Preserved benefit Age claim form and information leaflet
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
PBA
05/11 Preserved benefit
Age claim form and information leaflet
Before completing this benefit application form, you are advised to read the PSS Product Disclosure
Statement at www.pss.gov.au or call 1300 000 377.
The attached benefit application form should be completed by preserved benefit members of the Public
Sector Superannuation (PSS) Scheme who are claiming payment of their preserved benefit having both
reached age 55 and retired from the workforce.
Your Government Super at Work
Any financial product advice in this document is general advice only and has been prepared without taking account of your personal objectives, financial situation or needs.
Before acting on any such general advice, you should consider the appropriateness of the advice, having regard to your own objectives, financial situation or needs. You may wish
to consult a licensed financial advisor. You should obtain a copy of the PSS Product Disclosure Statement and consider its contents before making any decision regarding your super.
Commonwealth Superannuation Corporation (CSC) ABN: 48 882 817 243 AFSL: 238069
RSEL: L0001397 Trustee of the Public Sector Superannuation Scheme (PSS) ABN: 74 172 177 893 RSE: R1004595
1 of 14Explanatory notes The benefit application form
Your accurate completion of the benefit
application form allows us to process the
Read this first! application as soon as possible after a claim has
been made. Take care when completing this form.
These explanatory notes are intended to assist If you do not complete the benefit application
you to complete the attached benefit application form correctly, the processing of your benefit will
form. They are not intended to provide a detailed be delayed, or may be paid incorrectly.
explanation of your benefit options.
It is suggested that you separate the notes from the
form (if joined) so that you can refer to them as Section A – Personal details
you complete the application form.
Please complete all the boxes in this section. It
enables us to identify you and any other potential
beneficiary, and tells us where we can contact you.
Where can you find out
Relationship details
more about your benefit
Details of your relationship status, including same
entitlements? sex or opposite sex de facto relationships, should
There are many publications provided by the be provided. You may wish to include a copy of
Commonwealth Superannuation Corporation your marriage certificate or registered relationship
(CSC) that explain the various benefit options certificate with your application. This would speed
which are available to you. Before completing this up the process in the event that a spouse’s benefit
benefit application form, you are advised to read becomes payable.
the PSS Product Disclosure Statement available
For the definition of a spouse for death benefits, see
at www.pss.gov.au or call 1300 000 377.
the Death benefits fact sheet at www.pss.gov.au.
There are also fact sheets on Tax and your PSS
benefit and Preservation of benefits which you Contact details
should read. These are available from us or from The postal address you provide is where all
the PSS website at www.pss.gov.au correspondence will be sent.
Other sources of information include A contact phone number is also required in case
the following: we need to contact you regarding the payment of
>> Our Call Centre can provide details of your your benefit.
benefit entitlement, explain the benefit options If you have an email address, inclusion of your
and provide information on the value of your current email address will be helpful.
prospective benefits. For more information:
Telephone: 1300 000 377
Facsimile: (02) 6272 9613
Section B – Identification
Email: members@pss.gov.au requirements
>> It is in your interest to seek professional advice To protect against fraud, money laundering,
before you make a decision on a benefit. terrorism financing and safeguard your benefit, we
We cannot provide you with financial advice. need you to provide documentation to prove your
identity before we can process your benefit request.
You need to provide certified copies of four
Forms you need to complete identifying documents listed in Section 2 on
when claiming your PSS the application form. The person certifying the
documents must attest that the documents are
preserved benefit true copies, and that you are the valid holder of the
identification.
>> the attached benefit application form
We will store copies of identification electronically
>> If you have chosen to receive all or part of your
in a secure environment and securely destroy the
benefit as a pension and you wish to claim
paper copies. We will use all copies only for the
the tax free threshold and/or any available
purpose of confirming your identity.
offsets and deductions against your pension
benefit, you should complete a Tax file If you are providing copies of bills or statements,
number declaration form, obtainable from the you should black out any personal financial
Australian Taxation Office (ATO), or designated information or details of transactions in order to
newsagents that distribute ATO forms. protect your privacy.
Your Government Super at Work
2 of 14Section C – Employment The claim date for payment of your preserved
benefit must be a date that occurs after you have
details met both of the eligibility requirements set out
above. You must claim your benefit once you
You must sign the Employment status declaration
reach age 65.
in all cases. Note: There are penalties for making
false declarations in respect of claims for benefits. The date of claim cannot be earlier than the
date you complete this application and must be
‘Retiring from the workforce’ a date NO LATER than 60 days after the date of
Members who are ‘gainfully employed’ within completing this application.
the meaning of the Superannuation Industry Section 5 is where you nominate the date from
(Supervision) Act 1993 (SIS Act) for at least which you would like to claim your PSS preserved
10 hours per week, are taken as having remained benefit on age grounds. Any pension benefit
in the workforce. commences with effect from the day after the
claim date.
Section D – Information What are your entitlements?
acknowledgment If the full value of your benefit remains preserved
in the PSS, you are entitled to claim your benefit as:
Please complete this acknowledgment that
you have received and understood sufficient >> a fully indexed pension
information to be able to make an informed choice >> a pension and lump sum combination
of how you would like your benefit paid and that
you have been advised to read the PSS Product or
Disclosure Statement before completing >> a lump sum benefit.
this form.
If you have previously elected for a refund of part
You are making a formal election under the of your PSS benefit, you are only entitled to receive
provisions of the Superannuation Act 1990. your preserved benefit as a lump sum amount.
This election is binding and cannot normally
be changed, although CSC may, at its absolute Transfer amounts paid to the PSS
discretion, agree to cancel an election in
certain circumstances. The treatment of your transfer value amount paid
into the PSS is dependent upon when it was paid.
Information sources are shown at the start A transfer amount paid after 31 December 1995 is
of these explanatory notes and it is strongly treated differently to an amount paid before that
recommended that you make use of them before date, unless it is related to:
proceeding to complete this application form.
>> employment during a period of LWOP
You should also note that, if your benefit has been that commenced
changed and you then change your mind about
the benefit payment arrangements, a fee will be or
charged by us for the reissuing of the payment. >> prior employment that ceased, before
1 January 1996.
Section E – Eligibility Transfer value amounts paid to the PSS before
1 January 1996
requirements, claim date and Generally, your transfer amount will be treated as
overview of entitlements part of your total benefit and will be paid exactly as
you have elected. For example:
Eligibility
>> if you choose to receive your total benefit as a
To be eligible to claim your PSS preserved benefit pension (Option 1), any transfer amount(s) will
you must have both: also be paid as a pension
>> attained 55 years of age >> if you choose a pension/lump sum
>> retired from the workforce. combination (Option 2), we will pay your
transfer amount(s) in the same ratio of pension
Claim date to lump sum as the rest of your benefit,
You must provide a claim date when completing or
your benefit application form. If you do not
>> if you choose to receive your total benefit as a
nominate a date the benefit application form
lump sum, any transfer amount(s) will also be
will be returned to you.
paid as a lump sum.
Your Government Super at Work
3 of 14If you want to receive your transfer amount in any It is therefore, strongly recommended that you
other form or combination (i.e. the main benefit read the PSS fact sheet Tax and your PSS benefits
as a pension and transfer amount as a lump sum) and/or consult a licensed financial adviser to assist
you should contact us, before completing the you in making a decision as to which arrangement
application form attached to this leaflet, to obtain suits your situation.
an SR-Supplement.
If you have an outstanding surcharge debt, you
The supplement contains additional elections for will have to make an election on the repayment
transfer amounts and should be completed and option to apply. If deducted from your lump sum,
attached to the main application form. the surcharge is deducted before tax is applied.
If deducted from the pension, there will be a
Transfer value amounts paid to the PSS after reduction in the amount of pension payable for
31 December 1995 the life of the pension.
Most transfer amount payments made to the PSS Your benefits will be paid in accordance with your
after 31 December 1995 are not included in the instructions at Section 8. You should also complete a
calculation of your final benefit accrual and remain Tax file number declaration form (see Section I).
identified as a separate lump sum, referred to as
an Accumulated Transfer Amount. This amount Option 3—lump sum only, no pension
cannot be converted to pension. This amount can If you want to take your entire benefit as a
either be rolled over or taken in cash. lump sum, either in cash or as a rollover to another
Unless you advise us otherwise, we will pay fund or retirement savings account (RSA), select
the transfer value to the bank account you this option.
have nominated for your pension or lump sum Any outstanding surcharge debt will be deducted
payment. If you have elected to rollover your from the lump sum before it is paid.
benefit, we will pay the transfer value to your
rollover fund. The benefit will be paid in accordance with your
instructions in Section H.
Section F – Benefit options
Section G – Election for
Option 1—pension only, no lump sum (only
available if all of your benefit remains preserved in reduced initial pension benefit
the PSS)
in return for increased spouse
If you want to receive your entire benefit as a
pension, select this option. and/or children’s pension
Any outstanding surcharge debt will be deducted benefit
from your pension entitlement through the This section only applies to you if you are claiming
application of pension reduction factors. all or some of your benefit as a pension (ie Benefit
The result will be a reduction in the amount of Options 1 or 2).
pension payable for the life of the pension.
The PSS Rules give contributing and preserved
Your benefits will be paid into the bank account benefit members a choice of rate for the
nominated by you in Sections H.3 to H.7. You reversionary pension payable on death.
should also complete and forward a Tax file
number declaration form (see Section I). If you elect to take all or part of your benefit as a
pension then, should a spouse’s pension become
Option 2—part pension and part lump sum payable, your spouse will be entitled to 67% of your
(only available if all of your benefit remains pension entitlement at date of death.
preserved in the PSS)
You may, however, elect to receive a reduced
If you want to receive your benefit as a pension now in return for your spouse receiving
combination of pension and lump sum, an increased pension should a spouse’s pension
select this option. become payable.
This option allows you to convert at least 50% of If you elect for the reduced pension, your pension
your total PSS benefit to pension. The balance of will be reduced to 93% of that payable had you not
your PSS benefit is then paid as lump sum. elected for this option. In return, an eligible spouse
You can tell us which part of your benefit should would be entitled to a pension of 85% of your
be used up first when buying a pension. You can reduced pension benefit.
choose between the taxed or untaxed amounts. Benefits to eligible children/orphans would also be
If you do not tell us which to use, we will use the increased under this option.
untaxed amount first.
You need to complete this section to therefore
This may not, however, be the best arrangement advise us that you either:
for your particular circumstances.
Your Government Super at Work
4 of 14a) do not wish to take a reduced pension of 93% of
your initial pension entitlement
Section J – Taxation matters
J1 Start date for taxation purposes
or
For taxation purposes, your lump sum benefit is
b) elect to take a reduced pension of 93% of your
called a superannuation lump sum payment.
initial pension entitlement.
The start date relates to the date your eligible
You should ensure that you are fully aware of the
service period (ESP) commenced and is used
future implications in relation to this choice. In
to calculate the various components of your
particular, you should be aware that you cannot
superannuation lump sum payment for
change your choice should your situation change
taxation purposes.
in relation to your spouse and/or children after
your election is made. Generally, your ESP is the number of days
between the date you commenced your current
If you need more information before making your
employment (which may be earlier than the date
choice you can contact our Contact Centre for
you joined the CSS or PSS), and the date your
further details.
payment is made. If you were formerly a CSS
member who commenced membership before
1 July 1983 and you have a long service leave start
Section H – Benefit payment date that is earlier than your CSS start date, that
arrangements earlier start date applies as your ESP start date.
Earlier periods of employment for which you paid
Lump sum payments a transfer value into the CSS or PSS are added to
your ESP. If this is the case, please fill in the start
H1 Lump sum cash payment date of that earlier period of service.
We can only pay your lump sum into an Australian If you do not show a date in this section, we will
account held in your name. If it’s a joint account, use the date on which you joined the PSS Scheme
one of the names listed must be yours. as your start date (unless you transferred from the
Taxation legislation states that once an amount CSS Scheme, in which case your CSS start date will
has been paid to you or deposited in your bank be used).
account, you cannot subsequently roll it over. J2 Your tax file number (TFN)
H2 Rollover fund nominations In accordance with the Taxation Laws Amendment
You need to check that you can rollover your (Tax File Numbers) Act 1988, we are required to
benefit to a complying super fund, rollover fund, deduct PAYG tax at the top marginal rate plus the
RSA, or use it to purchase an annuity. Medicare levy from benefits if a person does not
provide a tax file number (TFN).
You can nominate up to two rollover funds or RSAs
to receive all or part of your lump sum benefit. If you have not been issued a TFN you should
lodge a Tax file number application or enquiry
We will make all rollover cheques payable to your for an individual form with the Australian
nominated rollover funds and unless you specify Taxation Office (ATO). Forms are available at
otherwise, we will send them directly to your www.ato.gov.au or all ATO branches. You must
nominated fund(s). provide proof of identity at the time you lodge
the form.
J3 Approval to advise your TFN to
Section I – Superannuation rollover funds
contributions surcharge We will provide your TFN to the receiving fund
You only need to fill in this section if you have an unless you instruct us not to. Please note that there
outstanding surcharge debt. Please refer to the are consequences for not supplying your TFN
Superannuation contributions surcharge fact sheet to a fund.
for more information.
J4 Tax file number declaration
If you have chosen to receive all or part of your
benefit as a pension (Section G, options 1 or 2)
and you wish to claim the tax free threshold
and/or available offsets and deductions against
your pension benefit, you should complete this
ATO declaration form and attach it to your
benefit application.
Your Government Super at Work
5 of 14Documents you may receive Privacy
from us CSC and its Administrator, ComSuper are
collecting the information on this form for the
After your benefit is paid you will receive some following reasons:
documents associated with your entitlements.
Depending on which benefit you choose, these >> to confirm your identity
documents may include:
>> to assess your eligibility for payment of
>> a benefit payment letter, advising you of your the benefit
benefit entitlement and when your payment
>> to pay your benefit
will be made
>> to contact you
>> a rollover benefits statement, in duplicate for
each rollover nominated in Section H, which CSC and ComSuper are committed to protecting
shows the breakup, for taxation purposes of any personal information we hold about you. Your
each rollover you nominate information will not be used for any other purpose
or disclosed to another party unless:
>> a PAYG payment summary, in duplicate, for
any lump sum cash payment paid to you >> you authorise us to do so
>> a rollover payment cheque (or cheques), made >> the disclosure is authorised by law. This may
payable to your nominated rollover fund(s) include disclosing your personal information
to other government agencies that have specific
and
legislative authority to collect this information
>> a pension payment summary and annual as required by policy and legislation. We will
pension increase advice (which are sent to you not disclose your personal information to these
in July each year if you are receiving a pension). agencies unless it is lawful to do so.
Do NOT lose these documents. They may be
required to complete tax returns, lodge rollovers, Change of address
or apply for Centrelink benefits, etc. It will take If you receive a pension it is very important that
some time to issue replacements. you advise us of any change in your postal address
or your bank account details. This will enable us
Rollover requirements to forward information to you each year regarding
your benefit.
Rollover cheques are sent to you at the postal
address you nominate on your benefit application All enquiries: 1300 000 377
form. It is your responsibility to lodge them
with the rollover fund with a copy of the
rollover benefits statement.
Note: Do not send any rollover forms to us.
What next?
When you have completed your benefit
application form, the completed form should
be sent to us.
Note: We cannot process the payment of your
benefit until after the date you have nominated
as the date from which your preserved benefit
is to be paid. You may, however, submit your
application form before this date. This will allow us
to check that all documentation and information
has been provided.
Remember, the sooner we get your correctly
completed application form, the less likelihood
there is of any delay in the processing of
your benefit.
Your Government Super at Work
6 of 14PBA
05/11 Preserved benefit
Age claim form
Hints for using this form
>> read the explanatory notes and each section of the form carefully before filling it in
>> use CAPITAL LETTERS and a black or blue pen
>> sign your name where needed. If you don’t sign the relevant sections of the form, it will be returned to you.
SECTION A Personal details
Reference number (AGS)
D D M M Y Y Y Y
Cessation date
/ /
Salutation Mr Mrs Ms Miss Other
GIVEN NAME(S)
Your name
SURNAME
D D M M Y Y Y Y
Date of birth
/ /
Previous memberships 1
Have you had any other
periods of PSS membership? 2
If so, please list the reference
(AGS) number(s) for each of 3
those memberships.
4
RESIDENTIAL ADDRESS
Address
SUBURB STATE POST CODE
POSTAL ADDRESS
SUBURB STATE POST CODE
Section A continued on next page
Your Government Super at Work
Any financial product advice in this document is general advice only and has been prepared without taking account of your personal objectives, financial situation or needs.
Before acting on any such general advice, you should consider the appropriateness of the advice, having regard to your own objectives, financial situation or needs. You may wish
to consult a licensed financial advisor. You should obtain a copy of the PSS Product Disclosure Statement and consider its contents before making any decision regarding your super.
Commonwealth Superannuation Corporation (CSC) ABN: 48 882 817 243 AFSL: 238069
RSEL: L0001397 Trustee of the Public Sector Superannuation Scheme (PSS) ABN: 74 172 177 893 RSE: R1004595
7 of 14BUSINESS HOURS
Phone number
AFTER HOURS
MOBILE NUMBER
Email address
@
Relationship Married Single De facto
GIVEN NAME(S)
Spouse’s name
SURNAME
D D M M Y Y Y Y
Spouse’s date of birth
/ /
D D M M Y Y Y Y
Start date of
de facto relationship / /
(if applicable)
Please go to Section B Identification requirements on next page
Your Government Super at Work
8 of 14SECTION B Identification requirements
To protect against fraud, money laundering, For example, you could supply a copy of your birth
terrorism financing and safeguard your benefit, certificate (from column A) and copies of your
we need you to supply documentation to prove Medicare card, a phone bill and an electricity bill
your identity. Under some circumstances we may (from column B).
request further information from you.
You will need to supply certified copies of one If you are supplying copies of bills or
document from column A in the table below AND statements, you should black out any personal
certified copies of three documents from column B. financial information or details of transactions
in order to to protect your privacy. We will
store copies of identification electronically in
A B
a secure environment and securely destroy the
Passport (current or Medicare card paper copies. We will use all copies only for the
expired by less than purpose of confirming your identity.
two years)
Birth certificate or A current statement from
extract, issued by an a financial institution Certification must appear on the front of the
Australian or foreign with the same address documents. All copies of documents supplied
government (either in and name as on the must be certified as true and correct copies of the
English or accompanied application and not more original by one of the following:
by an English translation than three months old.
prepared by an accredited This statement must be >> a legal practitioner enrolled on the roll of a
translator) the account that you are supreme court or the high court of Australia
requesting payment into >> a judge or magistrate of a court
Birth card issued by a state Copy of an electricity bill >> a chief executive officer of a Commonwealth court
registry of births, deaths with the same address >> a registrar or deputy registrar of a court
and marriages and name as on the
application >> a Justice of the Peace (JP)
Australian citizenship Copy of a telephone bill
>> a notary public
certificate with the same address >> a police officer
and name as on the >> an agent or a permanent employee of the
application Australian Postal Corporation with two or
Current drivers licence Copy of a gas bill with more years of continuous service in an office
or permit issued by same address and name as supplying postal services to the public
state or territory or on the application
>> an Australian consular officer or an Australian
foreign government
diplomatic officer
Current identification Copy of a rates bill with >> a finance company officer with two or more
card issued to a public same address and name as
years of continuous service with one or more
sector employee on the application
finance companies
An identification card Valid credit card
>> a person employed by, or an authorised
issued to a student at
a tertiary education representative, of the holder of an Australian
institution financial services licence with two or more
continuous years of service
Pension or other social A document from column
security benefit card A not yet provided >> a member of the Institute of Chartered
Accountants of Australia (ICA), Certified
Proof of age card issued by Copy of a tax return
Practicing Accountants (CPA Australia)
a state or territory, letter from the Australian
containing your Taxation Office with the
or National Institute of Chartered
photograph same address and name as Accountants (NIA ) with two or more years of
on the application continuous membership.
A national identity A letter from Centrelink For a full list of certifying authorities, visit the
card, containing your or Department of Comlaw website at www.comlaw.gov.au.
photograph, issued by a Veterans’ Affairs with the
foreign government (either same address and name as The certifying authority also must confirm
in English or accompanied on the application in writing that you are the valid holder of the
by an English translation identification that you are presenting and that any
prepared by an accredited copies are true copies of the original.
translator)
Citizenship certificate The certification must include the name, address,
issued by a foreign country occupation, phone number and registration
(either in English or
number (if applicable) of the certifying authority.
accompanied by an English
translation prepared by an
accredited translator)
Your Government Super at Work
9 of 14SECTION C Employment status declaration
I have ‘retired from the workforce’ (See definition in Section C of the
Explanatory notes).
SIGNATURE
Signature and date Date signed
D D M M Y Y Y Y
/ /
SECTION D Information acknowledgement
(Benefit processing may be delayed if this acknowledgment is NOT completed)
I have been given enough information to make an informed decision about how I would like my
benefit to be paid.
I also understand that, by choosing a benefit option in Section F, I am making a formal election under
the provisions of the PSS legislation and this benefit election cannot be changed except in certain
circumstances approved by CSC.
SIGNATURE
Signature and date Date signed
D D M M Y Y Y Y
/ /
I declare that the information I have provided is true and correct to the best of my knowledge. I acknowledge
that it may be a criminal offence to knowingly provide false or misleading information or documents.
If you need more information, or would like to talk about the options you have, please call an
Information Officer on 1300 000 377, facsimile (02) 6272 9613, or email members@pss.gov.au.
You should also note that, if after your benefit has been paid, you wish to change your mind about the
payment arrangements, a fee will be charged by us to re-issue the payment.
SECTION E Claim date
FULL NAME
I,
whose reference
number (AGS) is
hereby give written notice to CSC
D D M M Y Y Y Y
that I wish to claim my
preserved benefit on / /
INSERT CLAIM DATE
I understand the preserved benefi t will become payable on the day after the claim date.
SIGNATURE
Signature and date Date signed
D D M M Y Y Y Y
/ /
Your Government Super at Work
10 of 14SECTION F Benefit options
Please ensure that only ONE benefit option is completed
Option 1 Pension only, no lump sum
FULL NAME
I,
whose reference
number (AGS) is
elect to take my entire benefit as a pension.
SIGNATURE
Signature and date Date signed
D D M M Y Y Y Y
/ /
You have now completed this section. You must now go to Bank account details to tell us where you
would like your pension benefit paid.
Option 2 Part pension and part lump sum
FULL NAME
I,
whose reference
number (AGS) is
elect to to take part of my preserved benefit as a pension and part as a lump sum.
I wish to convert
%
of my preserved benefit (cannot be less than 50% of the total preserved benefit)
to an preserved pension, with the balance of my benefi t to be paid to me as a
lump sum.
I wish to be paid a lump sum benefit of
$
GROSS
(cannot be more than 50% of the total benefit), with the balance to be paid to
me as a pension.
SIGNATURE
Signature and date Date signed
D D M M Y Y Y Y
/ /
You have now completed this section. You must now go to Section G, to tell us how you would like
your lump sum benefit paid.
Option 3 Lump sum only, no pension
FULL NAME
I,
whose reference
number (AGS) is
elect to take my entire benefit as a lump sum.
Section F continued on next page
Your Government Super at Work
11 of 14SIGNATURE
Signature and date Date signed
D D M M Y Y Y Y
/ /
You have now completed this section. You must now go to Section H, to tell us how you would like
your lump sum benefit paid.
SECTION G Election for reduced initial pension benefit in return
for increased spouse’s and or children’s pension benefit
Only complete this section if you have chosen Benefit Options 1 or 2.
I have read the information contained in Section G of the Explanatory notes, and
advise that I do not wish to take a reduced pension of 93% of my initial pension entitlement
OR
elect to take a reduced pension of 93% of my initial pension entitlement
SIGNATURE
Signature and date Date signed
D D M M Y Y Y Y
/ /
You have now completed this section. You must now go to Section H to tell us how you would like your
benefit to be paid.
SECTION H Benefit payment arrangements
Lump sum payments
H1 Complete this to tell us how much of your lump sum you would like as a cash payment
Lump sum cash payment, comprising: (See also Section H3 for bank account details)
Either: A gross $
dollar amount:
Or %
A percentage of
my lump sum:
Or
My non-concessional
contributions
Or (This will be the balance of your preserved benefit after
The benefit balance you elect to have any part rollover)
after any rollovers
Rollover details
H2 Rollover fund or retirement savings account (RSA) nominated to receive all or part of your lump sum
my entire lump sum benefit
OR only part of my lump sum benefit (please choose one):
a gross dollar amount of
$
OR a percentage of lump sum
%
OR balance after lump sum cash payment
Section H continued on next page
Your Government Super at Work
12 of 14Rollover fund or RSA nominated to receive all or part of your lump sum
Name of fund or RSA
AUSTRALIAN BUSINESS NUMBER
ABN of fund or RSA
Membership number
for fund or RSA
OR
SPIN of fund or RSA
SPIN = superannuation product identification number
Postal address of fund
SUBURB STATE POST CODE
Bank account details
H3 Please provide the account details for the payment of any cash lump sum and/or pension.
Type of financial Savings bank Building Trading bank Credit union
institution society
Name of institution
Name of account
holder
Branch location
Branch (BSB) number -
Account number
Note: Unless you specify in writing, your taxed components will be released first.
If the BSB number or account number you have provided is incorrect, the payment will not be
accepted by your financial institution. If you have any doubts what your correct BSB number or
account number is, you should confirm these details with your financial institution before including
them in this form.
The information I have supplied is true and correct.
SIGNATURE
Signature Date signed
D D M M Y Y Y Y
/ /
Section I continued on next page
Your Government Super at Work
13 of 14SECTION I Superannuation contributions surcharge
I would like my outstanding superannuation contributions surcharge debt deducted from either:
my pension
OR
my lump sum.
SECTION J Taxation matters
What is your
tax file number?
ComSuper, acting on behalf of CSC, is authorised to collect your tax file number (TFN) under the
provisions of the Superannuation Industry (Supervision) Act 1993. The legal uses of your TFN are
summarised in Section I of the Explanatory notes.
Important Note: If you have already provided your TFN to us you are under no obligation to provide it again when making an
application for benefits. However, if your TFN is NOT recorded by us, payment of your benefits may be delayed.
Can we give your Yes
TFN to the rollover
No
fund(s) / RSA(s)
nominated above?
Tax file number declaration
Pension recipients should also obtain and complete a Tax file number declaration form (obtainable
from the ATO) in order to claim any available tax rebates and deductions. Attach the completed
declaration to this application form.
SECTION K Checklist
Have you:
>> read all the Explanatory notes, received a benefit estimate and any other information
you require ?
>> made an informed choice?
>> filled in all the sections applicable to you?
>> signed the Information acknowledgment at Section D?
>> signed an election option in Section F?
>> completed any rollover details in Section G?
>> completed the bank account details in Section G?
>> provided your TFN in Section H?
>> attached your completed Tax file number declaration form (for pension recipients only)?
>> attached certified copies of documents requested in Section B to prove your identity?
You have now completed this form
Please return it, with any attachments to:
PSS
GPO Box 2252
Canberra City ACT 2601
END FORM
email phone tty post
members@pss.gov.au 1300 000 377 (02) 6272 9827 PSS
GPO Box 2252
web overseas callers fax
Canberra City ACT 2601
www.pss.gov.au +61 2 6272 9622 (02) 6272 9613
14 of 14You can also read
