Zurich Account-Based Pension Application Form Zurich Account-Based Pension Before you sign this application form, be aware that the application form must be included in, or must accompany a valid Product Disclosure ment (PDS) for the product in accordance with legal requirements. The PDS will help you to understand the product and decide if it is appropriate to your needs. Please ensure you read the PDS carefully before you sign this application form. This application form is dated 1 April 2018. Please ensure you have read the Your privacy section in the ZSP/ZABP Fee Guide and Additional Information booklet before completing this form. Please use BLOCK LETTERS and tick where applicable. Please see the application checklist on the back page of this application form. Do you have a current Zurich investment? Yes No Office use only SPIN ZUR0469AU Account Number Client Number Adviser s stamp Adviser Adviser No. Phone No. Is this account-based pension the result of an internal transfer from an existing Zurich investment? Yes No Requirements, International Automatic Exchange of Information for Tax Purposes and Customer Tax Compliance & Other Relevant Laws Zurich is required to satisfy various regulatory and compliance obligations, including under the Anti-Money Laundering/ Counter- Terrorism Financing Act 2006 (Cth) and international exchange of information for tax purposes (such as Common Reporting Standards and U.S. Foreign Account Tax Compliance Act (FATCA)). In connection with legal and regulatory requirements regarding the international exchange of information for tax purposes, including the Common Reporting Standards and U.S. Foreign Account Tax Compliance Act (FATCA) and laws and regulations related thereto, we are required to apply certain due diligence procedures to identify the tax residency or tax residencies of certain persons related to the investment. In order to comply with this obligation, the member and any person entitled to access the cash value, change the beneficiary or perform certain other actions with respect to the investment as described by law (together Member ) must at our request provide us with an accurate self-certification regarding the jurisdiction or jurisdictions in which the Member is a tax resident and, if applicable, respond to our request for documentary evidence and a taxpayer identification number or equivalent as is requested under the relevant regulation. At our request and based upon an indication that a self-certification of tax residency is required, if it is considered that the most recent self-certification may no longer be reliable or accurate, you must provide within 30 days a (new) self-certification and other supporting documentation. In accordance with applicable law, we will periodically report certain information about Members, including name and address, date of birth, and financial details relating to the policy to the appropriate tax authority(ies) or other authority(ies) designated by law. We reserve all rights to take any steps that we deem appropriate, including the right not to execute payment instructions until we have received all information and documentation to our satisfaction, or to cancel the policy, with immediate effect, in the event that we discover that an Investor and/or contractual beneficiary provided an incorrect self certification, that any other information or documentation provided in connection with identification and due diligence procedures is inaccurate or incomplete or a Member and/or contractual beneficiary did not provide us with a self-certification or other information as requested by us within the response time set out in our request. Failure to fully respond to our request within the time period may still result in the reporting of information about the Investor and/or contractual beneficiary to the appropriate tax authority or other authorities. As a Member of the Fund, you must provide the required identity verification information. Zurich may, from time to time, require additional information from you, which you must provide. In accordance with our obligation, Zurich will monitor your transactions; may also delay or refuse to process certain transactions. We may also be required to disclose information about you to a regulator or law enforcement body. In addition, the Zurich worldwide group of companies has obligations under various Australian and foreign laws. Despite anything to the contrary in this PDS or any other document related to the products described in this PDS, the products terms will operate subject to all laws with which a Zurich worldwide company considers it must comply. Zurich Account-Based Pension Application Form Page 1 of 28
1. Member details Title Surname Given name(s) Male Female Date of birth / / Residential address Postal address Contact details Work ( ) Home ( ) Mobile Email Identification requirements Under the Anti-Money Laundering and Counter Terrorism Financing Act 2006, we require specific forms of identification in order to open your account. In addition to the proof of identification requirements outlined on page 10 of this application form, we are legally required to identify Politically Exposed Persons (PEP). IMPORTANT: You must answer the following question before Zurich will be able to process your application. Are you a Politically Exposed Person (PEP) (as defined on page 12)? Yes No If Yes, please provide details of how you meet the definition of a PEP: 2. Investment and Payment details Please tick your required option (where relevant). This plan can generally only be purchased with unrestricted non-preserved Superannuation Lump Sum monies. Refer to ZSP/ZABP Fee Guide and Additional information booklet. Investment amount (minimum $20,000) $ How many superannuation lump sums are you rolling over? Does your investment result from the direct transfer of the withdrawal or residual capital value of a superannuation income stream originally purchased prior to 1 July 1994? Yes No Payment details Income required before tax (if applicable) $ per payment OR Minimum (as specified by Government restrictions) This selection will apply for the current and following financial years until you nominate an alternative selection in writing. Date of first income payment / / Payment Frequency Monthly Quarterly Half-yearly Yearly Page 2 of 28 Zurich Account-Based Pension Application Form
2. Investment and Payment details (continued) Account details (of the account that your income payments will be deposited to) Name of institution Branch address Account name Bank//Branch (BSB number) Account number Email/Fax transaction option Do you wish to utilise the email/fax transaction option? Yes No By ticking this box you are confirming that you have read and understood the terms and conditions that apply to this option and agree to be bound by those terms and conditions. Please refer to the ZSP/ZABP Fee Guide and Additional Information booklet. If you have any questions regarding this application form, please call Zurich Customer Care on 131 551 Send your completed application form to: Zurich Customer Care, Locked Bag 994, North Sydney NSW 2059 Zurich Account-Based Pension Application Form Page 3 of 28
3. Investment mix and Pension payment options Are you selecting the Automatic Investment Adjuster feature? Yes No If Yes do not fill out the investment selection table below, go straight to Section 4. If No please complete investment section below. Investment Selection Please indicate your investment selection (maximum 10 options). IMPORTANT: If no investment option selection is made below, Zurich will be unable to accept your application until such time as a valid selection has been made. I direct the Trustee to allocate my investment in the investment options and the proportions that I have indicated below: Name of option Code APIR Code Investment Mix (%)* Drawdown Rate/Pension Payment (%)*# Diversified options Capital Stable SB ZUR0003AU % % Balanced BB ZUR0004AU % % Managed Growth MB ZUR0005AU % % Priority Growth 7B ZUR0242AU % % Managed Share EB ZUR0006AU % % Sector specific options Cash CB ZUR0002AU % % Australian Fixed Interest XB ZUR0243AU % % Australian Property Securities PB ZUR0247AU % % Global Property Securities 4B ZUR0569AU % % Australian Value Share AB ZUR0244AU % % Global Thematic Share IB ZUR0055AU % % Global Equity Income 2B ZUR0609AU % % Global Growth Share 9B ZUR0610AU % % Equity Income ZB ZUR0541AU % % Externally managed option Colonial First Australian Share QB ZUR0599AU % % * Should an investment option be depleted to a zero balance, you will be advised by Zurich. # If no drawdown rate is specified, Zurich will use the same percentage as the Investment Mix. Total 100% 100% Please make cheque(s) payable to Zurich Australia Limited. All cheques must be in Australian dollars and drawn on an Australian bank. Page 4 of 28 Zurich Account-Based Pension Application Form
4. Nomination of beneficiaries As a member of the Zurich Master Superannuation Fund through the Zurich Account-Based Pension plan you have a choice of making a binding death benefit nomination OR a reversionary beneficiary nomination. Please refer to the ZSP/ZABP Fee Guide and Additional Information booklet for more information about these nominations. You are under no obligation to make a binding death benefit nomination OR reversionary beneficiary nomination. However you must be aware if you do not have a valid binding death benefit nomination or reversionary beneficiary nomination, or if a nominated beneficiary is no longer your dependant at death, the trustee will pay your death benefit (or applicable portion) to your estate, unless the trustee believes that your estate is insolvent. If you make a nomination, you can only make EITHER a binding death benefit nomination, or a reversionary beneficiary nomination. You are not able to have both. Binding death benefit nomination IMPORTANT original binding death benefit nomination section must be returned. Zurich are unable to accept email or faxed copies. Your binding death benefit nomination will not be valid until Zurich receives the original. If you have any enquiries regarding your binding death benefit nominations, including if you are unsure if the person you have nominated is a dependant, please contact your financial adviser or Zurich Customer Care on 131 551. Please use BLOCK letters. Beneficiary details If you have additional dependants, you should photocopy this page and attach it to your Zurich Account-Based Pension application form. Beneficiary 1 Surname First Name Date of birth / / Residential address Relationship to member? Spouse Child Financial Dependant Interdependent Portion of total benefit % Beneficiary 2 Surname First Name Date of birth / / Residential address Relationship to member? Spouse Child Financial Dependant Interdependent Portion of total benefit % Beneficiary 3 Surname First Name Date of birth / / Residential address Relationship to member? Spouse Child Financial Dependant Interdependent Portion of total benefit % Legal Personal Representative Portion of total benefit % Total must equal 100% or all nominations will be invalid. 100 % Zurich Account-Based Pension Application Form Page 5 of 28
4. Nomination of beneficiaries (continued) Declarations I am a member of the Zurich Master Superannuation Fund, or have applied to be a member. I have read and understood the ZSP/ZABP PDS and the ZSP/ZABP Fee Guide and Additional Information booklet and the consequences of making a binding death benefit nomination. I understand that my death benefits will be paid in accordance with my instructions provided the nomination remains binding and subject to superannuation law. I understand that if a beneficiary nominated to receive a benefit predeceases me, or if a person nominated is not a dependant as defined by the Superannuation Industry (Supervision) Act 1993 (SIS Act) or legal personal representative at the time of my death, my benefit will be paid in accordance with the default provisions current at the time of my death. I understand this binding death benefit nomination overrides all previous nominations including nominations made in any product application form(s). I understand that this binding death benefit nomination applies to the product specified in this application form only and that I need to make a separate nomination in respect of any other product(s) I may have under the Zurich Master Superannuation Fund. I understand it is my responsibility to regularly review my nomination to ensure it remains current and also that this nomination is binding for a period of three years only. I understand I can cancel this nomination at any time in writing to the Trustee. I understand this nomination is not binding until received and accepted by the Trustee or its delegate. I understand this declaration must be signed and dated by me in the presence of two witnesses (who are not nominated by me as a beneficiary of my death benefit), and that both of the witnesses must be over the age of 18. Original signature of member Witness declaration Two witnesses must complete the declaration below and sign, declaring that the member signed this form in the presence of both witnesses. As witnesses you declare that as at the date of signing: you are over 18; you are not nominated to receive a benefit; you were present when the member signed this form. Witness 1 Witness 2 Title Surname Title Surname Given name Residential address Given name Residential address Suburb Suburb Original signature of Witness 1 7 Date witnessed (must be the same date as the member signed) / / Original signature of Witness 2 7 Date witnessed (must be the same date as the member signed) / / Page 6 of 28 Zurich Account-Based Pension Application Form
4. Nomination of beneficiaries (continued) Reversionary beneficiary (binding) I nominate the following person as my reversionary beneficiary to whom the Account-Based Pension payments will generally continue to be paid in the event of my death. Declarations I understand I can only nominate one (and not more than one) of my dependants (as defined by the Trust Deed). A dependant may be a spouse, a child, a financial dependant, or a person with whom I have an interdependency relationship. I understand that once accepted by the Trustee the reversionary beneficiary nomination is binding and that my death benefits will be paid according to this nomination provided the nomination remains valid. I understand this binding nomination overrides all of my previous nominations to the Trustee (if any). I understand I should review the appropriateness of my nomination annually or as my circumstances change. I understand that my decision is irrevocable and that I can only change or remove my reversionary beneficiary by completing a new application form and transferring to a new Zurich Account-Based Pension or by cashing in my investment. I understand there may be some income tax and Social Security implications related to the nomination of a reversionary beneficiary. Reversionary beneficiary details Title Surname Given name(s) Male Female Date of birth / / Relationship to member Residential address Postal address (if different to above) 5. Condition of release Please tick your required option. Account-Based Pensions can generally only be purchased with unrestricted non-preserved superannuation lump sum money. If any part of your superannuation lump sum contains preserved or restricted non-preserved benefits, you will need to complete and sign the following declaration. For conditions of release involving permanent incapacity or severe financial hardship, please contact Zurich Customer Care on 131 551. To the Trustee of the Zurich Master Superannuation Fund I have reached my preservation age and have ceased gainful employment and have no intention of ever again seeking to become gainfully employed either on a part time or full time basis OR I am age 60 or more and have ceased gainful employment on or after my 60th birthday OR I am age 65 or over Date on which the above occurred / / Internal transfer (from an existing Zurich account) Investment number(s) Full transfer of (approximate amount) $ OR Partial transfer of $ Member name I request that the non-preserved benefits held under the above mentioned investment number(s) be transferred to my new Account-Based Pension. Member s signature Zurich Account-Based Pension Application Form Page 7 of 28
6. Member Application and Declaration Part A All applicants to read and sign the following declaration. I understand, in accordance with the conditions of the Trust Deed and the rules governing the Fund, that: Zurich Australian Superannuation Pty Limited is the Trustee for the Zurich Master Superannuation Fund; I understand that the Trustee may need to obtain further information and documents from me after the Trustee has received my application, during the course of my investment or while I am a member of the Fund; I understand that the Trustee can not issue units in the Fund and/or accept my application to become a member of the Fund until all the information and documents requested relating to my identity have been received and the Trustee has verified my identity. I understand that the Trustee may also need to identify me again as well as any person acting on my behalf, any person I am acting for, any person I request that the Trustee transfer my investment to or my legal personal representative (if I die) at any time after the Trustee has accepted my application or prior to the Trustee permitting a transaction such as a redemption or transfer of my investment; By applying to invest or become a member in the Fund, I also acknowledge that the Trustee may decide to delay or refuse any request or transaction, including by suspending the issue or withdrawal of units in the Fund, if the Trustee is concerned that the request or transaction may breach any obligation of, or cause the Trustee to commit or participate in an offence under, any law, and the Trustee will incur no liability to me if this occurs; Title to any policy effected on my life vests in the Trustee; I am precluded from using the Plan as a collateral security; I can only make an investment to the Zurich Master Superannuation Fund in accordance with the appropriate legislation. I hereby apply to Zurich Australian Superannuation Pty Limited, the Trustee of the Zurich Master Superannuation Fund, for membership of the Zurich Master Superannuation Fund as set out in the application form. In consequence of my application being accepted I agree to comply with the rules governing the Fund, and further certify that: I am eligible for membership of that Fund in accordance with the appropriate legislation; I understand that my application cannot be processed for consideration by the Trustee unless it is accompanied by the forms and a cheque as described in the Application Checklist on the following page; I direct the Trustee to implement the investment instructions in accordance with section 3; I understand that the number of units purchased in an investment option will depend on the unit price at the date of purchase and that the unit price may rise and fall as the market value of the investments of the relevant investment option change; I understand that my adviser may be paid remuneration from Zurich as detailed in the PDS and ZSP/ZABP Fee Guide and Additional Information booklet ; I have nominated the dependant(s) and/or my estate as shown in section 4 to receive benefits from the Fund in the event of my death; I have read the PDS and all incorporated documents referred to in the PDS (current as at the date of my application); I agree that Zurich can provide confirmation of any reportable transactions by allowing me to access Zurich Customer Care or through my adviser; I understand that the Trustee may be required to deduct income tax (PAYG) instalments from my pension payments; I understand that my pension payments may be varied by the Trustee to meet Government guidelines and regulations. If you wish to utilise the Email/Fax Transaction Option and have ticked the Yes box at the relevant question on page 3 of this application form: I hereby confirm I have read and understood and agree to be bound by the terms and conditions that apply to the email/fax transaction option, as stated in the ZSP/ZABP Fee Guide and Additional Information booklet. Member s signature Page 8 of 28 Zurich Account-Based Pension Application Form
6. Member Application and Declaration (continued) Part B This section is to be completed only where you have agreed with your financial adviser to have a Member Advice Fee deducted from your Account. The Member Advice Fee can be collected as either, or a combination of: Initial Member Advice Fee: A set dollar amount (or percentage of your account expressed as a dollar amount) deducted as a one-off as agreed to between you and your financial adviser; and/or Ongoing Member Advice Fee: A set dollar amount, or percentage of your account as agreed to between you and your financial adviser deducted from your account on a monthly basis. I have agreed to pay my adviser the following Member Advice Fee(s): Initial Member Advice Fee of $ which will be deducted as a one-off fee. Ongoing Member Advice Fee of either $ per month, or an amount equivalent to % pa of my account balance at the time the Ongoing Member Advice Fee is deducted. Note: Whilst there are no caps that apply to the Member Advice Fees, generally speaking an Initial Member Advice Fee should be no greater than 5% of your initial investment, and the Ongoing Member Advice Fee should be no greater than 1% pa of your account balance. Any amounts greater than these levels will require approval by the Trustee before processing your Zurich Account-Based Pension application. I direct Zurich Australia Limited, as agent of Zurich Australian Superannuation Pty Limited, to deduct the Initial Member Advice Fee amount by withdrawing units from my account following my initial investment and to deduct the Ongoing Member Advice Fee amount by withdrawing units from my account on a monthly basis (based on the anniversary date). In addition, I accept the following conditions in relation to the Member Advice Fee(s): It is my responsibility to be satisfied of the reasonableness of the Member Advice Fee and the quality of the advice; The Trustee is under no duty to review (either initially or at some later time) the advice given; The Zurich Master Superannuation Fund Trust Deed specifically excludes the Trustee from any liability for advice given by an adviser; and The adviser is not an agent of the Trustee. Further, where I direct Zurich Australia Limited ( Zurich ) to deduct a Member Advice Fee(s) from my Account, I accept and agree the following: The Member Advice Fee(s) is a fee agreed to between myself and my Adviser and is deducted under the terms of the Zurich Account-Based Pension and paid to my Adviser by Zurich; Zurich will have no discretion whether to pay the fee that I have authorised to my adviser, except in circumstances where Zurich considers the fee is greater than the maximum guidelines set out above; The fee agreed to represents payment for superannuation services provided for the provision of superannuation advice and does not relate to my investments generally; and To stop the Ongoing Member Advice Fee arrangement, I must submit a request in writing. Member s signature Application Checklist Before sending in your application form please check that you have done the following: Attached cheque(s) made payable to Zurich Australia Limited Attached your Tax File Number Declaration form (Note You do not need to complete if you have reached age 60) Attached your Withholding Declaration form (if applicable) Attached a Superannuation Lump Sum Rollover ment Signed and dated section 5 (if applicable) and section 6 Part A and, if applicable, 6 Part B Provide sufficient identification information (see page 11) Zurich Account-Based Pension Application Form Page 9 of 28
7. Adviser use only Please fill in the details below for each Adviser who has an interest in this Application form. Name Adviser No. Phone No. Fax No. Remuneration Split % 1. % 2. % Total 100% By providing your adviser details above, you represent and warrant that you are appropriately authorised to provide financial advice in relation to this product. You acknowledge that Zurich may, in its absolute discretion, decline a request to pay the Member Advice Fee (the arrangement) in order to comply with its obligations under any relevant law. You agree to immediately notify Zurich on becoming aware of termination of this arrangement by the Member, or on otherwise ceasing to be entitled to fees paid pursuant to this arrangement. You indemnify, and must keep indemnified, Zurich, against all costs, losses or liabilities suffered or incurred by Zurich arising out of any negligence, fraud or misconduct by you, your authorised officers, your agents or employees, or as a result of a breach of your obligation under any relevant law in relation to this arrangement. Is this your first application with Zurich, or have you recently changed licensee? No Yes Please attach your business card to this application. Member Advice Fee remuneration If your client agrees to have a Member Advice Fee deducted from their Fund account, Part B of Section 6 of this application form will need to be completed and signed by the client. The amounts shown in that section as an Initial Member Advice Fee and/or Ongoing member Advice Fee will be paid to you in accordance with the declaration the client signs. Please note there is no additional amount for GST paid on these amounts. Adviser declaration The information shown on the application accurately and completely records the information given. Adviser s signature Adviser 1 Adviser 2 Adviser Proof of Identity declaration By signing this declaration, I declare that the attached documents are true copies of the original or certified copies of the documents sighted and used by me to satisfy the applicable customer identification procedure requirements and I have complied with all the relevant obligations under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (Cth) and any associated rules or regulations as well as any Guidance Notes (including but not limited to any associated schedules) approved by The Financial Services Council ( FSC ) and/or the Financial Planning Association of Australia ( FPA ). Document(s) Document Number(s) Date verified / / Adviser s signature Print name Page 10 of 28 Zurich Account-Based Pension Application Form
8. Identification information In addition to your application form you will need to provide sufficient information to us in order for us to verify your identity. Proof of Identity Verification Information We need to verify 2 items of information you provided us in the application form: Your full name; and Either your date of birth or residential address. What identification items do we need from you? You need to attach a certified copy (see below) of ONE of the following photographic documents (Please tick which one applies): A Current Australian passport (provide the pages that identify you, including the page with your photograph); An Australian or Territory driver s licence bearing your photograph (front and back copies are required); A proof of age card issued by an Australian or Territory (must contain a photograph of you); A Foreign passport containing your photograph and signature (see below for information on providing foreign language documents). OR If you cannot provide a certified copy of one of the above documents then you must provide certified copies of one document from column A and one document from column B. A Australian birth certificate OR Australian death certificate (for death claims only) B Letter from Centrelink (or other Commonwealth, or Territory agency) issued to you within the last 12 months regarding a government assistance payment showing your name and residential address Australian citizenship certificate Utilities bill or local government notice issued to you within the last three months showing your name and residential address Health card issued by Centrelink Notice issued by the ATO to you within the last 12 months showing your name and residential address Pension card issued by Centrelink (front and back copies) Notice from school principal showing name, residential address and period of attendance of person under 18 issued within previous three months If you cannot provide any of these documents or you are unsure how to complete your identification form please contact Zurich Customer Care on 131 551 for assistance. If your application includes a Rollover To enable Zurich to finalise your Rollover, the Fund from which you are transferring may require proof of identification to be provided together with either Transfer form on page 21, or with their Redemption Form. Please note that the processing of your Rollover may be delayed where you do not provide adequate identification. Where you have provided your TFN to the Fund from which you are transferring from, you will not have to provide certified proof of identity documents. Instead they will be able to validate your identity using the ATO s SuperTIC service. Where they are unable to validate your TFN, you will be required to provide a certified copy of ONE of the above photographic documents. For a complete list of persons who can certify copies of documents, please contact Zurich Customer Care on 131 551, or refer to the Zurich website, www.zurich.com.au How to certify a copy of a document The law requires that we receive certified copies of the identification documents you provide us. A certified copy is a document that has been certified as a true copy of an original document by certain persons. An example of a certified document: I, John Smith of 123 Park Street, Sydney NSW 2000 in the capacity of a Justice of the Peace certify that this copy is a true and accurate copy of the original. Signature: J. Smith Date: 1 / 3 /2018 Please note: any identification documents that are in a foreign language must be accompanied by an English translation from an accredited translator. once your plan has been established, if identification documents are being certified outside of the Commonwealth of Australia, generally speaking they may only be certified by an Australian consular officer (within the meaning of the Consular Fees Act 1955) or an Australian diplomatic officer. For further information on obtaining certification whilst overseas, please contact Zurich Customer Care on 131 551 (when calling from Australia) or +61 2 9995 1111 (when calling from overseas). Zurich Account-Based Pension Application Form Page 11 of 28
8. Identification information (continued) Who are Politically Exposed Persons (PEPs) Any individual: (a) who holds a prominent public position or function in a government body or an international organisation, including: Head of or head of country or government; government minister or equivalent senior politician; senior government official; Judge of the High Court or Federal Court of Australia, a Supreme Court of a or Territory, or a Judge of a court of equivalent seniority in a foreign country or international organisation; governor of a central bank or any other position that has comparable influence; or senior foreign representative, ambassador, or high commissioner; high-ranking member of the armed forces; or board chair, chief executive, or chief financial officer of, or any other position that has comparable influence in, any enterprise or international organisation; (b) who is an immediate family member of a person referred to in paragraph (a), including a spouse, de facto partner, child, child s spouse or de facto partner, or parent; (c) who is a close associate of a person referred to in paragraph (a), which means any individual who is known to have: joint beneficial ownership of a legal entity or legal arrangement with a person referred to in paragraph (a); or sole beneficial ownership of a legal entity or legal arrangement that is known to exist for the benefit of a person described in paragraph (a). Page 12 of 28 Zurich Account-Based Pension Application Form
Retirement Super Consolidator Retirement Super Consolidator Zurich Superannuation Plan Cash option Before you sign this application form, be aware that the application form must be included in, or must accompany a valid Product Disclosure ment (PDS) for the Zurich Account-Based Pension in accordance with legal requirements. The PDS will help you to understand the Zurich Account-Based Pension product and the Retirement Super Consolidator and decide if they are appropriate to your needs. Please ensure you read all parts of the PDS carefully before you sign this application form. This application form is dated 1 April 2018. Please ensure you complete the Zurich Account-Based Pension Application form which can be found on page 1 of this booklet. Please ensure you have read the Your privacy section in the ZSP/ZABP Fee Guide and Additional Information booklet before completing this form. Office use only SPIN ZUR0473AU Account Number Client Number Adviser s stamp Adviser Adviser No. Phone No. Please use BLOCK LETTERS and tick where applicable. Do you have a current Zurich investment? Yes No Is this account-based pension the result of an internal transfer from an existing Zurich investment? Yes No 1. Member details Title Surname Given name(s) Male Female Date of birth / / Residential address Postal address (if different to above) Contact details Work ( ) Home ( ) Mobile Email Zurich Account-Based Pension Application Form Page 13 of 28
2. Contribution details Step 1: Indicate the details and amount of your rollover (if any). Superannuation lump sum rollover details: Please ensure that your previous fund has been instructed to roll over your funds. For that purpose you can use the Authorisation to transfer superannuation benefits between funds form if required. Fund name Policy/Membership number Approximate amount of rollover $ $ $ Step 2: Nominate the type and amount of contribution (if any). Contribution details: Please indicate below the type and amount of each contribution you are making to the Retirement Super Consolidator. Contribution type Lump sum (single) amount Personal voluntary $ Self employed $ Spouse $ Please complete section 3 Total $ Please make cheque(s) payable to Zurich Australia Limited. All cheques must be in Australian dollars and drawn on an Australian bank. 3. Notice of intent to claim a deduction IMPORTANT: If you are eligible to claim a deduction for contributions made to the Retirement Super Consolidator, you MUST provide the trustee with a valid notice of intent to claim a deduction form before the establishment of your Zurich Account-Based Pension plan. A valid Notice of intent to claim a deduction form can be obtained: On the Superannuation Forms page on www.zurich.com.au By calling Zurich Customer Care on 131 551 On the ATO website, www.ato.gov.au (Google search ATO notice of intent to claim). Note: You can claim for a deduction for your personal superannuation contributions if, among other things, all of the following apply: you are still a member of your super fund when you give your fund trustee a valid notice in the approved form, on time; when you give your notice, your fund has not begun to pay an income stream (for example, a pension) based on part or all of the contributions for which you intend to claim a deduction; you have received acknowledgment from your fund of your intention to claim a deduction; and your fund has accepted your contribution for which you want to claim a deduction. Page 14 of 28 Zurich Account-Based Pension Application Form
4. Condition of release Please tick your required option. Account-Based pensions can only be purchased with unrestricted non-preserved superannuation lump sum money. Before your money can be transferred to the Zurich Account-Based Pension you will need to complete the following declaration. For conditions of release involving permanent incapacity or severe financial hardship, please contact Zurich Customer Care on 131 551. To the Trustee of the Zurich Master Superannuation Fund I have reached my preservation age and have ceased gainful employment and have no intention of ever again seeking to become gainfully employed either on a part time or full time basis OR I am age 60 or more and have ceased gainful employment on or after my 60th birthday OR I am age 65 or over. Date on which the above occurred / / 5. Establishment of the Zurich Account-Based Pension Please select either of the following options, by ticking the required option. Please establish my new Zurich Account-Based Pension once all superannuation monies (as shown in section 2) have been received and processed OR Please establish my new Zurich Account-Based Pension on / / (The specified date must be within 60 days of all your superannuation monies being received) 6. Declaration and acknowledgment I understand, in accordance with the conditions of the Trust Deed and Rules, that: Zurich Australian Superannuation Pty Limited is the Trustee for the Zurich Master Superannuation Fund; I understand that the Trustee may need to obtain further information and documents from me after the Trustee has received my application, during the course of my investment or while I am a member of the Fund; I understand that the Trustee can not issue units in the Fund and/or accept my application to become a member of the Fund until all the information and documents requested relating to my identity have been received and the Trustee has verified my identity. I understand that the Trustee may also need to identify me again as well as any person acting on my behalf, any person I am acting for, any person I request that the Trustee transfer my investment to or my legal personal representative (if I die) at any time after the Trustee has accepted my application or prior to the Trustee permitting a transaction such as a redemption or transfer of my investment; By applying to invest or become a member in the Fund, I also acknowledge that the Trustee may decide to delay or refuse any request or transaction, including by suspending the issue or withdrawal of units in the Fund, if the Trustee is concerned that the request or transaction may breach any obligation of, or cause the Trustee to commit or participate in an offence under, any law, and the Trustee will incur no liability to me if this occurs; Title to any policy effected on my life vests in the Trustee; I am precluded from using the plan as a collateral security; Benefits under this Fund are fully preserved until I have retired and attained my preservation age, or in circumstances as allowed by superannuation legislation or the Australian Prudential Regulation Authority; I can only make contributions to the Zurich Master Superannuation Fund in accordance with the appropriate legislation, as detailed in the Zurich Superannuation Plan and Zurich Account-Based Pension Fee Guide and Additional Information booklet. I hereby apply to Zurich Australian Superannuation Pty Limited, the Trustee of the Zurich Master Superannuation Fund, for membership of the Zurich Master Superannuation Fund as set out in the application form. In consequence of my application being accepted I agree to comply with the rules governing the Fund, and further certify that: I am eligible for membership of that Fund in accordance with the appropriate legislation; I understand that the number of units purchased will depend on the Unit Value of the Cash option at the date of purchase; I have read the PDS and all incorporated documents referred to in the PDS (current as at the date of my application); I agree that Zurich can provide confirmation of any reportable transactions by allowing me to access Zurich Customer Care or through my adviser. I understand that the Trustee is required to deduct from my investment any contributions tax which may be payable and that only the net after tax amount of my contribution will be invested; I understand that the total of my rollovers and contributions will be transferred to the Zurich Account-Based Pension according to my instructions in section 5. Member s signature Zurich Account-Based Pension Application Form Page 15 of 28
7. Your privacy Zurich is bound by the Privacy Act 1988 (Cth). In completing the forms or questions herein you will be providing us with your personal and, perhaps, sensitive information. Please refer to the Your privacy section in the ZSP/ZABP Fee Guide and Additional Information booklet. For a more detailed explanation of Zurich s Privacy Policy please visit our website at www.zurich.com.au or contact the Zurich Privacy Officer on 132 687 or email us at privacy.officer@zurich.com.au. 8. Adviser use only Please fill in the details below for each Adviser who has an interest in this Application form. Name Adviser No. Phone No. Fax No. 1. 2. Is this your first application with Zurich, or have you recently changed licensee? No Yes Please attach your business card to this application. Adviser declaration The information shown on the application accurately and completely records the information given. Adviser s signature Adviser 1 Adviser 2 Adviser Proof of Identity declaration By signing this declaration, I declare that the attached documents are true copies of the original or certified copies of the documents sighted and used by me to satisfy the applicable customer identification procedure requirements and I have complied with all the relevant obligations under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (Cth) and any associated rules or regulations as well as any Guidance Notes (including but not limited to any associated schedules) approved by The Financial Services Council ( FSC ) and/or the Financial Planning Association of Australia ( FPA ). Document(s) Document Number(s) Date verified / / Adviser s signature Print name Page 16 of 28 Zurich Account-Based Pension Application Form
Zurich Account-Based Pension Internal Seamless Transfer form This form is to be used when transferring superannuation benefits from the Zurich Deferred Annuity or from the Zurich Master Superannuation Fund ( the Fund ) to the Zurich Account-Based Pension. Please only supply the original of this form as Zurich is unable to process from an email, fax or photocopy. 1. Member/Investor details Title Surname Given name(s) Male Female Date of birth / / Residential address Postal address (if different to above) Contact details Work ( ) Home ( ) Mobile Email 2. Investment details Zurich investment number(s) 3. Transfer amount Full transfer of (approximate amount) $ OR Partial transfer of $ Important note: Any existing life insurance cover you have on the Zurich superannuation investment(s) being transferred will cease on the day of the transfer. 4. Source of contributions For the current financial year I confirm that the contributions to my exiting Zurich investment have been paid by: Myself as an eligible person (Please go to Section 5) My employer (including salary sacrifice contributions) and the balance by myself as personal contributions (Please go to Section 6) Myself as personal contributions only (Please go to Section 7) My employer only (including salary sacrifice contributions by my employer on my behalf) (Please go to Section 7) Zurich Account-Based Pension Application Form Page 17 of 28
5. Notice of intent to claim a deduction IMPORTANT: If you are eligible to claim a deduction for contributions made to your existing Zurich plan, you MUST provide the trustee with a valid notice of intent to claim a deduction form before the establishment of your Zurich Account-Based Pension plan. A valid Notice of intent to claim a deduction form can be obtained: On the Superannuation Forms page on www.zurich.com.au By calling the Zurich Customer Care on 131 551 On the ATO website, www.ato.gov.au (Google search ATO notice of intent to claim). Note: You can claim for a deduction for your personal superannuation contributions if, among other things, all of the following apply: you are still a member of your super fund when you give your fund trustee a valid notice in the approved form, on time; when you give your notice, your fund has not begun to pay an income stream (for example, a pension) based on part or all of the contributions for which you intend to claim a deduction; you have received acknowledgment from your fund of your intention to claim a deduction; and your fund has accepted your contribution for which you want to claim a deduction. 6. Paid by my employer and the balance by myself as personal contributions If the contributions were paid by your employer and the balance by yourself as personal contributions please complete this section. Of the $ contribution to (the Fund) during the period 1 July to 30 June I intend to claim $ as a tax deduction. Of this amount, please specify how much was paid by you as personal contributions, and how much was paid by your employer as employer contributions in order for us to process your redemption. $ paid by my employer $ paid by myself as personal contributions 7. Member declaration and discharge NOTE: Please return this original form as we are unable to process from an email, fax or photocopy. I declare that the information provided on this form and any supporting documentation is accurate, true and correct. Where the transfer represents a full transfer of my entitlement I agree that my receipt of that benefit constitutes a full and effective discharge from Zurich Australian Superannuation Pty Limited (the Trustee of the Fund) or Zurich Australia Limited (where applicable) of its obligations under the existing Zurich investments listed in section 2. Signature of investment owner 8. Your privacy Zurich is bound by the Privacy Act 1988 (Cth). In completing the forms or questions herein you will be providing us with your personal and, perhaps, sensitive information. Please refer to the Your privacy section in the ZSP/ZABP Fee Guide and Additional Information booklet. For a more detailed explanation of Zurich s Privacy Policy please visit our website at www.zurich.com.au or contact the Zurich Privacy Officer on 132 687 or email us at privacy.officer@zurich.com.au. Page 18 of 28 Zurich Account-Based Pension Application Form
9. Adviser Use Only Seamless transfer and exit fee waiving If an exit fee applies to the Zurich superannuation investment(s) to be transferred this exit fee may be waived upon transfer to the Zurich Account-Based Pension. This transaction is called a seamless transfer. A seamless transfer is effected when the account balance of an existing nil entry fee Zurich superannuation investment is transferred to a new account-based pension. No remuneration is paid on transfer and the withdrawal fee period under the new account-based pension takes into account the period elapsed in the previous Zurich superannuation investment (i.e. the withdrawal fee period does not restart upon transfer). However the remaining withdrawal fee period and the percentage withdrawal fee applicable will generally change (based on the account-based pension fee structure). Please note that there may be circumstances where existing Zurich superannuation investments may not qualify for a seamless transfer. If any amount of remuneration is to be paid on transfer any exit fee that applies to the Zurich superannuation investment(s) to be transferred will be payable at the time of transfer and the investment will not qualify for a seamless transfer. Please contact Zurich Customer Care on 131 551 to check the seamless transfer availability and details for a specific investment or if you are unsure of whether your client s existing Zurich superannuation investment qualifies for a seamless transfer. Adviser name Adviser no. Phone no. ( ) Fax no. ( ) Adviser s signature Questions? Call 131 551. Please send your completed application form to: Zurich Customer Care, Locked Bag 994, North Sydney, NSW, 2059 Zurich Account-Based Pension Application Form Page 19 of 28
This page left blank intentionally. Page 20 of 28 Zurich Account-Based Pension Application Form
Zurich Account-Based Pension Authorisation to transfer superannuation benefits between funds Use this form if you want to transfer monies from your previous superannuation fund to your new Zurich Account-Based Pension or to the Retirement Super Consolidator. Important notes Please make sure you sign the authorisation over the page. Please complete all details on this form. Transfers cannot be made if the previous fund details are different from the information you complete on this form. If transferring from more than one fund, photocopies of this form will be accepted. We recommend that you talk to your adviser if the superannuation accounts you wish to transfer: have any life cover attached; were recommended to you by an adviser; if an exit fee is charged by your previous fund (if unsure please check with your previous fund for details of your benefit entitlement); or if you expect that further employer contributions may be made to your previous fund, for example, if you are still working casually in that industry and your employer contributions can only be made to that fund. Please note: The Fund which you are transferring will require you to attach certified identification to this form. For details of identification requirements, please refer to page 11. 1. Personal details Zurich Master Superannuation Fund Unique Superannuation Identifier (USI): 33 632 838 393 987 Account number Title Surname Given name(s) Male Female Date of birth / / Residential address Contact details Work ( ) Home ( ) Mobile Email 2. New fund details Please transfer monies from my previous superannuation fund to: The Retirement Super Consolidator (i.e. new Zurich Superannuation Plan Cash option account) My new Zurich Account-Based Pension Zurich Account-Based Pension Application Form Page 21 of 28
3. Transferring fund details To ensure this transfer occurs as promptly as possible please complete as much information as possible. Fund name Transferring Superannuation Fund Unique Superannuation Identifier Number (USI): Policy number/membership number Address of fund Telephone number ( ) Full transfer of (approximate amount) $ OR Partial transfer of $ Name of administration company (if known) Name of employer contributing to this fund Date I left that employer (if applicable) / / My personal details when I belonged to the previous fund were: 1) if any of your details are the same as this ZABP application, you don t have to write them again 2) if there has been a name change, please provide certified evidence of the name change. Title Surname Given name(s) Address 4. Applicant s authorisation I request and authorise the Trustee of the transferring fund to transfer any benefits (including any superannuation contributions received in respect of me after I have ceased to be a member of the transferring fund) to the Zurich Master Superannuation Fund. I understand that the Trustee of the transferring fund is discharged from any further liability in respect of any amount once benefits have been transferred. I understand that both superannuation funds are complying superannuation funds under the Superannuation Industry (Supervision) Act. I understand that in certain cases Zurich Australian Superannuation Pty Limited and Zurich Australia Limited may be required by law to deduct tax from the untaxed portion, if any, of the Superannuation Lump Sum transferred from the previous fund. I approve the deduction of transfer fees (if any) from the benefits transferred (subject to legislative restrictions). I understand that any life insurance cover under the transferring fund may automatically cease upon transfer of my benefits from that Fund. I authorise both superannuation fund trustees to provide information about me to each other for the purpose of this transfer; and I understand that I may ask the transferring fund trustee for information I reasonably require about any benefit entitlements I may have in the transferring fund (including information about any fees that may apply to the rollover and information about the effect of the rollover on any benefit entitlements) and I confirm that I have obtained any information that I require. Applicant s signature 5. Your privacy Zurich is bound by the Privacy Act 1988 (Cth). In completing the forms or questions herein you will be providing us with your personal and, perhaps, sensitive information. Please refer to the Your privacy section in the ZSP/ZABP Fee Guide and Additional Information booklet. For a more detailed explanation of Zurich s Privacy Policy please visit our website at www.zurich.com.au or contact the Zurich Privacy Officer on 132 687 or email us at privacy.officer@zurich.com.au. Page 22 of 28 Zurich Account-Based Pension Application Form
6. Trustee declaration The Trustee of the Zurich Master Superannuation Fund, Zurich Australian Superannuation Pty Limited ABN 78 000 880 553 AFSLN 232500, confirms that the Zurich Master Superannuation Fund: Is a complying superannuation fund as defined under Section 42 of the Superannuation Industry (Supervision) Act 1993 (the Act); Is a resident regulated superannuation fund as defined under Section 10 of the Act; Is not subject to a direction under Section 63 of the Act, nor does it expect to receive a direction under this Section. Further, the Trustee confirms that the Trust Deed governing the Zurich Master Superannuation Fund will accept transfers and rollovers from other complying superannuation funds and that such transfers and rollovers will be preserved in accordance with the Act (if required). David Hallahan, Company Secretary Zurich Australian Superannuation Pty Limited 7. Applicant s authorisation to release information I hereby authorise you to release details to Zurich Australia Limited of the rollover/transfer of my superannuation funds currently held by you to the Zurich Master Superannuation Fund SFN 2540/969/42 for the purposes of obtaining the current status and progress of my transfer request. Applicant s signature 8. To the paying institution Electronic transfer: Please note the Zurich Master Superannuation Fund s USI is 33 632 838 393 987. Payment by cheque: Please make cheque payable to: Zurich Australia Limited and post to: Zurich Customer Care, Locked Bag 994, North Sydney NSW 2059 Please use the following relevant Superannuation Provider Identification Number (SPIN) (where applicable) based on the selection made in section 2 of this form: Retirement Super Consolidator Zurich Account-Based Pension ZUR0473AU ZUR0469AU Office Use Only Date received / / Date actioned / / Applicant s signature checked Yes No Previous Fund authorised Yes No Zurich Account-Based Pension Application Form Page 23 of 28
This page left blank intentionally. Page 24 of 28 Zurich Account-Based Pension Application Form
Zurich Account-Based Pension Application Form Page 25 of 28