Application to transfer super benefits to a KiwiSaver scheme Use this form if you want to transfer your full benefit to a KiwiSaver scheme account. NOTE: You can only start the transfer process once you have permanently emigrated to New Zealand and you have opened a KiwiSaver scheme account that will accept your Australian superannuation benefit. Please use a dark pen and CAPITAL letters, or type directly into this form online, print it and send it to us. Use ( ) to mark boxes. Forms are located on our website at firststatesuper.com.au/ forms. If you have any questions, please call us on +61 2 4298 6049. * Please provide a certified copy of a utility bill for basic household amenities, such as water, electricity or gas, providing evidence of your name and current address in New Zealand. 1. Your personal details Member number Account number Date of birth (DD-MM-YYYY) F S S U Title Last name Given name(s) Last residential address in Australia Suburb State Postcode Permanent address in New Zealand* City/town Postcode Daytime contact number Mobile number Email (for security reasons, please ensure that your nominated email address is your personal email address and not a role-based email address such as employee_title@company.com.au) You must open the KiwiSaver account before requesting a transfer. We will need to confirm that the scheme is registered. 2. Receiving KiwiSaver scheme account details Name of KiwiSaver scheme Postal address of KiwiSaver scheme (please provide an original letter from the KiwiSaver scheme, or any scheme documentation that shows the scheme's postal address) City/town Postcode Cheques to the KiwiSaver scheme will be issued in Australian dollars. You may be charged a conversion fee by the receiving scheme. Country Contact number Email KiwiSaver scheme registration no. (from your KiwiSaver provider) KiwiSaver account number Your Inland Revenue Department (IRD) number page 1 of 4
3. Privacy of information The personal information provided on this form is collected by and held for First State Super by the fund administrator, Mercer Administration, in accordance with the Australian Privacy Principles of the Privacy Act 1988 (Cth), for the purpose of administering accounts and providing services associated with fund membership. For further information about how personal information is handled, please call us on +61 2 4298 6049 or visit firststatesuper.com.au/privacy to view the privacy policy (a hard copy of the policy may also be provided on request). The policy contains information about access to and correction of personal information, how a complaint can be made about a privacy breach and other important information about how personal information is collected, used and disclosed. Please see Witnesses for a statutory declaration on page 4 for more information on the qualifications required to witness each type of statutory declaration. 4. Statutory declaration You can make a statutory declaration under the Commonwealth of Australia Statutory Declarations Act 1959 or under the New Zealand Oaths and Declarations Act 1957. Please tick the appropriate declaration and ensure the appropriate witness for the declaration is used. I, make this declaration under the Commonwealth of Australia Statutory Declarations Act 1959. I am a former resident of Australia and I have emigrated permanently to New Zealand I have elected to open a KiwiSaver scheme account and transfer my superannuation benefits from Australia to New Zealand I request and consent to the payment of my full superannuation benefit to the nominated KiwiSaver account I have sufficient information to make an informed decision about the transfer of my benefit from First State Super I understand that a $36 exit fee will be applied to my transfer and any insurance cover I hold through the fund will cease I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under Section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this form are true in every particular. OR I, solemnly and sincerely declare that: I am a former resident of Australia and I have emigrated permanently to New Zealand I have elected to open a KiwiSaver scheme account and transfer my superannuation benefits from Australia to New Zealand I request and consent to the payment of my full superannuation benefit to the nominated KiwiSaver account I have sufficient information to make an informed decision about the transfer of my benefit from First State Super I understand that a $36 exit fee will be applied to my transfer and any insurance cover I hold through the fund will cease I make this solemn declaration conscientiously believing the same to be true and by virtue of the New Zealand Oaths and Declarations Act 1957. Declared at this (eg. 13th) day of (month) in the year You and your witness must sign this form on the same day. Signature of member Date (DD-MM-YYYY) page 2 of 4
4. Statutory declaration (continued) Please see Witnesses for a Statutory Declaration on page 4 for eligible witnesses. Before me (print name of witness in BLOCK LETTERS) Signature of witness Date (DD-MM-YYYY) Qualification of witness Address City/town Postcode Country Please see the Providing proof of identity fact sheet on our website for alternate Australian issued documents that can be used to prove your identity. 5. Proof of identity You must provide certified proof of identity before your funds will be released, unless you have already provided this information. If any of your personal details (i.e. name and/or address) have changed you will need to submit an updated certified copy of a proof of identity document to us. The document you provide must come from our list of identity documents and must show your new personal details (e.g. if you have moved, the new document you provide must include your new address). We can request current certified copies of proof of identification documents if this is considered necessary. Primary identification documents Please forward a certified copy of ONE of the following documents (see the Providing proof of identity fact sheet for certification requirements): a current passport, similar travel document or national identity card (issued by an Australian or foreign government or the United Nations) containing your photograph and signature* a current drivers licence issued by an Australian or foreign government containing your photograph* * Documents not written in English must be accompanied by an English translation prepared by a translator accredited by the National Accreditation Authority for Translators and Interpreters Ltd (NAATI). Send the form to this address. 6. Where to send your completed form Return the completed form to First State Super PO Box 1229 Wollongong NSW 2500 Australia. page 3 of 4
Notes Witnesses for a statutory declaration If you are outside Australia, see Who can certify? on the first page of the Providing proof of identity fact sheet attached for details of people eligible to witness an Australian Statutory Declaration. Only certain people may witness a New Zealand statutory declaration. A list of people who can be witnesses is set out in Section 9 to the New Zealand Oaths and Declarations Act 1957 which can be accessed via the following link: http://www.legislation.govt.nz/act/ public/1957/0088/latest/dlm314553.html Tax file number Under the Superannuation Industry (Supervision) Act 1993, your superannuation fund is authorised to collect your TFN, which will only be used for lawful purposes. These purposes may change in the future as a result of legislative change. The trustee of your superannuation fund may disclose your TFN to the Commissioner of Taxation or to another superannuation provider when your benefits are being transferred, unless you request the trustee of your superannuation fund in writing that your TFN not be disclosed to any other trustee. It is not compulsory to provide your TFN but if you don t, you may pay additional tax and your contributions may not be accepted. Checklist Have you confirmed that your New Zealand KiwiSaver account can accept a transfer of your super money? Have you enclosed a certified copy of a utility bill? Have you enclosed an original letter/document from the KiwiSaver scheme showing their postal address? Have you had your statutory declaration witnessed by an authorised witness for the relevant statutory declaration? Have you enclosed a copy of a listed proof of identity document(s), certified by an authorised certifier? page 4 of 4
Fact Sheet Providing proof of identity (for members outside Australia) To protect your benefit entitlement and ensure your privacy is maintained, we need certified documentation verifying your identity before we can process certain requests. These are some of the transaction requests that must be supported by certified proof of identity (CPOI): 5 You wish to apply for a benefit payment or transfer, which includes a transfer to another fund if you don t provide your tax file number or the other fund is a self-managed super fund 5 You wish to apply to open an income stream account 5 You wish to advise a change of name. If you are transferring money from another find, they may also require POI documents if you haven t provided your TFN to that fund or they are unable to verify your identity. These documents should be sent directly to your other fund. Providing certified proof of identity is a three-step process: 1 Collect your originals Acceptable documents for the purpose of verifying your identity are: 5 a current passport, similar travel document or national identity card (issued by an Australian or foreign government or the United Nations) containing your photograph and signature; or 5 a current driver s licence issued by an Australian or foreign government containing your photograph. If you are an Australian citizen or only temporarily out of Australia, there are a number of other documents which, if issued in Australia, can be used to verify your identity. The fact sheet Providing proof of identity on our website has details. Documents not written in English must be accompanied by an English translation prepared by a translator accredited by the National Accreditation Authority for Translators and Interpreters Ltd (NAATI). 2 Photocopy your originals 3 Have your photocopies certified true and correct Who can certify? Take your photocopies and your original documents to a person who can certify documents. Only certain people may certify personal identity documents. Outside Australia, you can have copies of your documents certified by consular staff at an Australian: 5 Embassy 5 High Commission 5 Consulate. Visit the Australian Department of Foreign Affairs and Trade website at dfat.gov.au for a listing of these offices by country. You may be charged a fee for this service. If you are unable to reach an Australian Embassy, High Commission or Consulate, your documents can be certified by a notary public. Otherwise, certain professionals who work in Australia can certify and witness documents overseas. A list of these professionals is included at the back of the Commonwealth Statutory Declaration, which you can obtain from the Australian Attorney General s website at www.ag.gov.au. For instance, a doctor who is registered to practise medicine in Australia may witness or certify your documents when overseas but a doctor who is registered to practise medicine in a foreign country (and not in Australia) cannot. How to certify? All copied pages of original documents (including any change of name documents) need to be certified as true copies by an authorised person. The authorised person must see both the original and the copy in order to ensure both documents are identical, then certify each page by writing I certify that this document is a true copy of the original, followed by their signature, printed name, qualification (e.g. notary public), registration number (if applicable) and date. If the certification is not in English, it must be accompanied by an English translation prepared by a translator accredited by the National Accreditation Authority for Translators and Interpreters Ltd (NAATI). Module 3.12a Managing POI outside Australia 1
Fact Sheet Providing proof of identity (for members outside Australia) Have you changed your name? If you have changed your name, you will need to provide a certified copy of the document that links the name in our records to the name on your identity document(s). The linking document must be issued by a government department or agency, and if not in English, accompanied by an English translation prepared by a translator accredited by the National Accreditation Authority for Translators and Interpreters Ltd (NAATI). If the name we hold for you is incorrect, but not as a result of a change, you will need to provide a Commonwealth Statutory Declaration outlining the reason for this difference and include a list of all names you are known by. You can download a Commonwealth Statutory Declaration from the Australian Attorney General s website at www.ag.gov.au. The Statutory Declaration must be witnessed by an authorised person who can certify personal identity documents. See Who can certify? on page 1. After considering the reason(s) you provide, we may require additional documents before we can confirm your identity and process your application. Service and advice Phone +61 2 4298 6049 Email enquiries@firststatesuper.com.au Web firststatesuper.com.au Post PO Box 1229 Wollongong NSW 2500 This is general information only and does not take into account your specific objectives, financial situation or needs. You should consider the Member Booklet (Product Disclosure Statement) for the product you hold or intend holding before making any decisions. Call us on 1300 650 873 for a copy, free of charge, or visit firststatesuper.com.au. FSS Trustee Corporation (FTC) ABN 11 118 202 672, AFSL 293340, the trustee of the First State Superannuation Scheme (First State Super) ABN 53 226 460 365. M3.12a_PROOFIDOUTAUST_06/17 Module 3.12a Managing POI outside Australia 2