8132019 Apply for a Payment (Temporary Residents)

httpslidepdfcomreaderfullapply-for-a-payment-temporary-residents 14

8132019 Apply for a Payment (Temporary Residents)

httpslidepdfcomreaderfullapply-for-a-payment-temporary-residents 24Issued by AustralianSuper Pty Ltd ABN 94 006 457 987 AFSL 233788 Trustee of AustralianSuper ABN 65 714 394 898

8132019 Apply for a Payment (Temporary Residents)

httpslidepdfcomreaderfullapply-for-a-payment-temporary-residents 34Issued by AustralianSuper Pty Ltd ABN 94 006 457 987 AFSL 233788 Trustee of AustralianSuper ABN 65 714 394 898

Please complete in pen using CAPITAL letters Print 983095 to mark boxes Form must be completed in full

STEP 1 PROVIDE YOUR PERSONAL DETAILS

Last name

First name

Date of birth Male Female Mr Ms Mrs Miss Dr

D D M M Y Y Y Y X X X X X X X

Member number Tax file number

Street address

Suburb State Postcode

Country

Postal address (if different to street address)

Suburb State Postcode

Country

Telephone (business hours) Telephone (after hours) Mobile

Email

Name of your last employer contributing for you into AustralianSuper

Has your employment with this employer ceased X Yes Date you finished work D D M M Y Y Y Y X No

STEP 2 PROVIDE PAYMENT DETAILS

Payment will be in Australian dollars and can be made by EFT or cheque (please choose ( 983095) one of the two options below)

X Electronic Funds Transfer (EFT) payment to an Australian bank account ndash for fast payment

Account name Name of bank or financial institution

Branch BSB number Account number

X Cheque payment

If the cheque is to be sent to an address thatrsquos different from that provided in section 1 please provide the new address below

Street address

Suburb State Postcode

Country

Apply for a payment (temporary residents)

10130 1112 page 1 of 2

For how we use your TFN

go to wwwaustraliansupercom RefTFN

If you donrsquot provide your TFNyoursquore likely to pay more tax than

you need to

8132019 Apply for a Payment (Temporary Residents)

httpslidepdfcomreaderfullapply-for-a-payment-temporary-residents 44page 2 of 2

STEP 3 CONFIRM THE DOCUMENTS YOU NEED ARE ATTACHED

X Irsquove attached the copies of the following documents as required

For account balances of less than $5000

X Copy of your passport containing photo and signature

X Copy of your Temporary Resident Visa showing that thevisa has expired or been cancelled

X Copy of your passport showing your arrival stamp in

and your departure stamp from Australia

For account balances of $5000 or more

X Copy of your passport containing photo and signature

X A written statement from the Department ofImmigration and Citizenship (see below) stating that

rsaquo your Temporary Resident Visa has expired or been

cancelled and

rsaquo yoursquove permanently departed Australia

See the information on the front of this form for more details

STEP 4 SIGN THIS FORM

The information is correct To the best of my knowledge the information provided on this form is correct I was a temporary

resident and I have permanently departed Australia

The information will be used to action the request The personal information provided on this form will be used to action the

request Go to wwwaustraliansupercomprivacy for full details on the collection and use of personal information A $35 fee

will be charged Any Australian tax payable will be deducted before the payment is made (usually 35 of taxable amounts)

Sign here

Date

D D M M 2 0 Y Y

STEP 5 SEND THIS FORM AND YOUR DOCUMENTS TO US

Please send this form and the documents listed in step 3 to

AustralianSuperGPO Box 1901MELBOURNE VIC 3001

AUSTRALIAWe need your original form so you canrsquot fax your application to us

If you have any questions call us on 1300 300 273 between 800am and 800pm (AEST) Monday to Friday or on

+61 3 8663 1699 if yoursquore outside Australia

Please return this completed form and the documents listed to AustralianSuper GPO Box 1901 MELBOURNE VIC 3001 AUSTRALIA

Questions Telephone 1300 300 273 Web wwwaustraliansupercom

8132019 Apply for a Payment (Temporary Residents)

httpslidepdfcomreaderfullapply-for-a-payment-temporary-residents 24Issued by AustralianSuper Pty Ltd ABN 94 006 457 987 AFSL 233788 Trustee of AustralianSuper ABN 65 714 394 898

8132019 Apply for a Payment (Temporary Residents)

httpslidepdfcomreaderfullapply-for-a-payment-temporary-residents 34Issued by AustralianSuper Pty Ltd ABN 94 006 457 987 AFSL 233788 Trustee of AustralianSuper ABN 65 714 394 898

Please complete in pen using CAPITAL letters Print 983095 to mark boxes Form must be completed in full

STEP 1 PROVIDE YOUR PERSONAL DETAILS

Last name

First name

Date of birth Male Female Mr Ms Mrs Miss Dr

D D M M Y Y Y Y X X X X X X X

Member number Tax file number

Street address

Suburb State Postcode

Country

Postal address (if different to street address)

Suburb State Postcode

Country

Telephone (business hours) Telephone (after hours) Mobile

Email

Name of your last employer contributing for you into AustralianSuper

Has your employment with this employer ceased X Yes Date you finished work D D M M Y Y Y Y X No

STEP 2 PROVIDE PAYMENT DETAILS

Payment will be in Australian dollars and can be made by EFT or cheque (please choose ( 983095) one of the two options below)

X Electronic Funds Transfer (EFT) payment to an Australian bank account ndash for fast payment

Account name Name of bank or financial institution

Branch BSB number Account number

X Cheque payment

If the cheque is to be sent to an address thatrsquos different from that provided in section 1 please provide the new address below

Street address

Suburb State Postcode

Country

Apply for a payment (temporary residents)

10130 1112 page 1 of 2

For how we use your TFN

go to wwwaustraliansupercom RefTFN

If you donrsquot provide your TFNyoursquore likely to pay more tax than

you need to

8132019 Apply for a Payment (Temporary Residents)

httpslidepdfcomreaderfullapply-for-a-payment-temporary-residents 44page 2 of 2

STEP 3 CONFIRM THE DOCUMENTS YOU NEED ARE ATTACHED

X Irsquove attached the copies of the following documents as required

For account balances of less than $5000

X Copy of your passport containing photo and signature

X Copy of your Temporary Resident Visa showing that thevisa has expired or been cancelled

X Copy of your passport showing your arrival stamp in

and your departure stamp from Australia

For account balances of $5000 or more

X Copy of your passport containing photo and signature

X A written statement from the Department ofImmigration and Citizenship (see below) stating that

rsaquo your Temporary Resident Visa has expired or been

cancelled and

rsaquo yoursquove permanently departed Australia

See the information on the front of this form for more details

STEP 4 SIGN THIS FORM

The information is correct To the best of my knowledge the information provided on this form is correct I was a temporary

resident and I have permanently departed Australia

The information will be used to action the request The personal information provided on this form will be used to action the

request Go to wwwaustraliansupercomprivacy for full details on the collection and use of personal information A $35 fee

will be charged Any Australian tax payable will be deducted before the payment is made (usually 35 of taxable amounts)

Sign here

Date

D D M M 2 0 Y Y

STEP 5 SEND THIS FORM AND YOUR DOCUMENTS TO US

Please send this form and the documents listed in step 3 to

AustralianSuperGPO Box 1901MELBOURNE VIC 3001

AUSTRALIAWe need your original form so you canrsquot fax your application to us

If you have any questions call us on 1300 300 273 between 800am and 800pm (AEST) Monday to Friday or on

+61 3 8663 1699 if yoursquore outside Australia

Please return this completed form and the documents listed to AustralianSuper GPO Box 1901 MELBOURNE VIC 3001 AUSTRALIA

Questions Telephone 1300 300 273 Web wwwaustraliansupercom

8132019 Apply for a Payment (Temporary Residents)

httpslidepdfcomreaderfullapply-for-a-payment-temporary-residents 34Issued by AustralianSuper Pty Ltd ABN 94 006 457 987 AFSL 233788 Trustee of AustralianSuper ABN 65 714 394 898

Please complete in pen using CAPITAL letters Print 983095 to mark boxes Form must be completed in full

STEP 1 PROVIDE YOUR PERSONAL DETAILS

Last name

First name

Date of birth Male Female Mr Ms Mrs Miss Dr

D D M M Y Y Y Y X X X X X X X

Member number Tax file number

Street address

Suburb State Postcode

Country

Postal address (if different to street address)

Suburb State Postcode

Country

Telephone (business hours) Telephone (after hours) Mobile

Email

Name of your last employer contributing for you into AustralianSuper

Has your employment with this employer ceased X Yes Date you finished work D D M M Y Y Y Y X No

STEP 2 PROVIDE PAYMENT DETAILS

Payment will be in Australian dollars and can be made by EFT or cheque (please choose ( 983095) one of the two options below)

X Electronic Funds Transfer (EFT) payment to an Australian bank account ndash for fast payment

Account name Name of bank or financial institution

Branch BSB number Account number

X Cheque payment

If the cheque is to be sent to an address thatrsquos different from that provided in section 1 please provide the new address below

Street address

Suburb State Postcode

Country

Apply for a payment (temporary residents)

10130 1112 page 1 of 2

For how we use your TFN

go to wwwaustraliansupercom RefTFN

If you donrsquot provide your TFNyoursquore likely to pay more tax than

you need to

8132019 Apply for a Payment (Temporary Residents)

httpslidepdfcomreaderfullapply-for-a-payment-temporary-residents 44page 2 of 2

STEP 3 CONFIRM THE DOCUMENTS YOU NEED ARE ATTACHED

X Irsquove attached the copies of the following documents as required

For account balances of less than $5000

X Copy of your passport containing photo and signature

X Copy of your Temporary Resident Visa showing that thevisa has expired or been cancelled

X Copy of your passport showing your arrival stamp in

and your departure stamp from Australia

For account balances of $5000 or more

X Copy of your passport containing photo and signature

X A written statement from the Department ofImmigration and Citizenship (see below) stating that

rsaquo your Temporary Resident Visa has expired or been

cancelled and

rsaquo yoursquove permanently departed Australia

See the information on the front of this form for more details

STEP 4 SIGN THIS FORM

The information is correct To the best of my knowledge the information provided on this form is correct I was a temporary

resident and I have permanently departed Australia

The information will be used to action the request The personal information provided on this form will be used to action the

request Go to wwwaustraliansupercomprivacy for full details on the collection and use of personal information A $35 fee

will be charged Any Australian tax payable will be deducted before the payment is made (usually 35 of taxable amounts)

Sign here

Date

D D M M 2 0 Y Y

STEP 5 SEND THIS FORM AND YOUR DOCUMENTS TO US

Please send this form and the documents listed in step 3 to

AustralianSuperGPO Box 1901MELBOURNE VIC 3001

AUSTRALIAWe need your original form so you canrsquot fax your application to us

If you have any questions call us on 1300 300 273 between 800am and 800pm (AEST) Monday to Friday or on

+61 3 8663 1699 if yoursquore outside Australia

Please return this completed form and the documents listed to AustralianSuper GPO Box 1901 MELBOURNE VIC 3001 AUSTRALIA

Questions Telephone 1300 300 273 Web wwwaustraliansupercom

8132019 Apply for a Payment (Temporary Residents)

httpslidepdfcomreaderfullapply-for-a-payment-temporary-residents 44page 2 of 2

STEP 3 CONFIRM THE DOCUMENTS YOU NEED ARE ATTACHED

X Irsquove attached the copies of the following documents as required

For account balances of less than $5000

X Copy of your passport containing photo and signature

X Copy of your Temporary Resident Visa showing that thevisa has expired or been cancelled

X Copy of your passport showing your arrival stamp in

and your departure stamp from Australia

For account balances of $5000 or more

X Copy of your passport containing photo and signature

X A written statement from the Department ofImmigration and Citizenship (see below) stating that

rsaquo your Temporary Resident Visa has expired or been

cancelled and

rsaquo yoursquove permanently departed Australia

See the information on the front of this form for more details

STEP 4 SIGN THIS FORM

The information is correct To the best of my knowledge the information provided on this form is correct I was a temporary

resident and I have permanently departed Australia

The information will be used to action the request The personal information provided on this form will be used to action the

request Go to wwwaustraliansupercomprivacy for full details on the collection and use of personal information A $35 fee

will be charged Any Australian tax payable will be deducted before the payment is made (usually 35 of taxable amounts)

Sign here

Date

D D M M 2 0 Y Y

STEP 5 SEND THIS FORM AND YOUR DOCUMENTS TO US

Please send this form and the documents listed in step 3 to

AustralianSuperGPO Box 1901MELBOURNE VIC 3001

AUSTRALIAWe need your original form so you canrsquot fax your application to us

If you have any questions call us on 1300 300 273 between 800am and 800pm (AEST) Monday to Friday or on

+61 3 8663 1699 if yoursquore outside Australia

Please return this completed form and the documents listed to AustralianSuper GPO Box 1901 MELBOURNE VIC 3001 AUSTRALIA

Questions Telephone 1300 300 273 Web wwwaustraliansupercom