Withdrawal Fm 1 July 2015 Customer Services Phone 13 38 63 Fax 02 9234 6668 Email customer@onepath.com.au Website anz.com This fm is f existing invests in ANZ Superannuation Savings Account only. INSTRUCTIONS Complete the relevant sections, sign and return this fm to the following address: ANZ Superannuation Savings Account OnePath Life Limited GPO Box 4028 Sydney NSW 2001 Member number Tax file number* * If you have not provided your TFN, some contributions and the untaxed element of a rollover may attract further tax. Please refer to the ANZ Superannuation Savings Account PDS f further details on the collection of TFN s. 1. MEMBER DETAILS Surname Given name(s) Date of Birth (dd/mm/yyyy) Residential address (this cannot be a PO Box) Postal address (if different from above) Phone Home Business Mobile Fax Email 2. PROOF OF IDENTITY You need to supply a certified copy f each fm you send in. I have attached a certified copy of my driver s licence passpt I have attached certified copies of both: Birth/Citizenship Certificate Centrelink Pension Card and Centrelink payment letter Government Local Council notice (less than one year old) with name and address. A certified copy is a photocopy which has been compared with the iginal and endsed as a true copy by an individual approved to do so, f example a Justice of the Peace, legal practitioner, Australia Post employee, etc. F me infmation on identification requirements and who can certify documents, please refer to the Know your customer identification requirements on page 5 of this fm. Note: We cannot accept iginal certified copies by fax, photocopies of certified identification. Page 1 of 7
Withdrawal Fm 3. TAX QUESTIONNAIRE If you intend to claim a tax deduction f your personal contributions want to vary a previous notice of intent you gave your super fund, please ensure you have completed and returned a Notice of intent to claim vary a deduction f personal super contributions fm (attached) and have received acknowledgement from the Trustee befe you submit this Withdrawal Fm. Reason f benefit payment request I have completed and submitted a choice of fund nomination to my employer, nominating another fund. I am requesting a partial withdrawal only. I am an ANZ Superannuation Savings Account member wishing to close my account. F any other benefit payment requests (such as Severe Financial Hardship, Specified Compassionate Grounds if you are a departed Tempary Australian Resident), please contact Customer Services on 13 38 63. 4. ROLLOVER Total rollover Partial rollover If partial, please state amount required $ (net) Name of rollover institution USI of the destination product Superannuation Fund No. (SFN)* and/ Australian Business No. (ABN)* Contact name (if known) Cheque payable to Policy/Reference No. Postal address Phone (business) Please attach a letter of compliance if the rollover is to a self-managed super fund. * Either the SFN ABN must be completed pri to your withdrawal being processed. Page 2 of 7
Withdrawal Fm 5. ELIGIBILITY TO WITHDRAW A LUMP SUM CASH PAYMENT Are you a permanent resident citizen of Australia New Zealand a holder of a subclass 405 410 visa? Yes please continue to complete this section. No Please note that from 1 April 2009, an individual who has, at any stage, been a tempary resident and is not a permanent resident of Australia is not a citizen of Australia New Zealand and is not a holder of a sub class 405 410 visa, is only able to withdraw their preserved superannuation benefits under limited conditions of release, including: death, terminal medical condition, permanent incapacity, tempary incapacity, unclaimed money payment, and departed tempary resident. Exceptions apply to individuals who have satisfied a condition of release pri to 1 April 2009. Please speak to your financial adviser f me infmation. I would like to withdraw a lump sum cash payment. I have met one of the conditions of withdrawal, as indicated by me below. Please tick one of the following: Retirement: I have reached my preservation age and have permanently retired from the wkfce. Retirement: I am aged 60 years me and have ceased an arrangement of gainful employment since attaining age 60 years. I am aged 65 years me. The amount to be withdrawn is unrestricted non-preserved. I have left my ANZ Superannuation Savings Account participating employer and my date of ceased employment is Note: a benefit will only be payable under this rule if the member s balance is less than $200. Other* Date (dd/mm/yyyy) Severe financial hardship Compassionate grounds Departed tempary resident Permanent incapacity * Do not use this fm f withdrawals relating to death claims, a terminal medical condition the Family Law Act 1975. Please phone Customer Services on 13 38 63 f claim requirements. 6. WITHDRAWAL INSTRUCTIONS a. Full withdrawal only I would like to withdraw my total account balance. I am aware that any fees and any taxes will be deducted befe payment is made. b. Partial withdrawal only I would like to make a partial withdrawal of: $ Please tick one of the following:. Please indicate below whether this amount is to be net gross. Net: I would like my withdrawal to be net of fees and taxes. This means that the amount I have nominated is the exact amount that I will receive after any fees and taxes are deducted. Gross: I would like my withdrawal to be gross of fees and taxes. This means that the amount I have nominated is befe any fees and taxes are deducted. 7. DIRECT CREDIT FACILITY (CASH PAYMENTS ONLY) Cash payments only, can be credited directly into your financial institution account. Please provide your full details below. Note: Allow up to five days f clearance (direct crediting is not available on the full range of account types e.g. credit unions and building societies. Please check with your financial institution). Name of financial institution Account name Bank (BSB number) Account number Note: ANZ will take care to ensure that your benefit payments are made in accdance with this authity. However, we accept no responsibility f any loss which occurs as a result of increct bank details you provide to us. If the bank rejects the payment of your benefits into the bank account you have provided, we will make the payment to you by cheque. Page 3 of 7
Withdrawal Fm 8. CHEQUE PAYMENTS Please send a cheque to my postal address below: Name Address State Postcode 9. DECLARATION AND SIGNATURE Your final account balance cannot be calculated until the day payment is actually made. The amount that will be paid depends on the current value of your account, your employer fwarding any outstanding amounts, investment earnings losses and any taxes and fees that may apply to your account. If you have any concerns you should discuss these with your financial adviser. By completing this fm: I consent to the collection, use, stage and disclosure of my personal infmation (including health infmation) as described in ANZ s Privacy Policy which is available at anz.com, by calling Customer Services. If I have provided infmation about another person in this application (f example a beneficiary life insured), I declare that I have the consent of that person to do so. I understand that OnePath requires me to infm the person concerned that I have done so and direct them to the Privacy Policy which is located at anz.com I consent to OnePath using and sharing my Tax File Number with members of the ANZ Group to provide services (including account consolidation) and products to me. I accept that OnePath may send me infmation about its products services from time to time. I understand that I may notify OnePath of my decision not to receive further infmation by contacting OnePath directly. I authise my financial adviser (where I have nominated financial adviser) to receive and access my personal infmation f the purposes of managing my investment. Where there is a change to this authity relating to my adviser, I will notify OnePath of the change. I declare that I am not bankrupt insolvent under administration and that the infmation provided by me in this fm is true and crect. I request the Trustee, OnePath Custodians Pty Limited (OnePath Custodians) and OnePath Life Limited (OnePath Life) to act upon and give effect to the directions given by me in this notice. I acknowledge that I am not aware and have no reason to suspect that my investment is derived from, related to used to fund, money laundering, terrism financing other similar activities and my instructions in relation to my investment will not result in ANZ any of its related group companies breaching any related laws regulations in Australia any other country. I acknowledge that should I, my estate, receive a payment from OnePath Custodians in full satisfaction of my benefits under the policy and/ the Fund, OnePath Custodians will have fully discharged their obligations under the Trust Deed governing the Fund and the policy, and that any payment made to in respect of me shall be net of any lump sum tax paid, as required by law, to the Australian Taxation Office. I declare that the infmation completed on this fm is true and crect. I declare that I have read and understood the benefit payment rules in the PDS. Name of member Signature of member Date (dd/mm/yyyy) Page 4 of 7
Know your customer identification requirements 1 July 2015 The Anti-Money Laundering and Counter-Terrism Financing Act 2006 (Cth) requires us to identify you and verify your identity befe we make a payment of your super. The infmation outlined below relates to individuals and sole traders only. INDIVIDUALS/SOLE TRADERS You can do one of two things to provide evidence of client identity verification to us: Financial advisers only complete the ANZ Identification Fm which verifies you have collected sufficient identification from your client. Note: you are not required to send in iginals copies of identification if you use this fm. Individuals not using the services of a financial adviser send in iginal certified copies* (not iginal documents) of the following: one primary photographic identification document, one primary non-photographic identification document and one secondary identification document. Note: We cannot accept certified copies by fax email. Primary photographic identification document One of: Current Australian driver s licence Australian passpt (current expired less than two years ago) Proof of Age document issued by a State Territy Feign government issued passpt similar travel document containing the person s signature*. Or, if none of these documents can be provided, both: Current feign driver s licence that contains the person s date of birth* and Feign government issued identity card containing the person s signature*. Primary non-photographic identification document Australian Birth Certificate birth extract Australian Citizenship Certificate Feign government issued birth certificate* and Centrelink Pension Card Feign government issued certificate of citizenship*. Secondary identification document Commonwealth, State Territy issued document dated within the last 12 months that recds the provision of financial benefits to the person and which contains the person s name and residential address. Australian Taxation Office issued document dated within the last 12 months that recds an amount payable owed to the person and which contains the person s name and residential address. Local Government body utilities provider issued document dated within the last three months that recds the provision of services to that address that person and which contains the person s name and residential address. If the person is under the age of 18, a notice dated within the last three months from a school principal containing the person s name and residential address and the period of attendance at that school. * Documents not in English must be accompanied by an English translation prepared by an accredited translat. A certified copy is a document that has been certified as a true copy of the iginal. Examples of who can certify documents are: a person enrolled on the roll of a a notary public a bank building society officer with Supreme Court the High Court as a a police officer two me years of continuous service legal practitioner a judge, registrar deputy registrar of a court a magistrate a chief executive officer of a Commonwealth court a Justice of the Peace an agent of Australia Post in charge of supplying postal services to the public a permanent employee of Australia Post with two years continuous service employed in supplying postal services to the public an Australian consular diplomatic officer a finance company officer with two year s continuous service an officer authised representative of an AFSL holder with two years continuous service a member of the Institute of Chartered Accountants in Australia, CPA Australia Institute of Public Accountants. Note: The person who is authised to certify documents must make sure all pages have been certified as true copies by writing stamping certified true copy followed by their signature, printed name, contact details, qualification (e.g. Justice of the Peace, Australia Post employee, etc.) and date. The person certifying a document must be either an Australian citizen a permanent resident of Australia. A full list of persons who can certify documents is available from Customer Services on 13 38 63. Page 5 of 7
Notice of intent to claim vary a deduction f personal super contributions 1 July 2015 Customer Services Phone 13 38 63 Fax 02 9234 6668 Email customer@onepath.com.au Website anz.com 1. MEMBER ACCOUNT NUMBER Member number 2. MEMBER DETAILS Surname Given name(s) Date of Birth (dd/mm/yyyy) Postal address Phone Home Business Mobile Fax Tax file number* Note: You don t have to provide your TFN to us. However, if we do not have your TFN, we may not be able to accept your contributions. Providing your TFN will also assist us in crectly identifying you. 3. CONTRIBUTION DETAILS You must complete and return this notice to the Trustee if you intend to claim a taxation deduction f part all of your personal superannuation contributions. Financial year ended 30 June 20 My personal contributions to this Fund covered by this notice $ Is this notice varying an earlier notice Yes No The amount of these personal contributions I will be claiming as a tax deduction $ Note: A tax deduction f personal superannuation contributions may only be claimed by people in certain circumstances. Please refer to the ATO TaxPack, your financial adviser Accountant to determine if you are eligible to claim a personal tax deduction. Page 6 of 7
Notice of intent to claim vary a deduction f personal super contributions 4. DECLARATIONS 4A. Declaration Intention to claim a tax deduction Use this declaration if you have not previously lodged a notice with the Fund f these contributions. I am lodging this notice befe both of the following dates: the day that I lodged my income tax return f the year stated in section 2 of this notice the end of the income year after the year stated in section 2 of this notice. At the time of completing this notice: I intend to claim the personal contributions in section 2 of this notice as a tax deduction I am a member of the Fund the Fund still holds these contributions the trustee of the Fund has not begun to pay a superannuation income stream based in whole part on these contributions I have not included these contributions in an earlier notice. The infmation given on this fm is crect and complete. Name of member Signature of member Date (dd/mm/yyyy) If you do not wish to claim a Tax Deduction, you do not have to complete part 4A. 4B. Declaration Variation of previous deduction notice Use this declaration if you have already lodged a notice with the Fund f these contributions and you wish to reduce the amount stated in that notice. I intend to claim the personal contributions in section 2 of this notice, as a tax deduction. I wish to vary my previous notice f these contributions by reducing the amount I advised in my previous notice. I confirm that either: I have not yet lodged my income tax return f the relevant financial year and this variation notice is being lodged on befe the 30 June in the financial year following the year the contribution was made the Australian Taxation Office has disallowed my claim f a deduction f the relevant year and this notice reduces the amount stated in my previous notice by $ The infmation given on this fm is crect and complete. Name of member Signature of member Date (dd/mm/yyyy) If you do not wish to vary a Tax Deduction, you do not have to complete part 4B. Page 7 of 7 M3069/0715