for the purposes as set out in this form. If the trustee of the Equip Rio Tinto fund does not have my TFN, I confirm that I understand the implications of not providing this, including that additional tax may be deducted from my benefit. I discharge the trustee of the Equip Rio Tinto fund of all further liability in respect of the benefits paid and/or transferred as described in this form. Signature Date / / Please return your completed form to the Equip Rio Tinto fund, GPO Box 4303, Melbourne, VIC 3001. Step 7 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.
Step 8 Complete the checklist To enable your payment to be processed promptly, please ensure you have correctly completed this form before returning it to the fund. Have you: Provided your member details in Step 1? Attached supporting documentation for any change of name, date of birth or address detailed in Step 2? Provided complete payment instructions in Step 3 (including preservation declaration if you are requesting a cash payment)? Signed and dated the form (Step 7)? Completing Proof of Identity If applicable, have you attached the correct identification as outlined in the Completing proof of identity section? Select the identification you have provided: One Primary identification document; or Two Alternative identification documents (one from each of the lists specified) Is your identification current? If providing an Australian Passport, one that has expired within the last two years is acceptable. Is your document correctly certified? Ensure the certifier has included ALL of the following on each page: Written or stamped certified true copy Signature and printed name Date the date MUST be within twelve months of the date we receive your completed form. Qualification (such as Justice of the Peace, Australia Post employee, etc) Please refer to the Completing proof of identity section for more details on how to certify a document and a list of valid certifiers. 20170728
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.123456789 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. V7.1
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 Offi cer 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 fi nance 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 offi cer; or a non-commissioned offi cer within the meaning of the Defence Force Discipline Act 1982 with two or more years of continuous service or a warrant offi cer 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 S ervices 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: http://www.transparency.org V7.1