Application for benefit payment or transfer

Application for benefit payment or transfer Use this form if you want to cash in your benefit or transfer all or part of your super balance to another super fund. This form should not be used by temporary residents. See our fact sheet Departing Australia Superannuation Payments for more information. Please use a dark pen and CAPITAL letters, or type directly into this form online, print and sign it and send it to us. Use ( ) to mark boxes. All forms are on our website under Forms. IMPORTANT: If you want to use your account balance to start a First State Super income stream, just complete the income stream member application form. The Notes at the back will help you complete this form. If you have any questions, please call us on 1300 650 873. 1. Your personal details Member number Title M F Date of birth (DD-MM-YYYY) Last name Given name(s) Residential address Suburb State Postcode Postal address (if different from residential) Suburb State Postcode Daytime contact number Mobile number NOTE It isn t compulsory to provide your TFN but if you don t, (1) you may pay additional tax on your benefit payment and (2) you may need to supply proof of identity if you wish to transfer your benefit. See Notes at the back of the form. Tax file number (if not previously provided) Email (for security reasons, please ensure that your nominated email address is your personal email address and not a role-based email address such as employee_title@company.com.au) 2. Work test declaration Only complete this section if you have turned 65 and then made voluntary contributions (salary sacrifice, spouse or personal contributions) and have not returned a work test declaration that covered your most recent voluntary contributions. You must complete a work test to be eligible to contribute to the fund. I have worked in paid employment for at least 40 hours within 30 consecutive days during the financial year in which my most recent voluntary contributions were made. If you have not worked in paid employment for at least 40 hours within 30 consecutive days during the financial year in which your most recent voluntary contributions were made, we will refund those contributions. page 1 of 8

IMPORTANT If you request a partial withdrawal, you may lose your insurance cover if you don t retain enough money in your account to cover your insurance premiums. Also, if the amount you wish to withdraw does not allow $1,500 to remain in your account, then the amount released will be your account balance less $1,500. 3. What would you like to do? Cash my benefit Please complete sections 4, 5 (if applicable), 6, 8 and 9. My whole benefit All my benefit, less $1500 to keep my account open My full unrestricted non-preserved amount The following amount $,,. Note: If you are under 60, tax may be payable on your benefit. Please place a cross in this box amount shown above is the benefit you require after tax. Roll over to another fund (you must complete a separate form for each fund) Please complete sections 5 (if applicable), 7, 8 and 9. My whole benefit My benefit less $1500 to keep my account open if the The following amount $,,. 4. Cashing declarations and employer information IMPORTANT If you are terminally ill or permanently incapacitated and wish to access your benefit, call us for the form you need to complete. Condition of release declarations You must satisfy one of these conditions of release to withdraw your super in cash. For more information, see our fact sheet Access to your super available from our website and customer service. Please the options that apply to you: Date of birth Preservation age I declare that I am aged 65 years or over; or Before 1 July 1960 55 I declare that I am aged 60-64 years and have ceased a paid employment arrangement since turning age 60,* or I declare that I am aged between my preservation age (see table) and age 64 years and have permanently retired; or 1 July 1960 to 30 June 1961 56 1 July 1961 to 30 June 1962 57 1 July 1962 to 30 June 1963 58 1 July 1963 to 30 June 1964 59 After 30 June 1964 60 I declare that I have ceased paid employment with an employer who contributed to my account and I wish to withdraw my restricted non-preserved benefit; or I declare that I have ceased a paid employment arrangement with a participating employer and my account balance is under $200. I wish to access an existing unrestricted non-preserved benefit. * Please provide the details below if you have turned 60 and ceased a paid employment arrangement: Date ceased paid employment: If the date is more than five years ago, please record the year only. Employer name page 2 of 8

IMPORTANT If your final contribution is not received within 30 days of the date you sign this form, your benefit will be paid and your account will be closed so that payment is not delayed. 5. Final contribution details (full withdrawals only) Only complete this section if your employer still has a final contribution payment to make for you (e.g. a compulsory SG contribution). If there is a contribution outstanding, you can choose to close your account and receive your payment without waiting for the final contribution payment OR wait for the final contribution to arrive then close your account. If we receive a contribution after your account is closed, the contribution will be refunded to the employer. OR Close my account without waiting for any further contributions from my employer Wait for the final contribution from my employer and then withdraw my benefit and close my account. Please provide the details of the employer currently making contributions to your account: Date terminated employment: Expected date of contribution Employer name Employer contact name Employer phone number Employer email address 6. Payment details (for full or partial cash payment) Payment can be made directly to your bank account, or by cheque to either your residential address or postal address. Pay direct to my bank account shown below. Note: If you would like payment into your bank account, the account must be in your name and you must provide the account details below, together with a copy of your statement or passbook showing your full name and account details. Your statement/passbook details must match the banking details you provide below. If you do not provide a bank statement, then payment will be made by cheque to your current postal address. If you have already provided a copy of your statement or passbook showing your full name and account details that match the banking details below, you do not need to provide another copy. Account name BSB number Account number Name of financial institution Branch Post a cheque to my residential address; or Post a cheque to my postal address. Note: Cheques can only be made out to you, not third parties. page 3 of 8

IMPORTANT: Unless you are transferring to an SMSF, please ensure that you include your TO fund s full address, Unique Superannuation Identifier (USI) and member number or we may not be able to process your request. 7. Transfer all or part of your benefit to another super fund Payment will be made to the rollover fund you nominate to an account in your name. A payment to a selfmanaged superannuation fund will be made to the fund s registered name and mailed to the registered address recorded on the government s Super Fund Lookup website at www.superfundlookup.gov.au. Where the SMSF fund status is not clear, we may require additional documentation to process the rollover. Are you transferring money to a self-managed super fund (SMSF)? Yes No IMPORTANT: If you wish to roll over amounts to more than one fund, you must complete a separate form for each fund. Name of the other fund (your TO fund) Address of other fund Suburb State Postcode Fund ABN Unique Superannuation Identifier (USI) Member number Contact number 8. Proof of identity (also see page 7 of the Notes) IMPORTANT! If you are overseas and want to apply for a benefit payment, please contact us because different certification rules apply. Payments to you We require a certified copy of proof of identity (POI) document(s) before we can pay your benefit. If you have already provided a certified copy of your POI document(s), you do not have to provide it again, as long as your name or residential address have not changed. The primary documents we accept are listed below. The secondary documents we accept, and the people who can certify ALL documents, are listed under Proof of identity on page 7. This section also explains the documents we require if you have already provided a certified copy of POI document(s) but your name or residential address has subsequently changed. We may request updated and/or additional certified copies of POI documents at any time if we consider this is necessary for the security of our members benefits. Primary identification documents We require a certified copy of ONE of the following primary documents: current Australian state/territory driver s licence containing your photograph Australian passport current card issued under an Australian state or territory law to prove your age and containing your photograph current foreign passport or similar travel document containing your photograph and signature. * Secondary identification documents Alternatively, we require certified copies of TWO secondary documents. A list of secondary documents is included on page 7 of the Notes. * Documents written in a language other than English must be accompanied by an English translation prepared by an accredited translator. Benefit transfers For transfers to APRA-regulated funds, you should provide your tax file number (TFN). If you do not provide your TFN, you must provide the certified POI document(s) described above. For transfers to self-managed super funds (SMSFs) you must provide the certified POI document(s) described above. page 4 of 8

9. Declaration I declare that the information I have provided in this form is true and correct. I understand that my insurance cover will cease if I don t have enough funds remaining in my super account to pay premiums. I declare that I have sufficient information to make an informed decision about the payment/transfer of my benefit from First State Super. If I have asked the trustee to defer the payment of my benefit until my final SG payment comes in, but I have not provided a date for the final contribution, I authorise my employer to provide this date on my behalf. I understand that if I withdraw my account balance in full, any contributions received by First State Super from my participating employer after the payment/transfer will be refunded. I declare that I am an Australian or New Zealand citizen or a permanent resident of Australia and not a current or former temporary resident of Australia. I declare that I am the member of First State Super who is signing this declaration or I have been given Power of Attorney by the member and this Power of Attorney remains valid. A certified copy of the Power of Attorney has been provided. I understand that if I don t provide my tax file number, I may have additional tax deducted from my benefit, and the taxed component of any cash payment will be taxed at the highest marginal rate plus the Medicare levy and any other applicable levies. I understand that a $36 exit fee will be applied to my payment/transfer. I have read and understand the First State Super privacy policy. Please sign and date form here. Signature Date signed (DD-MM-YYYY) Name (print in CAPITAL letters) 10. Privacy The personal information you provide on this form is collected by and held for First State Super by the fund administrator, Pillar Administration, in accordance with the Australian Privacy Principles of the Privacy Act 1988 (Cth), for the purpose of administering your account and providing you with services associated with your fund membership. For further information about how your personal information is handled, please phone us on 1300 650 873 or visit firststatesuper.com.au/privacyandgovernance to view the privacy policy (a hard copy of the policy may also be provided on request). The policy contains information about how you may access and seek correction of your personal information, how you may complain about a breach of your privacy and other important information about how your personal information is collected, used and disclosed. Send the form to this address. 11. Where to send your completed form Return the completed form to First State Super PO Box 1229 WOLLONGONG NSW 2500. If you have any questions, please call us on 1300 650 873. Checklist Have you completed all relevant sections of the application form and enclosed all documents required to support this application? Have you provided employment and final contribution information, if applicable? Have you provided your TFN, which is recommended if you are transferring to an APRA-regulated fund or taking your benefit in cash? Have you included proof of identity documents (if required) properly certified by an eligible signatory? Have you signed and dated the Section 9 Declaration? If you are self-employed, have you sent us your Notice of intent to claim or vary a deduction for personal super contributions form, if relevant. Once your money is transferred or paid to you, you will not be able to claim a deduction for personal contributions made to us. page 5 of 8

Notes For information about access to and withdrawing your superannuation, you should read the current Member Booklet (Product Disclosure Statement), and our fact sheets that discuss the conditions you must meet to access your super. The Member Booklet and the fact sheets are available on our website and they are also available free of charge from customer service on 1300 650 873. IMPORTANT: If you are transferring all or part of your account balance to start a First State Super income stream, you DO NOT need to complete this form. You only need to complete the income stream member application form. Your personal details Email address The email address you provide will replace any email address we currently hold for you. For security reasons, please ensure that your nominated email address is your personal email address and not a role-based email address such as employee_title@company.com.au. Tax file number When applying for your benefit we encourage you to provide your tax file number (TFN) if you have not already done so. You don t have to provide your TFN but if you choose not to, and you are applying for your total benefit, the payment will be reduced by the amount of any additional tax payable on your concessional contributions, and the benefit, if taken in cash, will be taxed at the highest marginal rate plus the Medicare levy and any other applicable levies. 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. The trustee of your superannuation fund may disclose your TFN to the Commissioner of Taxation or to another superannuation provider when your benefits are being transferred, unless you request the trustee of your superannuation fund in writing that your TFN not be disclosed to any other trustee. Cashing in your benefit Cashing declarations You must satisfy one of the conditions of release listed in Section 4 if you want to cash in your benefit. See our fact sheet Access to your super, available on our website and from customer service, for more information. Payment details If you would like payment into your bank account, the account must be in your name and you must provide these account details in Section 6, together with a copy of your statement or passbook showing your full name and account details. Generally, your payment will be processed within 3 business days of receipt of your correctly completed benefit payment form. Transferring your benefit to another super fund You can roll over or transfer all or part of your benefit to another super fund at any time by completing the information requested in Sections 3 and 7. Generally, your rollover will be processed within 3 business days of receipt of the completed benefit payment or transfer form. If you are transferring to an APRA-regulated fund and you provide your TFN, you do not need to provide proof of identity (POI) documents. If you do not provide your TFN you will need to provide certified POI documents and your transfer may take longer to process. Super funds regulated by the Australian Prudential Regulation Authority (APRA) are typically large funds with hundreds or thousands of members. Funds which are not regulated by APRA are self-managed super funds (SMSFs), and have four or fewer members. If you are transferring to an SMSF you need to provide certified documents to prove your identity. page 6 of 8

Proof of identity We require a certified copy of your proof of identity (POI) documents before we can pay your benefit. If you have already provided a certified copy of your POI document(s), you do not have to provide it again, as long as your name or residential address have not changed. If you have already provided certified copies of your POI documents but either your name or residential address has since changed, you must provide evidence of the change(s) as follows: Change of name If you have changed your name, you must provide a certified copy of one of the following name change documents: marriage certificate or certificate of registration (if you are on the relationship register) issued by the Births, Deaths and Marriages Registration Office (ceremonial certificates cannot be accepted) deed poll or change of name certificate from the Births, Deaths and Marriages Registration Office. If you have reverted to your maiden name on divorce, we will require a divorce certificate and a linking document such as your marriage certificate showing your original maiden name. Change of residential address If you have changed your residential address, you must provide a certified copy of a POI document showing your new residential address. If it is more convenient, you can provide the original (rather than a certified copy) of a recent notice issued by your local council or a recent utilities bill addressed to you at your current residential address. Power of attorney If you are requesting benefits on behalf of the member as the holder of their Power of Attorney, you must provide certified copies of POI documents for yourself and the member. We may request updated and/or additional certified POI documents at any time if we consider this is necessary for the security of our members benefits. Acceptable documents and certification The primary and secondary documents we accept are shown below. The people who can certify these documents are shown on page 8. Providing certified POI is a three-step process: 1 Collect your originals Collect your proof of identity document(s). We have listed the documents you can use below. You can provide: 2 Photocopy your originals Photocopied originals must be properly certified. 3 Have your photocopies certified Take your photocopies and your original documents to a person who can certify documents. A list of authorised certifiers and certification guidelines is included under Certification of personal documents on page 8. Either: A certified copy of one of the following documents: current Australian state/territory driver s licence with your photograph Australian passport current card issued under an Australian state or territory law for the purpose of proving your age and containing your photograph current foreign passport or similar travel document containing your photograph and signature*. Or: One certified document from this list: an Australian birth certificate or extract issued by a state or territory a citizenship certificate issued by the Commonwealth a current Centrelink pension card that entitles you to receive financial benefits AND One certified document from this list: a notice issued by the ATO within the last 12 months that shows your name and current residential address and records an amount payable to or by you e.g. your last tax return a notice issued by a local council or utilities provider in the last three months showing the provision of services to you and your current residential address e.g. rates notice, electricity or water bill a notice issued by the Commonwealth or a state or territory government within the last 12 months showing your name and current residential address and the provision of financial benefits to you e.g. Centrelink letter. * Documents not written in English must be accompanied by an English translation prepared by an accredited translator. page 7 of 8

Certification of personal documents All copied pages of original POI documents (including any change of name documents) need to be certified as true copies by an authorised person with the appropriate Australian qualifications or registration (see below) who cannot be the owner or addressee of the document. The authorised person must sight the original and the copy to ensure both documents are identical, then make sure all pages have been certified by writing 'I certify that this document is a true copy of the original', followed by their signature, printed name, qualification (e.g. justice of the peace, Australia Post employee, etc.), registration number (if applicable) and date. The following people can certify copies of the originals: police officer Australia Post employee in charge of an office providing postal services (charges may apply) Officer or an authorised representative of an Australian Financial Services Licensee (AFSL) with two or more years continuous service medical practitioner legal practitioner pharmacist justice of the peace magistrate nurse optometrist dentist chiropractor physiotherapist psychologist veterinary surgeon full-time teacher employed at a school or tertiary institution. Samantha Sample has provided a copy of her identification that includes her signature, full name, date of birth and current residential address. The authorised person has sighted the original identification and confirmed that the copy is a true copy. Details for the authorised person to include are full name, qualification, registration number (if applicable), date and signature. Samantha SAMPLE 123 ANY ST SUBURB NSW 2000 Licence No. 12345678 Licence Class C Driver Licence SAMPLE Donor A Conditions S Date of Birth 01 JAN 1980 Card Number 2 123 456 789 Expiry 01 JAN 2020 "I certify that this document is a true copy of the original." Name: Kate Anderson Qualification: JP Registration no: 123456 Date: 31 March 2016 page 8 of 8