Salary Packaging Application

Salary Packaging Application Employee Information Title First Name Last Name Address Suburb State Post Code Home Phone Work Phone Mobile Work Email Home Email Employer Name Your next pay date / / Employment Status Casual Part Time Full Time Do you have a HECS/HELP loan? Yes No Gross Annual Salary Payroll Cycle Weekly Fortnightly Monthly Other Salary Package Allocation Benefit Item Allocation per pay Notes General Expenses (e.g. mortgage, personal loans, rent, Everyday Purchase Card, etc.) 1 Meal & Accommodation Card 2 FBT Free Expenses 3 Total Allocation (excluding administration fees) 4 Notes 1. These payments relate to expenses which typically do not incur GST (e.g. mortgage, rent, personal loans). The maximum allocation should not exceed $15,900 per FBT year (01/04 31/03). 2. You must complete a separate Westpac Employee Benefit Card Cardholder Request form. The maximum allocation should not exceed $2,550 per FBT year (01/04 31/03). 3. These payments relate to expenses which are not subject to FBT (e.g. laptops, self-education expenses, income protection insurance, professional subscriptions/memberships). There is no minimum or maximum allocation for these items 4. The total allocation includes all listed expenses. Any applicable administration fees will be added to your total allocation. Please refer to page 13 of your Salary Packaging Handbook for a list of all applicable fees Page 1 of 6

General Living Expenses $15,900 per annum Option A: Direct Expense Payments These payments have a regular instalment amount, occur on a regular basis and are included within the $15,900 FBT limit. i.e. Mortgage Repayments Personal Loan Repayments Rental Payments Credit Card Payments Regular Payments Type of Expense (e.g. Mortgage Repayments) Payment to Address of Payee Bank: Branch: EFT Details (copy of bank statement required to verify details) Bpay Details (copy of bank statement required to verify details) Account Name: BSB - Account Number Bank: Account Name: Biller Code Biller Reference Yes, I have attached copies of all supporting documentation which confirms the type of general expense I wish to package, including cost and payment method Option B: Everyday Purchase Card The Everyday Purchase Card is a Westpac VISA credit card issued by Simplygreen and allows you to package most of your living expenses, such as electricity, gas, water and everyday shopping. Using this card means you don t need to keep receipts and all of your expenses remain tax compliant. Your fortnightly payroll contribution is transferred to your card and available to you within 48 hours of Simplygreen receiving the funds from your Employer. Yes, I would like to order an Everyday Purchase Card and have completed the Westpac Card Application form Yes, I understand that there are Westpac annual fees associated with this card, which will be automatically deducted from my first fortnightly contribution No, I do not require an Everyday Purchase Card Page 2 of 6

Meal Entertainment & Accommodation $2,550 per annum Meal & Accommodation Visa Credit Card The Meal & Accommodation Card is a Westpac VISA credit card issued by Simplygreen and allows you to package expenses related to meal entertainment, accommodation & venue hire. Your fortnightly payroll contribution is transferred to your card and available to you within 48 hours of Simplygreen receiving the funds from your Employer. Yes, I would like to order a Meal & Accommodation Card and have completed the Westpac Card Application form Yes, I understand that there are Westpac annual fees associated with this card, which will be automatically deducted from my first fortnightly contribution No, I do not require a Meal & Accommodation Card FBT Free Expenses FBT Free and otherwise deductible Expenses These payments are for expenses that may not have a fixed instalment amount, or do not occur on a regular basis. Payments will be made on receipt of a completed Reimbursement Claim Form, ie: Laptop computers/ipads and similar tablet devices used predominately for work Work related Mobile phone expenses Airport Lounge Memberships Self-Education Expenses Professional Subscriptions/Memberships Reimbursement Payments Type of Expense Payment to Address of Payee Bank: Branch: EFT Details (copy of bank statement required to verify details) Account Name: BSB - Account Number Yes, I have attached copies of all supporting documentation which confirms the type of expense I wish to package, including the estimated annual cost. Page 3 of 6

Employee Declaration I understand and accept the terms and conditions detailed in this document. In addition, I understand and declare that: 1. I will be ineligible to claim a tax deduction for all salary packaging payments made in relation to otherwise deductible items 2. I will meet any cost including FBT liability arising from the implementation of my salary package. 3. I acknowledge that my Employer has recommended that I obtain financial advice prior to commencing salary packaging. 4. I will provide substantiation documents to Simplygreen upon their request. This may include the following: Mortgages/Loans: Schedule of repayments from your bank Rent: Payment Schedule or Rental Agreement from your Real Estate Agent Credit Cards: Full statement of purchases to the value required Receipts: In your, your spouse, or joint names Employee Name (print): Employee Signature: Date: / / Send your completed Forms to: Email support@simplygreen.com.au Or Fax 03 9249 9600 Page 4 of 6

Salary Packaging Terms & Conditions Your employer has engaged Simplygreen Australia Pty. Ltd. ( Simplygreen ) to provide Salary Packaging Services to eligible employees. Simplygreen will only provide Salary Packaging services to you on the basis that it is approved by your employer to be eligible to participate in the salary packaging program. Simplygreen will only provide salary packaging for those benefits identified in an approved list (Ref. Salary Packaging Manual). Term Simplygreen will provide Salary Packaging Services to you from the commencement date and shall continue for a period of time during which you elect to have your salary packaged administered by Simplygreen. Salary Packaging (In Advance) A salary packaging arrangement must be entered into before you provide the services for which your Employer will pay salary and wages. Application Forms / Substantiation Documentation To commence salary packaging you are required to complete a Salary Packaging Application Form. Reimbursements and Regular Benefit Payments will only be processed upon receipt of the signed Application form, approved Payroll Deduction Schedule and the appropriate substantiation documentation. You must guarantee that all information supplied to Simplygreen by you is true, complete and accurate in all respects and that you will notify Simplygreen immediately of changes to such information. Acknowledgements / General Conditions You acknowledge that; Prior to entering into salary packaging you should have sought independent qualified financial advice as the complexities of salary packaging can have a significant impact on your financial situation. Benefit payments and reimbursements will only be made by Simplygreen where it has received the expected payroll deductions for which you have submitted an appropriate payroll deduction authority. The payroll deductions must match the salary packaging deduction request indicated on the Payroll Deduction Schedule. Should a discrepancy exist between payroll deductions received by Simplygreen and payments requests, Simplygreen will notify you and your employer within forty-eight (48) hours of such a finding. Should insufficient funds be available to cover a payment transaction, no benefit payment will be made until sufficient funds have been received. Simplygreen will notify you and your employer within forty-eight (48) hours of such a finding. To be eligible to recover the Goods and Services Tax (GST) paid on a benefit you will be responsible to ensure that a Tax Invoice is obtained and submitted. A Tax Invoice must contain: The ABN of the entity issuing it; The GST inclusive price of the supply; The words tax invoice stated prominently; The date of issue; The name of the supplier and the recipient; The address or ABN of the recipient; A brief description of each item supplied; and For each description the quantity of the goods or the extent of the services provided. Should there be any changes to the employees personal details which Simplygreen hold on file (i.e. mailing address, bank account etc.) or changes to regular payment benefits (i.e. increases to insurance premiums, Page 5 of 6

etc.) Simplygreen must be notified by you in writing within five working days, or sooner if a benefit payment is required within this time frame. Where there are changes to the rate of GST, FBT or any other taxes or duties levied on Salary Packaged Benefits, or the manner in which all taxes and duties are calculated, your Total Employment Cost (TEC) established by your Employer will not increase as a result of such changes. Therefore, you will be required to meet the cost impost of such increases under the terms and conditions of the salary packaging arrangement. If surplus funds remain in your salary packaging account following a repayment or reimbursement transaction and you have no further salary packaging transactions to be undertaken upon written request, surplus funds will be passed back to your Employer for payment to you as ordinary salary and wages. The amount will be assessable as income and subject to income tax at your marginal tax rate. To be eligible to salary sacrifice work related items, you must use the work related items primarily for work purposes Additional superannuation contributions will only be made to a complying superannuation fund that complies with the Superannuation Industry (Supervision) Act and Regulations. It should also be noted, that your Employer may impose limits on the amounts of salary packaging for superannuation based upon the Australian Tax Office (ATO) Age Based Contribution Limits. In the event that your employment ceases with your Employer you agree to provide to Simplygreen written notification of such termination of employment as soon as is practicable. Upon the termination of employment or the cessation of you receiving a salary package benefit for any other reason, Simplygreen will cease the provision of services in respect of you, or in the case of ceasing a salary packaged benefit, cease provision of the benefit and any further payments to suppliers/vendors. On the cessation of benefits or salary packaging Simplygreen will issue a statement of the total balances outstanding. A credit balance will be passed back to your Employer for payment to you. This amount will be assessable as income and subject to income taxed at your marginal tax rate. Debit balances will be paid to Simplygreen forthwith on the receipt of statement. It should be noted that were employment is terminated and there is a debit balance in your salary packaging account, the debit balance must be paid from after-tax salary and wages (i.e. it cannot be salary packaged). The fees outlined in the Salary Packaging Handbook are the Employers Costs, however, in accordance with the Salary Packaging Handbook, the fees will be recovered from your package as a cost recovered by your Employer in the administration of your salary package. Simplygreen maintain the right to increase administration fees at its discretion and notify your employer and you in writing and by publication on the Simplygreen website. Leave Should you be absent from your employment on leave with full pay then deductions will continue to be made and benefits provided during the period of leave. Should you take leave of absence without pay from your employment then deductions cannot be made as you are not receiving salary. You will need to arrange payments from your own resources for this period. Simplygreen would require written notice from you prior to taking leave without pay. Privacy Notice You do not have to provide your personal information on this form. We collect and use personal information for the various purposes, including for contacting and communicating with you, research, marketing and business development. We may disclose the information for the purpose of providing products and services to customers, and as required by law. We may disclose information to third parties including parties located overseas. You may request access to personal information we hold about you or make a complaint by sending an email to info@simplygreen.com.au or contacting us by phone on 1300 664 323. For more information about our privacy practices you may visit our website where our Privacy Policy is available to be viewed in full. Page 6 of 6