Telstra Super Personal Plus Application Please complete this application form to open a Telstra Super Personal Plus account. RED SECTIONS FOR YOUR INFORMATION GREY SECTIONS TO FILL OUT INVESTMENT CHOICE BENEFICIARY NOMINATION SEARCH LOST SUPER YOUR TELSTRA SUPER CONSOLIDATE YOUR SUPER CONTRIBUTIONS INSURANCE Before you start read the Telstra Super Personal Plus Product Disclosure Statement (PDS) dated 17 November 2015 and the Important Information section at the end of this form to help you complete your application complete and give our Super Choice form to your employer if you would like your employer contributions to be paid into your new Telstra Super Personal Plus account. Download the Super Choice form from www.telstrasuper.com.au/forms if you are signing this form on behalf of another person, you will need to provide proof of the relationship in the form of a certified copy of linking document (such as guardianship papers or Power of Attorney). 1. Your Details Title Mr Mrs Miss Ms Other Surname Given name(s) Residential address Date of birth your basic info Suburb State Postcode Mobile Home phone no. Business phone no. Email address Postal address (if different to residential address) Suburb State Postcode P.T.O We re here to help If you have any questions or would like to talk to a Telstra Super Financial Adviser, please call us on 1300 033 166 between 8.00am and 5.30pm (Melbourne time), Monday to Friday.
NEW MEMBER 2. Eligibility to join Telstra Super (you must complete this section) OR OR OR I m a former employee of the Telstra Group. My employee number was (if known) I m a current Telstra Super member. My Telstra Super member number is I m transferring a benefit under the Family Law Act 1975. The reference number is I m an eligible family member of a current Telstra Super member. Please specify your relationship to the current Telstra Super member below. To see if you qualify as an eligible family member visit www.telstrasuper.com.au Relationship Their name is Their member no. (if known) Their date of birth 3. Provide your Tax File Number (TFN) and authorisation We are required to provide you with details on the collection of TFN s before you provide your TFN. See the Important Information section for details. CONSENT tfn TFN declaration I acknowledge that I have read the TFN provision in the Important Information section and understand that Telstra Super will not use my TFN for any unlawful purpose. TFN Super Search Consent You can give Telstra Super consent to use your TFN to search ATO records on your behalf for multiple/unclaimed super accounts in your name. We ll then provide you with information to help you consolidate your super accounts. This consent is voluntary. I acknowledge that I have read the TFN Super Search Consent in the Important Information section and give Telstra Super consent to use my TFN to search the ATO records to search for lost super on my behalf. My TFN is: Invest $ 4. Investment choice How would like your money invested? You can invest your super in one or more options. A buy-sell spread will apply to your investment choice. If you don t make an investment choice, your super will be invested in Telstra Super s MySuper arrangement. Refer to the Additional Information About Your Super Guide and Investment Guide, which forms part of the PDS and is available on our website www.telstrasuper.com.au/pds Option Percentage allocation Growth Balanced Diversified Income (restrictions apply ) Defensive Growth Conservative International Shares Australian Shares Property Fixed Interest Cash MySuper Total (must equal 100) = 100 Percentage allocation for the Diversified Income option must be equivalent to a dollar value of $100,000 or greater. By selecting MySuper, your super will be invested in the relevant age-based investment stage listed above and, as you age, will automatically be moved to the next applicable investment stage within the arrangement, without incurring a buy-sell spread. If you don t make an investment choice, your super will be invested in Telstra Super s MySuper arrangement, which is the default investment strategy for accumulation members and consists of three investment stages: MySuper Growth for members aged under 45, MySuper Balanced for members aged 45 to under 65, and MySuper Conservative for members aged 65 and over.
5. Making contributions and Employment declaration Contributions can only be accepted if you meet one of the following conditions. Please indicate which applies to you. I am under age 65, OR I am aged between 65 and 74 and gainfully employed for at least 40 hours in a period of not more than 30 consecutive days in the current financial year. Would you like to make an initial post-tax contribution? No Yes $ (make cheque payable to Telstra Super Pty Ltd and attach it to this application) Add to your Super Note: To arrange your employer contributions to be paid into your account, please complete and give to your employer our Super Choice form available from www.telstrasuper.com.au/forms 6. Insurance declaration (you must complete this section) You must select one option. Information about insurance cover available with your Telstra Super Personal Plus account can be found in the product disclosure statement available from www.telstrasuper.com.au/pds I require base death cover ($1.18 per week)* complete section A I require base death and TPD cover ($2.27 per week)* complete section B I do not require any insurance cover go to section 7 * Insurance cover will not commence before the date the application is accepted by the fund. Cover will only continue subject to your account balance being above the amount required to pay your insurance premiums. Did you know? You can apply for income protection cover if you are under age 65 and currently employed working at least 15 hours per week. Information and the application form is available from www.telstrasuper.com.au/insurance INSURE ME A. Apply for base death cover only Are you suffering from symptoms of ill health or disability to that extent that: a) you satisfy one of the applicable total and permanent disablement definitions Yes No b) you are terminally ill? Yes No B. Apply for base death and TPD cover a) Are you, currently absent from work, restricted or unable to carry out all the duties of your usual occupation on a full-time basis (for at least 30 hours per week) due to an illness, sickness, accident or injury, even if your actual employment may be full-time, part-time or casual? Yes No b) Have you been unable to work for a total of four or more weeks in the last 12 months because of illness, sickness, accident or injury? Please exclude leave taken to care for someone else. Yes No c) Have you been diagnosed with, or do you suffer from, an illness, sickness or injury that may cause permanent inability to work or a terminal illness that reduces, or is likely to reduce your life expectancy to less than 12 months from the date of this application? Yes No d) Have you ever been declined or had a loading, limitation or exclusion added for insurance cover for death only, death and total and permanent disablement or income protection cover? Yes No e) Have you ever been paid or are you eligible to be paid, or have you ever claimed or are you eligible to claim, or are you currently in the process of claiming, for any illness, sickness, accident or injury, Workers Compensation, other government benefits (such as sickness benefit, invalid pension) or any insurance policy providing terminal illness, total and permanent disablement or income protection cover? Yes No Note: If you answered yes to any of the questions above, you are not eligible to apply for base death and TPD insurance cover using this form. However, you may still apply for cover by completing a Personal Statement form, which is available from our website. Refer to the Telstra Super Personal Plus Insurance Guide available from our website for the definitions of terminally ill and total and permanent disablement.. Duty of disclosure Before you enter into an insurance contract with us, you are required under the Insurance Contracts Act 1984 to provide us with the information we need to decide whether we ll accept your application for insurance, what terms will apply and what your premium will be. You must comply with the Duty of Disclosure as described below. Your Duty of Disclosure applies when applying for insurance cover and when varying or replacing any existing insurance cover. It applies from the moment you start completing the application questions and until we advise that we have accepted your application for cover, variation or replacement and issued confirmation. You must answer all of our questions honestly and completely. You must tell us everything you know and everything that a reasonable person in the circumstances could be expected to know is relevant to our decision whether to insure you and whether any special conditions need to apply to the cover. You do not need to tell us about any matter that diminishes our risk, is of common knowledge, that we know or should know as an insurer or that we tell you we do not need to know. If you have not disclosed all relevant matters to us and we would not have entered into all or part of the cover on the same terms had we known about those matters, we may avoid all or part of the cover within three years of the commencement date. If your non-disclosure or misrepresentation is fraudulent and we would not have provided the cover on the same terms had we known about these matters, we may avoid all or part of the cover at any time. This means that we can treat the cover as if it never existed and we would not be liable to pay any claims. Alternatively, instead of avoiding all or part of the cover we may decide: (a) to reduce the benefits for all or part of the cover in accordance with a formula that takes into account the premium that would have been payable if you had disclosed all relevant matters to us, although any reduction to benefits payable in respect of your death can only occur within three years of the commencement date; or (b) for any benefits provided under the cover other than benefits payable in respect of your death, to vary the cover in such a way as to place you in the position you would have been in if you had disclosed all relevant matters to us. If you have applied for cover via a financial adviser it is also your responsibility to ensure that the information provided to your adviser is accurate and complete and that the correct information is entered into the Application Form.
7. Nominate your beneficiaries Just in case Nominating a beneficiary helps us to determine who should receive a death benefit in the event of your death. See the Important Information section provided with this form to understand the different type of nominations and who you can nominate. Type of nomination (select one option only) I wish to make a non-binding nomination complete section A below I wish to make a binding nomination complete section A & B below I do not wish to make a nomination go to section 8 Who A. Nominate your beneficiary(ies) Full Name Address Relationship to you (please tick one only) of benefit 1. Spouse Child Financial dependant Interdependency relationship 2. 3. 4. And/or my legal personal representative (Estate) Nominated percentages must total 100 and be entered as whole numbers only. 100 If you wish to nominate more beneficiaries please attach a separate sheet with details (ensure you and any applicable witnesses sign and date it on the same date). B. Binding nomination declaration This section must be completed by the member and two witnesses and must be signed and dated on the same date, otherwise it will be invalid. Member Sign Member declaration Full name Signature X Date Witness declaration I acknowledge that I m over 18 years of age, I am not nominated as a beneficiary on this form and that this form was signed and dated by the member in my presence and in the presence of the other witness. Please note witnesses must sign and date this form on the same date as you, otherwise it will be invalid. WITNESS sign Signature of Witness 1 Signature of Witness 2 Full name of Witness 1 Full name of Witness 2 Date Date
8. Politically Exposed Person 1. Are you a Politically Exposed Person (PEP)? See the Important Information section for the definition of a PEP. Yes No 2. If yes, please tick which PEP category applies to you a) I hold a prominent public position or function in a government body or an international organisation 1 b) I am an immediate family member of a person referred to in (a) above c) I am a close associate of a person referred to in (a) above. ARE YOU A PEP? 9. Your declaration and signature By signing this form, I: declare that I have read and understood the Telstra Super Personal Plus PDS dated 17 November 2015 and the Important Information section of this form. acknowledge that all the information I have provided on this form is true and correct to the best of my knowledge. acknowledge that I have nominated my insurance arrangements and that I have read and understood the duty of disclosure information and understand the consequences of non-disclosure. agree to be bound by the terms of the Telstra Super Trust Deed from the date I become a member of the fund. declare that I am aged 15 years or over. acknowledge that if I have more than one Telstra Super account the beneficiary nomination on this form is effective across all my accounts, except where I have nominated a reversionary beneficiary. If required, I confirm I have obtained and considered appropriate expert advice. understand that the beneficiary(ies) nominated on this form must be my dependants at the date of my death. Sign and date to validate form *Name X Sign *Signature X *Date Office use only Member no. Please return completed form to Telstra Super: Telstra Super Pty Ltd, PO Box 14309, MELBOURNE VIC 8001 Instructions for completing this form Before sending this form to Telstra Super, please check that you have: read and completed the form in its entirety, including the Important Information section. completed and provided your employer a Super Choice form to commence regular employer paid contributions (if applicable). provided your Tax File Number Declaration form. photocopied your completed application form for your records. Please return the original application form.
Important Information - Telstra Super Personal Plus Application (page 1 of 2) Information about providing your TFN to Telstra Super Your TFN is confidential. Before you provide your TFN we are required to tell you the following: Under the Superannuation Industry (Supervision) Act 1993, Telstra Super is authorised to collect your TFN. If provided, your TFN will only be used for lawful purposes. These purposes may change in the future as a result of legislative change. The Trustee may disclose your TFN to another super provider when your benefits are being transferred, unless you ask us in writing not to disclose your TFN to any other superannuation provider. You do not have to supply your TFN, but if you do not it may be more difficult to locate, identify or consolidate any super you have not claimed and: pre-tax contributions will be taxed at the highest marginal tax rate. Your fund may deduct this additional tax from your account. post-tax contributions cannot be accepted into your super fund. These consequences may change in the future. TFN Super Search Consent Telstra Super will use your TFN to: seek superannuation information relating to you using any facility provided by the Australian Taxation Office (ATO) when your membership of Telstra Super commences and from time to time while you remain a member of the fund as determined by Telstra Super; and prepare and provide to you for approval a transfer request form containing some details relevant to you (including your tax file number) in order to facilitate the transfer of any amounts identified by Telstra Super as a result of its inquiries to the ATO. Definition of a Politically Exposed Person Politically Exposed Person or PEP means an individual: (a) who holds a prominent public position or function in a government body or an international organisation, 1 including: (i) Head of State or head of a country or government; or (ii) government minister or equivalent senior politician; or (iii) senior government official; or (iv) Judge of the High Court of Australia, the Federal Court of Australia or a Supreme Court of a State or Territory, or a Judge of a court of equivalent seniority in a foreign country or international organisation; or (v) governor of a central bank or any other position that has comparable influence to the Governor of the Reserve Bank of Australia; or (vi) senior foreign representative, ambassador, or high commissioner; or (vii) high-ranking member of the armed forces; or (viii) Board chair, chief executive, or chief financial officer of, or any other position that has comparable influence in, any State enterprise or international organisation; or (b) who is an immediate family member of a person referred to in paragraph (a), including: (i) a spouse; or (ii) a de facto partner; or (iii) a child, a child s spouse or de facto partner; or (iv) a parent; or (c) who is a close associate of a person referred to in paragraph (a), which means any individual who is known (having regard to information that is public or readily available) to have: (i) joint beneficial ownership 2 of a legal entity or legal arrangement with a person referred to in paragraph (a); or (ii) sole beneficial ownership 2 of a legal entity or legal arrangement that is known to exist for the benefit of a person referred to in paragraph (a). 1. International organisation essentially means an organisation established by a formal political agreement by two or more countries which has the status of an international treaty. 2. Beneficial ownership means directly or indirectly owning 25 or more of an entity or exercising operational or financial control over an entity.
Important Information - Telstra Super Personal Plus Application (page 2 of 2) Nomination of beneficiary Binding nomination - a valid binding death benefit nomination gives you certainty about who will receive your benefit when you die and means Telstra Super must pay your death benefit according to your wishes in the event of your death to your eligible dependants. To be valid, a binding nomination must be signed and witnessed by two people over 18 who are not nominated as beneficiaries. A binding nomination must be updated at least every three years. Non-binding nomination - a non-binding nomination means that Telstra Super will be guided by your nomination in the event of your death, but will not be bound by it. Please note, your binding and non-binding nomination is effective across all your Telstra Super accounts. Who can be nominated as a beneficiary? You can nominate your eligible dependants or your legal personal representative(s) as your binding or non-binding beneficiaries. Only eligible dependants can be nominated as a reversionary beneficiary. You can nominate one or more of your dependents and/or legal personal representative(s). Your dependants include spouse a person to whom you are legally married, a person whether of the same or a different sex with whom you are in a relationship that is registered under an Australian State or Territory law, and a person whether of the same or a different sex with whom you are not legally married but who lives with you on a genuine domestic basis as a couple. child your child (or your spouse s child) of any age, including an adopted child, a step-child or an ex-nuptial child, or a child within the meaning of the Family Law legislation. financial dependant any other person totally or partially financially dependent upon you at the time of your death, or interdependency relationship any other person with whom you may have an interdependency relationship. An interdependency relationship is generally defined as: someone you have a close personal relationship with, and you live together, and one or both of you provide financial support for the other, and one or both of you provide domestic support and personal care for the other. You may also have an interdependency relationship with someone when you have a close personal relationship but do not satisfy the other criteria listed above by reason that one or both of you suffer from a physical, intellectual or psychiatric disability. Your legal personal representative is the person: nominated by you to be the executor of your will, or appointed to distribute your assets according to the laws of the relevant State or Territory (if you do not have a will). Telstra Super Pty Ltd complies with the Privacy Act 1988 (Cth). For further information on privacy, please contact the Privacy Officer on 1300 033 166 or visit our website at www.telstrasuper.com.au to download a copy of our Privacy Policy or Privacy Collection Statement. is a registered trademark of the Telstra Corporation Limited. Telstra Super Pty Ltd. is a registered trademark of the Telstra Corporation Limited. Telephone 1300 033 166 Facsimile 03 9653 6060 www.telstrasuper.com.au Telstra Super Pty Ltd, ABN 86 007 422 522, AFSL 236709, is the trustee of the Telstra Superannuation Scheme (Telstra Super) ABN 85 502 108 833. 217046/FA/W FM003/07/1215