Retain copies. Beneficiaries. Guarantee. Contact us

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1 North MyNorth Client data collection form MyNorth Super A guide to completing this form Purpose of this form This form may be used by you to collect client data for the submission of a MyNorth application on North Online. It does not replace the North Online application. All details from this form must be submitted on North Online in order for your client s application to be accepted by us. Client details At least one address and one contact phone number must be provided. Bank account details These details will be used for withdrawals, ad hoc direct debits and Regular savings plan. Listed securities A request for a share trading account must be made in the investment instructions section for clients wishing to trade listed securities. Declaration Your client(s) must sign a copy of the Declaration, which forms part of their Agreement with us. Your client(s) may sign the Declaration that is attached to this data collection form or that is attached to the North Online application. Your client(s) only needs to sign the Declaration once. If your client(s) signs the Declaration attached to this form, you should inform them that the Declaration forms part of their agreement with us. A copy of the signed Declaration must be attached to the MyNorth application generated from North Online, once the details have been submitted online, and retained by your office. Retain copies Please do not send the form or Declaration to the North Service Centre. A copy of the completed form is to be retained by you and a copy of the signed Declaration is to be attached to the completed North Online application form, which must also be retained. Documents may be retained in electronic format. Beneficiaries These sections are optional. Please ensure that the total benefit in the beneficiary section (if applicable) is equal to 100. If more space is required, please photocopy this section. Binding nominations are required to be witnessed and signed using the Binding nomination form that is produced at the end of the online application process or the form attached. The nominated beneficiary will not be recorded as binding until this has occurred. All details in these sections must be sent to the North Service Centre if they are to be recorded against the account. Guarantee All details must be completed if a Guarantee is required. Please refer to the MyNorth Super and Pension PDS Part B for more information. Contact us mail North Service Centre GPO Box 2915 MELBOURNE VIC 3001 web northonline.com.au phone Issue date 11 February 2016 North is a registered trademark of The National Mutual Life Association of Australasia Limited ABN Fund: Wealth Personal Superannuation and Pension Fund ABN Trustee: N.M. Superannuation Proprietary Limited ABN AFSL No of 17

2 Client data collection form ADVISER COPY ONLY PLEASE RETAIN Please print in CAPITAL LETTERS and place a cross in any applicable boxes Please note: Before completing this form please read the information provided in the latest issue of the MyNorth Super and Pension Product Disclosure Statement (PDS). The PDS can be found on northonline.com.au. Applications for MyNorth must be completed online at northonline.com.au using the data collected in this form. An asterisk (*) denotes a mandatory field. Client details* Tile: Dr Mr Mrs Miss Ms Date of birth: Surname Given name(s) Source of wealth* How has the client built their overall wealth? Income from employment Investment income Business income One-off payment Sale of assets Windfall Contact details* At least one phone number required* Home telephone Work telephone Mobile ( ) ( ) ( ) Home address Mailing address* Business address Postal address Tax details Tax file number* (TFN) (Not required if over 60 years of age, except if there is more than one rollover). I consent to my TFN being used and disclosed for any lawful purposes. Fund: Wealth Personal Superannuation and Pension Fund ABN Trustee: N.M. Superannuation Proprietary Limited ABN AFSL No of 17

3 ADVISER COPY ONLY PLEASE RETAIN Bank account details Provide at least one bank account. Account 1 name Account 2 name Name of bank/financial institution Name of bank/financial institution Bank/financial institution branch name Bank/financial institution branch name BSB number Account number BSB number Account number Regular savings plan Ad hoc withdrawals Regular savings plan Ad hoc withdrawals Account 3 name Account 4 name Name of bank/financial institution Name of bank/financial institution Bank/financial institution branch name Bank/financial institution branch name BSB number Account number BSB number Account number Regular savings plan Ad hoc withdrawals Regular savings plan Ad hoc withdrawals Managed Discretionary Account (Adviser Transaction Authority) No Yes You may only enter into a Managed Discretionary Account (MDA) with your client if you are licensed to operate an MDA. If your client selects Yes to an MDA, you should make sure that your client is aware that they have entered into an MDA arrangement with you which gives you discretion to transact on their account without further authority from them. You should refer them to disclosure documents for further information. Guarantee details Expected Retirement Age Protected Growth Term 10 years 20 years Investment strategy Moderately Defensive Balanced Growth 1 Protected Investment Term 6 years 8 years Investment strategy Moderately Defensive Balanced Protected Retirement 2 Investment strategy Moderately Defensive Balanced Joint Life Yes No 1 Available only with a 20 year Protected Growth guarantee. 2 Minimum application age is of 17

4 ADVISER COPY ONLY PLEASE RETAIN Investment instructions Cash account settings The cash account will be managed as follows: Minimum cash balance 1 Cash account should not fall below (minimum) Target cash balance Cash account should be no greater than (Target) of account value plus Minimum cash balance Trade settings Managed funds trade minimum Share trading account No Yes Dividend reinvestment plan No Yes Shares trade minimum per investment per trade per investment per trade (min of 1,000) Automatic buy instructions If cash account exceeds Target invest as per buy profile (includes managed funds and listed securities) invest as per buy profile (exclude listed securities) leave excess funds in cash account Dollar cost averaging No Yes Instalment amount Frequency Monthly Quarterly Half-yearly Yearly Day Last day of month Select day Next instalment date D D M M No end date End date Automatic sell instructions If cash account falls below minimum divest as per sell down profile divest as per sell down order pro rata across managed funds only Account rebalance instructions Automatically rebalance No Yes Rebalance frequency Quarterly Half-yearly Yearly Next rebalance date 1 A default of 5.00 Target cash balance will apply if an amount is not provided. 4 of 17

5 ADVISER COPY ONLY PLEASE RETAIN Investment instructions Investment profiles (excludes term deposits) Rebalance Investment name Code Buy profile () Sell profile () Profile () Exclude 5 of 17

6 ADVISER COPY ONLY PLEASE RETAIN Investment instructions (continued) Term deposit Term period (months or term maturity date) Amount () Interest payment frequency Interest payment type (cash account or term deposit) Automatically reinvest (N or Y) Reinvestment type (principal & interest or principal only) Reinvest with same details? 1 Term type (fixed term or fixed maturity date) Provider Term If different reinvestment instructions, enter details below. Reinvestment details Interest payment type (cash account or term deposit) Interest payment frequency Term period (months or term maturity date) Term type (fixed term or fixed maturity date) Term of 17

7 ADVISER COPY ONLY PLEASE RETAIN Regular savings plan Bank details must be provided on page 3 of this form if regular savings plan is selected. Regular investment type Select one: Personal Spouse Superannuation Guarantee/Award Salary Sacrifice Other family and friend Regular investment amount (minimum of 10 per payment) Indexation Select one: None CPI Percentage. (maximum of 7) Frequency Select one: Monthly Quarterly Half-yearly Yearly Payment date Select one: Last day of month OR Select day D D M M (only available for monthly frequency) (must be between 1 28) Beneficiaries Binding nominations are required to be witnessed and signed using the form that is produced at the end of the online application process or the one attached at the end of this form. The Binding nomination form must then be sent to the North Service Centre. Your nominated beneficiary will not be recorded as binding until this has occurred. Type of nomination Non binding nomination Binding nomination Nominated beneficiary details Legal Personal Representative AND/OR of benefit Beneficiary 1 Relationship to investor: Child Spouse Financial dependant Interdependent of benefit Surname Given name(s) Date of birth Address Beneficiary 2 Relationship to investor: Child Spouse Financial dependant Interdependent of benefit Surname Given name(s) Date of birth Address Please use a separate sheet if additional beneficiaries are required. 7 of 17

8 ADVISER COPY ONLY PLEASE RETAIN Adviser remuneration Member advice fee contributions Contributions (inclusive of GST) Rollovers (inclusive of GST) Regular savings plan (inclusive of GST) Member advice fee initial None Advice implementation Initial Plan preparation and research Member advice fee ongoing None Percentage per annum Member advice fee Monthly Quarterly Member advice fee ongoing Monthly Quarterly Dollar amount per annum Member advice fee Monthly with end date Indexation None CPI Other Indexation to apply on. (max of 7) Member advice fee ongoing Monthly with end date Indexation None CPI Other Indexation to apply on. (max of 7) Member advice fee No end date Monthly Quarterly Indexation None CPI Other Indexation to apply on. (max of 7) Member advice fee ongoing No end date Monthly Quarterly Indexation None CPI Other Indexation to apply on Shared commission (if applicable). (max of 7) Sales account number 1 Sales account number 2 8 of 17

9 ADVISER COPY ONLY PLEASE RETAIN Deposit details Type Rollover Contribution If Rollover is selected, please complete the attached External transfer request form. If Contribution is selected, please provide details below. Personal contributions Personal Personal contribution total Employer contributions SG/Award Salary sacrifice Employer contribution total Other contribution type Spouse CGT small business 15 Yr Exempt Personal injury Assessable foreign fund Payment method Other family and friend Direct termination payment Non assessable foreign fund CGT small business retirement exempt Other contribution total Total contribution amount Direct debit EFT Bpay Cheque Declaration I agree to be bound by the provisions and rules of the trust deed for the MyNorth Super Plan. I confirm that I have received (including an electronic version issued or a printout of it) and read and understood the current MyNorth Super and Pension disclosure document, as amended from time to time. I acknowledge that this application is subject to the terms and conditions of the disclosure document and, to the extent applicable to the MyNorth Super. I acknowledge that with the exception of any benefits arising out of a selected feature from MyNorth s Protected Growth Guarantee, Protected Investment Guarantee or Protected Retirement Guarantee (guarantee), neither the performance of, nor the payment of any particular return from, nor any increase in the value of the assets acquired using the investments listed in the PDS is guaranteed in any way by any member of the AMP group. I agree to release and indemnify N.M. Superannuation Proprietary Limited from and against all actions, proceedings, accounts, costs, claims and demands in respect of any liabilities arising directly or indirectly as a result of the use of the facilities offered including, but not limited to a failure by me or my financial adviser to comply with this Agreement, the relevant law, the Australian Securities Exchange (ASX) Market Rules, the Australian Securities Exchange Settlement Rules (ASTC Settlement Rules), and the customs, procedures, usages or practices of the ASX. I acknowledge that this release and indemnity does not apply to the extent that such liability is attributable to N.M. Superannuation Proprietary Limited s own neglect or default. I acknowledge that the internal and external systems used by N.M. Superannuation Proprietary Limited are vulnerable to disruptions or failures, which may result in my instructions or the instructions of my financial adviser not being executed or delayed according to the instructions given. I agree to release and indemnify N.M. Superannuation Proprietary Limited for any loss or damage arising directly or indirectly as a result of or in connection with any such disruption or failure. I agree that neither I nor any other person claiming through me has any claim against N.M. Superannuation Proprietary Limited or the MyNorth Super Plan in relation to a payment made or action taken by N.M. Superannuation Proprietary Limited under any of the facilities, if the payment or instruction is made in accordance with the relevant conditions and includes instructions that are later shown not to have been made by me. Registered to Bpay Pty Ltd ABN of 17

10 ADVISER COPY ONLY PLEASE RETAIN Declaration (continued) I acknowledge that N.M. Superannuation Proprietary Limited is entitled to: cancel or change the terms and conditions of the facilities offered but may not do so without giving me prior written notice, and decline or refuse to act on my instructions or the instructions of my adviser for any reason where N.M. Superannuation Proprietary Limited considers that it is reasonable in the circumstances to do so. I acknowledge that I may cancel the use of any of the facilities at any time by giving N.M. Superannuation Proprietary Limited written notice. I have read and understood the Your Privacy section within the current disclosure document. I consent to my personal information being collected and used in accordance with this section. I acknowledge that I can opt out from the use of that information for the purpose of direct marketing by telephoning I consent to my tax file number being used and disclosed for any lawful purpose. I authorise the Trustee to provide my financial adviser and/or their authorised delegate with information regarding my investments in the MyNorth Super. I authorise my financial adviser and/or their authorised delegate to act in accordance with my instructions online through North Online and to lodge details regarding those instructions on my behalf and that N.M. Superannuation Proprietary Limited may accept and act upon instructions lodged online by my financial adviser and/or their authorised delegate on my behalf without: requiring any further proof, instructions or confirmation from me to accept and act upon those instructions, and verifying that the financial adviser and/or their authorised delegate has the necessary authority to act on my behalf (including any authority given by me pursuant to the operation of a Managed Discretionary Account). I agree that I will ratify and confirm whatever my financial adviser and/or their authorised delegate does in exercising any instructions made on my behalf and I agree that neither I, nor any person claiming through me, has any claim against AMP for a transaction done by my financial adviser and/or their authorised delegate on my behalf. I agree that N.M. Superannuation Proprietary Limited (and any of its agents appointed for this purpose) may correspond with me using the address which I have provided in this application for any purpose related to the administration of my portfolio in the fund. I agree that all correspondence, including any disclosure obligations N.M. Superannuation Proprietary Limited may have to me under the Corporations Act 2001, except those deemed as an exception, will be provided to me via and/or the North Online Service and will not be mailed by post. I am eligible to join and make contributions, rollovers or transfers to the MyNorth Super and will continue to do so while I remain eligible. I acknowledge that where I have invested in an illiquid asset, any partial withdrawal or transfer which requires the sale of this investment may be processed in a period longer than 30 days. I agree that any nominated member advice fees will be paid to my financial adviser. I acknowledge that my financial adviser may, in some circumstances, decide to transition their responsibilities to another financial adviser (for example, by retiring, changing roles, merging their practice or selling all or part of their practice). If such circumstances arise, and unless I instruct otherwise: a. I understand that I will be notified within 30 days of the Trustee becoming aware of any such change, and my Member Advice Fee arrangements will be reconfirmed, and b. I authorise the Trustee to pay any nominated member advice fees from my account to my new financial adviser. Member s name Member s signature Date 10 of 17

11 External transfer request Please print in CAPITAL LETTERS and place a cross in any applicable boxes! Instructions when completing this form 1. Enter all details on North Online using the data collected in this form. 2. A copy of this form should also be retained for your records. 3. Print and complete a separate form for each fund that you wish to transfer from. Client details Tile: Dr Mr Mrs Miss Ms Date of birth: Surname Given name(s) Address MyNorth account number Tax File Number (TFN) Under the Superannuation Industry (Supervision) Act 1993, you are not obliged to disclose your TFN, but there may be tax consequences. See What happens if I do not quote my TFN? If you do not provide your TFN your FROM fund may request certified proof of identity documents. Fund details Fund name: Wealth Personal Superannuation and Pension Fund Unique Superannuation Identifier (USI): MyNorth Pension: NMS0039AU MyNorth Super: NMS0040AU ABN: Contact number: If you are not processing this payment electronically, please send a cheque payable to North at GPO Box 2915, MELBOURNE VIC Transferor fund details Fund name Fund policy or membership number Fund address Fund phone number ( ) Australian business number (ABN) Unique Superannuation Identifier (USI) Transfer amount Full transfer Partial transfer (Gross) Partial transfer (Net) Estimated amount Fund: Wealth Personal Superannuation and Pension Fund ABN Trustee: N.M. Superannuation Proprietary Limited ABN AFSL No of 17

12 Important information This transfer may close your account (you will need to check this with your from fund). This form can NOT be used to: transfer benefits if you don t know where your superannuation is transfer benefits from multiple funds on this one form a separate form must be completed for each fund you wish to transfer superannuation from change the fund to which your employer pays contributions on your behalf open a superannuation account, or transfer benefits under certain conditions or circumstances, for example if there is a superannuation agreement under the Family Law Act 1975 in place. What happens to my future employer contributions? Using this form to transfer your benefits will not change the fund to which your employer pays your contributions and may close the account you are transferring your benefits from. If you wish to change the fund into which your contributions are being paid, you will need to speak to your employer about Choice. For the appropriate forms and information about whether you are eligible to choose the fund to which your employer contributions are made, visit ato.gov.au or call the Tax Office on Things you need to consider when transferring your superannuation When you transfer your superannuation, your entitlements under that fund may cease. You need to consider all relevant information before you make a decision to transfer your superannuation. If you ask for information, your superannuation provider must give it to you. Some of the points you may consider are: Fees your from fund must give you information about any exit or withdrawal fees. If you are not aware of the fees that may apply, you should contact your fund for further information before completing this form. The fees could include administration fees as well as exit or withdrawal fees. Your to fund may also charge entry or deposit fees on transfer. Differences in fees funds charge can have a significant effect on what you will have to retire on. For example, a 1 increase in fees may significantly reduce your final benefit. Death and disability benefits your from fund may insure you against death, illness or an accident which leaves you unable to return to work. If you choose to leave your current fund, you may lose any insurance entitlements you have. Other funds may not offer insurance, or may require you to pass a medical examination before they cover you. When considering a new fund, you may wish to check the costs and amount of any cover offered. If you require additional information about superannuation, you may wish to visit the Australian Securities and Investment Commission website moneysmart.gov.au. What happens if I do not quote my tax file number (TFN) You are not obliged to provide your TFN to your super fund. However, if you do not provide your TFN, your fund may be taxed at the highest marginal tax rate plus the Medicare levy on contributions made to your account in the year, compared to the concessional tax rate of 15. Your fund may deduct this additional tax from your account. If your super fund does not have your TFN, you will not be able to make personal contributions to your super account. Choosing to quote your TFN will also make it easier to keep track of your super in the future. Under the Superannuation Industry (Supervision) Act 1993, your super 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 TFN may be disclosed to another super provider when your benefits are being transferred. Please send your completed and signed form to the fund from which you are transferring. Sending this form to the transferring fund may not always be sufficient and the existing service provider may require completion of their own withdrawal documentation. There may also be specific identification requirements your client needs to satisfy for the transferring fund. Please contact the transferring fund for further details. 12 of 17

13 Authorisation To the Trustee, I request that you transfer my existing superannuation entitlements as specified above to MyNorth Super. You are requested and duly authorised to provide all the relevant details, including details of my membership and any other information that may be required to effect this transfer. I make the following statements: The information I have provided in this form is true and correct. I am aware I may ask my superannuation provider for information about any fees or charges that may apply, or any other information about the effect this transfer will have on my insurance cover or other benefits. I have obtained or do not require such information. I consent to my TFN being used and disclosed for the purposes of consolidating my account and for any lawful purpose. I discharge the superannuation provider of my FROM fund of all further liability in respect of the benefits paid and transferred to my TO fund. I consent to you speaking with my financial adviser and/or their authorised delegate. Member s name Member s signature Date Please print and send to the transferor fund. Retain a copy of this document for your records. 13 of 17

14 This page has been left blank intentionally. 14 of 17

15 Binding nomination of beneficiaries Please print in CAPITAL LETTERS and place a cross in any applicable boxes! For binding nominations, ensure these steps are completed: 1. You have signed and dated the form. 2. Your form is witnessed on the same date by two non-beneficiaries. 3. Your total death benefit percentage totals Return your completed form to the North Service Centre. Client details* Account number Title: Dr Miss Mr Mrs Ms Surname Given name(s) Mailing address Information on nomination of beneficiaries A binding nomination gives you certainty about who will receive your superannuation benefit in the event of your death. When you have nominated a beneficiary and the nomination is valid under superannuation law, the Trustee will act in accordance with that nomination. However, the Federal Government has imposed strict conditions of who and how a beneficiary must be nominated. A beneficiary must be: a spouse (including de facto spouse) a child (including adopted child, step child, or an ex-nuptial child), or any person who is, or was at the relevant time, in the opinion of the Trustee in an interdependency relationship with the member (generally a close personal relationship between two people who live together, where one or both provides the other with financial support, domestic support and personal support), or a legal personal representative. If any beneficiary nominated is not your spouse, child, legal personal representative or interdependent at the date of your death, this notice will be invalid. This nomination may be amended or revoked at any time. It will be valid for a maximum period of three years if no amendment is made. The administrator will attempt to contact you before the nomination expires to ask you to renew your nomination. However, it is your responsibility to update and review it every three years. AMP accepts no liability for any failure on your part to do so. Your signature must be witnessed by two witnesses aged 18 years or over, neither of whom is nominated as a beneficiary. You should update your nomination if there is a change to your personal circumstances. If you nominate your legal personal representative, please ensure you have a valid and up-to-date will. If you die without a will, the Trustee is required to pay the benefit to a court-appointed administrator who will pay the benefit in accordance with a statutory formula, which varies from state to state. This can result in some classes of beneficiary being excluded (such as de facto spouse or same sex partner). Nominated beneficiary details Legal Personal Representative of benefit AND/OR Nomination 1 Relationship to investor: Child Spouse Financial dependant Interdependent of benefit Surname Given name(s) Date of birth Address Fund: Wealth Personal Superannuation and Pension Fund ABN Trustee: N.M. Superannuation Proprietary Limited ABN AFSL No of 17

16 Nominated beneficiary details (continued) Nomination 2 Relationship to investor: Child Spouse Financial dependant Interdependent of benefit Surname Given name(s) Date of birth Address Nomination 3 Relationship to investor: Child Spouse Financial dependant Interdependent of benefit Surname Given name(s) Date of birth Address Nomination 4 Relationship to investor: Child Spouse Financial dependant Interdependent of benefit Surname Given name(s) Date of birth Address Nomination 5 Relationship to investor: Child Spouse Financial dependant Interdependent of benefit Surname Given name(s) Date of birth Address 16 of 17

17 Declaration I have read the above information and understand these conditions. I direct the approved Trustee to accept my Binding nomination of beneficiaries for my account. Member s name Member s signature Date Witness declaration Witness A I declare the above notice was signed and dated by the member in my presence and that I am aged 18 years or older. Witness name Signature Date Witness B I declare the above notice was signed and dated by the member in my presence and that I am aged 18 years or older. Witness name Signature Date Your nominated beneficiary is not recorded as binding until the Binding nomination of beneficiaries form is signed, witnessed and sent to the North Service Centre for validation by the Trustee. Where to send this completed form North Service Centre Any questions? GPO Box MELBOURNE VIC of /16

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