GPO Box 89 Melbourne Vic 3001 VicSuper Member Centre 1300 366 216 vicsuper.com.au Application for superannuation benefits temporary residents departing Australia permanently * Indicates that providing this information is mandatory. Not doing so may delay the processing of your request. When completing this form, please ensure you use all capital letters eg and check boxes with a cross eg Step 1: Complete your personal details Member number* Title Mr Mrs Ms Miss Other (please specify) Surname* Given name/s* Residential address* (overseas address) Postcode* Postal address (if the same as above write AS ABOVE ) Postcode Country Telephone number Country code Number Email address Date of birth Gender Male Female Tax file number Under the Superannuation Industry (Supervision) Act 1993, you are not obliged to disclose your tax file number but there may be tax consequences if you do not. For more information see What if you do not quote your tax file number? on page 6. Step 2: Provide proof of identity* For more information on this step, see Proof of identity on page 5. I have attached certified copy of my passport or international travel documents. AND certified copy of an eligible document to confirm my residential address, as outlined in the Proof of identity section. Step 3: Your account balance* My account balance is over $5,000 My account balance is under $5,000 V219 04/14 P1 Please turn over
Step 4: Payment options* For more information on this step see Nominate your bank account for payment on page 6. Please select one of the following options relating to how you would like to receive your benefit: OR Please forward a cheque in $AUD to my overseas address. Please forward a cheque to my overseas address as a bank draft (in the currency of the country you are residing in). Note: a fee of $28AUD applies, which will be deducted from your final benefit. OR Please direct credit my nominated overseas bank account as detailed below. Note: a fee of $32AUD applies, which will be deducted from your final benefit. Account name Bank name Bank address Postcode Bank identification code (must be supplied) International banking account number (must be supplied) Account number (must be supplied) Please provide a copy of a bank statement to verify these details. Step 5: Read VicSuper s Privacy brochure (personal information) Step 6: Sign this form* The Privacy Act 1988 extends privacy regulation to the private sector, including VicSuper. This legislation governs the proper handling of personal information including how an organisation collects, uses, discloses and stores personal information. You should have received information on how VicSuper handles personal information either in your PDS or in VicSuper s Privacy brochure (personal information). If you have not received a copy, or would like another copy sent to you, please call our Member Centre on +61 3 9667 9679. I request and consent to the withdrawal of superannuation as described above and authorise VicSuper to give effect to this payment. By signing this request, I am making the following statements: I declare that I have fully read this form and the explanatory notes and the information completed is true and correct. I declare that I have received and read VicSuper s privacy information (Step 5). I discharge VicSuper from all further liability in respect of the benefits paid. I acknowledge that VicSuper may deduct tax (where applicable) from my benefit. I understand that any amount/s I have invested in the Term Deposit Option cannot be accessed before the maturity date. Only under special circumstances and at Trustee discretion, may VicSuper allow a term deposit to be terminated early. I understand there may be extra costs associated with an early termination, such as a reduction in interest accrued. I understand that unit prices will apply to the amount withdrawn on the day the withdrawal is processed from each investment option. I understand that any insurance cover I may have through my VicSuper Fund membership will cease upon full withdrawal of my benefit. I acknowledge that I can only withdraw my superannuation benefits from VicSuper as a temporary resident on an eligible visa who has permanently departed Australia, and have provided all required evidence of this. I acknowledge that VicSuper may require additional proof of identity in certain circumstances under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006. I understand that this withdrawal request is irrevocable. Name* Signature* Date* V219 04/14 P2 Please turn over
Step 7: Checklist If your account balance is over $5,000: Have you: Provided a written statement from DIAC stating that you were the holder of an eligible visa which has expired or been cancelled and you have permanently departed Australia Provided certified copies of proof of your identification Provided a certified copy of an eligible notice confirming your overseas residential address Signed the declaration in step 6. If your account balance is under $5,000: Have you: Provided a copy, or other evidence, of an eligible visa, showing that you were the holder of an eligible temporary visa that has now expired or been cancelled Provided a certified copy of your passport showing the arrival and the departed stamp from Australia (if you do not have a departed stamp, please see Conditions of release on page 6) Provided certified copies of proof of your identification Provided a certified copy of an eligible notice confirming your overseas residential address Signed the declaration in step 6. Step 8: Send your form to VicSuper Send your form and required information to: VicSuper, GPO Box 89 Melbourne Vic AUSTRALIA 3001 V219 04/14 P3
V219 04/14 P4 VicSuper Pty Ltd ABN 69 087 619 412 AFSL 237333 is the Trustee of VicSuper Fund ABN 85 977 964 496
GPO Box 89 Melbourne Vic 3001 VicSuper Member Centre 1300 366 216 vicsuper.com.au Application for superannuation benefits temporary residents departing Australia permanently If you have entered Australia on an eligible temporary residents visa and are subsequently departing Australia permanently, you are able to receive payment of any superannuation that has been accumulated in a regulated superannuation fund. For further information on conditions of release, please turn over. Important information regarding this withdrawal To receive your VicSuper superannuation benefit on the basis of you being a temporary resident who has departed Australia permanently, please complete this form and attach relevant information as required. Once all necessary paperwork is received and proof of identity requirements are met, your benefit will generally be paid within 10 working days. Please complete all details in BLOCK letters. Under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (AML/CTF Act) VicSuper is required to collect proof of your identity and to verify identification from a reliable and independent source. These requirements are explained in the Proof of identity section below. If you do not provide the proof of identity documents, including any additional identification or proof if requested, VicSuper may not be able to pay your benefit. Please send your completed form to VicSuper. We do not accept faxed requests. If you have any questions, please call our Member Centre on +61 3 9667 9679. Proof of identity You must provide proof of your identity for your benefit payment, regardless of the amount of your benefit. What information do you need to provide? You are required to provide your Full name Date of birth Residential address. As you reside overseas and/or you are directing VicSuper to make your benefit payment to an overseas address or to a foreign bank account, you must provide verification of all three items listed above. Therefore, you must provide a certified copy of: 1. A passport issued by the Commonwealth, or 2. A passport or a similar document issued for the purpose of international travel, that: a. contains a photograph and the signature of the person in whose name the document is issued b. is issued by a foreign government, the United Nations or an agency of the United Nations, and c. if it is written in a language that is not understood by the person carrying out the verification, is accompanied by an English translation prepared by an accredited translator. 3. And, one of the following: a. a licence or permit issued under the law or equivalent authority of a foreign country for the purpose of driving a vehicle that contains a photograph of the person in whose name the document is issued and contains their residential address, or b. a notice that: was issued to an individual by a local government body or utilities provider within the preceding three months contains the name of the individual and his or her residential address, and records the provision of services by that local government body or utilities provider to that address or to that person. Who can certify the document as a true copy? The following people are the only people who can certify copies for overseas residents: a judge of a court a registrar or deputy registrar of a court a police officer an Australian consular officer or an Australian diplomatic officer (within the meaning of the Consular Fees Act 1955). Employee of the Australian Trade Commission or employee of the Commonwealth who is: - in a country or place outside Australia; and - authorised under paragraph 3(d) of the Consular Fees Act Cwlth 1955; and - exercising his or her function in that place. The person who is authorised to certify documents must sight the original and the copy and make sure both documents are identical, then make sure all pages have been certified as true copies by writing or stamping certified true copy followed by their signature, printed name, qualification (eg judge, police officer etc) and date. If we do not receive the required proof of identity documents certified by an eligible person, your withdrawal will be delayed, as we will have to contact you to obtain copies certified by a person who is on the list above. Have you changed your name or are you signing on behalf of another person? If you have changed your name or are signing on behalf of the applicant, you will need to provide a certified linking document. A linking document is a document that proves a relationship exists between two (or more) names. Suitable linking documents include: Purpose Change of name Signed on behalf of the applicant Suitable linking documents Certified copy of marriage certificate, deed poll or change of name certificate from the Births, Deaths and Marriages Registration Office Certified copy of guardianship papers or Power of Attorney If you are providing a linking document due to a change of name or you are signing on behalf of another person, you must also provide certified copies of proof of identification documents as outlined. If both documents are not provided, your withdrawal will be delayed until correct documentation is provided. V219 04/14 P5
Conditions of release If your account balance is over $5,000, you must provide: A written statement from the Department of Immigration and Citizenship (DIAC) stating that: You were a holder of an eligible visa which has expired or been cancelled, and You have permanently departed Australia. This information can be obtained by completing the enclosed Certification of Immigration Status (form 1194) and paying the applicable fee. This form must then be sent to DIAC not VicSuper. You can, however, elect for DIAC to send the confirmation directly to us. Note: Unless this information is received, your benefit cannot be paid. Please refer to the enclosed letter for your account balance details. If your account balance is less than $5,000, you must provide: A certified copy, or other evidence, of an eligible visa, showing that you were a holder of an eligible temporary resident visa that has now expired or been cancelled, and A certified copy of your passport showing the arrival and the departed stamp from Australia (please provide a copy of the relevant pages). If your passport does not contain a departed stamp you will need to complete the enclosed Certification of Immigration Status (form 1194) and pay the applicable fee. This form must then be sent to DIAC - not VicSuper. Alternatively, the simplest way to make a claim if your balance is under $5,000 is to use the ATO online service. You can access this by following the links for temporary residents at www.ato.gov.au/superfunds. There is no fee for this service. Note: Unless this information is received, your benefit cannot be paid. Please refer to the enclosed letter for your account balance details. Nominate your bank account for payment This information relates to Step 4. You can only deposit your super withdrawal into an account held in your name or held jointly in your name. This does not include business accounts. No payments can be made into credit accounts such as Visa, Mastercard or American Express. Please check that your account details are correct, as we won t verify these with your bank or financial institution. VicSuper will not be liable for any errors that occur based on the account details you provide. Please allow up to 10 working days for the funds to be processed and received by your bank. What if you do not quote your tax file number? This information relates to Step 1. There is no requirement for you to provide your tax file number (TFN) and failing to do so is not an offence. However, if you have made concessional contributions to VicSuper in the current financial year, the highest marginal tax rate plus Medicare levy will apply, compared to the concessional tax rate of 15%. 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. V219 04/14 P6