Fill - Free fillable ATO - Rollover Initiation Request PDF form

Page 1

Sensitive (when completed)

BEFORE COMPLETING THIS FORM

n Read the important information below.

WHEN COMPLETING THIS FORM

n Refer to these instructions where a question shows a

message like this:

n Print clearly in BLOCK LETTERS.

AFTER COMPLETING THIS FORM

n Sign the authorisation.

n Attach the appropriately certified proof of identity documents.

n Review the checklist below.

n Send the request form to your FROM fund.

IMPORTANT INFORMATION

This transfer may close your account (you will need to

check this with your FROM fund).

This form can not be used to:

n transfer part of the balance of your super benefits

n transfer benefits if you don’t know where your super is

n transfer benefits from multiple funds on this one form

– aseparate form must be completed for each fund

youwish to transfer super from

n change the fund to which your employer pays contributions

on your behalf

n open a super account

n transfer benefits under certain conditions or circumstances

– for example, if there is a super agreement under the

Family Law Act 1975 in place.

CHECKLIST

Have you read the important information?

Have you considered where your future employer

contributions will be paid?

Have you completed all of the mandatory fields on the form?

Have you signed and dated the form?

Have you attached the certified documentation including

any linking documents if applicable?

WHAT HAPPENS TO MY FUTURE

EMPLOYER CONTRIBUTIONS?

Using this form to transfer your benefits will not change the

fundto which your employer pays your contributions, and may

close the account you are transferring your benefits FROM.

If you wish to change the fund into which your employer

contributions are being paid, you will need to speak to your

employer about super choice. For the appropriate forms and

information about whether you are eligible to choose the fund

towhich your employer contributions are made, visit ato.gov.au

or call the Australian Taxation Office (ATO) on 13 10 20.

THINGS YOU NEED TO CONSIDER WHEN

TRANSFERRING YOUR SUPERANNUATION

When you transfer your super, your entitlements under that

fundmay cease – you need to consider all relevant information

before you make a decision to transfer your super. If you ask

forinformation, your super provider must give it to you.

Some of the points you may consider are:

n Fees – your FROM fund must give you information about any

exit or withdrawal fees. If you are not aware of the fees that

may apply, you should contact your fund for further

information before completing this form. The fees could

include administration fees, and exit or withdrawal fees.

n Death and disability benefits – your FROM fund may insure

you against death, illness or an accident which leaves you

unable to return to work. If you choose to leave your current

fund, you may lose any insurance entitlements you have –

other funds may not offer insurance, or may require you to

pass a medical examination before they cover you. When

considering a new fund, you may wish to check the costs

andamount of any cover offered.

WHAT HAPPENS IF I DO NOT QUOTE MY

TAX FILE NUMBER (TFN)?

You are not required to provide your TFN to your super fund.

However, if you do not provide your TFN, your fund may be

taxed at the highest marginal tax rate, plus the Medicare levy,

oncontributions made to your account in the year, compared

tothe concessional tax rate of 15%. Your fund may deduct

thisadditional tax from your account.

If your super fund does not have your TFN, you will not be

ableto make personal contributions to your super account.

Choosing to quote your TFN will also make it easier to keep

track of your super in the future.

Under the Superannuation Industry (Supervision) Act 1993,

yoursuper 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 TFN may be

disclosed to another super provider when your benefits are

being transferred, unless you request in writing that your TFN

isnot to be disclosed to any other trustee.

TRANSFERRING TO YOUR SELF‑MANAGED

SUPERFUND

You must use this form to transfer your benefits to your

ownSMSF.

You should be aware that SMSFs are subject to the same rules

and restrictions as other funds regarding when benefits are to

bepaid out. In particular, super benefits in a SMSF are required

to be ‘preserved’, meaning they are not generally able to be

accessed until you are over age 55 and retired.

The trustee of your FROM fund may be able to request further

information from you about your status as a member, a trustee

or a director of a corporate trustee of your SMSF. Penalties may

apply for providing false or misleading information.

Completing the form Rollover initiation request

to transfer whole balance of superannuation

benets to your self‑managed super fund

NAT 74662‑06.2017

By completing this form, you will request the transfer of the whole balance of your super benefits to your self‑managed super

fund(SMSF). This form can not be used to transfer part of the balance of your super benefits.

You can only use this form to transfer your super benefits to an SMSF. For transfers to funds other than an SMSF, you must use

theform Request form for transfer of whole of balance of superannuation benefits between funds (NAT 71223).

This form will not change the fund to which your employer pays your contributions – the Standard choice form must be used by

youto change funds.

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Sensitive (when completed)

Completing proof of identity

You will need to provide documentation with this transfer

requestto prove you are the person to whom the super

entitlements belong.

ACCEPTABLE DOCUMENTS

The following primary and secondary identification documents

may be used:

EITHER

A certified copy of any ONE of the primary photographic

identification:

n driver’s licence issued under state or territory law

n passport issued by the Commonwealth that has not

expired within the past two years

Any ONE of

thefollowing

non‑photographic

identification

documents:

n birth certificate or

birth extract issued

by a State or

Territory of Australia

n citizenship

certificate issued by

the Commonwealth

n pension card

issued by

Centrelink that

entitles the person

to financial benefits

AND

Any ONE of the following

secondary identification

documents:

n notice issued by the

Commonwealth, or State or

Territory government within

the past 12 months that

records the provision of

financial benefits and

contains your name and

residential address –

forexample

– letter from Centrelink

regarding a government

assistance payment

n notice issued by the ATO

within the past twelve

months that contains your

name and residential

address – for example

– notice of an ATO

assessment

n notice issued by a local

government body or utilities

provider within the previous

three months – for example

– a rates notice from

localgovernment.

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.

The following table contains information about suitable linking

documents:

Purpose Suitable linking documents

Change of

name

Marriage certificate, deed poll or change of

name certificate from the Births, Deaths

and Marriages Registration Office

Signed on

behalf of the

applicant

Guardianship papers or Power of Attorney

CERTIFICATION OF PERSONAL DOCUMENTS

All copied pages of original proof of identification documents

(including any linking documents) need to be certified as true

copies by any individual approved to do so (see below).

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 – for example,

Justiceof the Peace or Australia Post employee – and date.

The following people can certify copies of the originals as

trueand correct copies:

n a person enrolled on the roll of a State or Territory Supreme

Court or the High Court of Australia as a legal practitioner

n a judge of a court

n a magistrate

n a Chief Executive Officer of a Commonwealth court

n a registrar or deputy registrar of a court

n a justice of the peace

n a notary public officer

n a police officer

n an agent of the Australian Postal Corporation who is in change

of an office supplying postal services to the public

n a permanent employee of the Australian Postal Corporation

with two or more years of continuous service

n an Australian consular officer or an Australian diplomatic officer

n an officer with two or more years of continuous service with

one or more financial institutions

n a finance company officer with two or more years of

continuous service (with one or more finance companies)

n an officer with, or authorised representative of, a holder of an

Australian Financial Services Licence (AFSL), having two or

more years continuous service with one or more licensees

n a permanent employee of the Commonwealth with two or

more years continuous service

n a permanent employee of the State or Territory, or State and

Territory authority with two or more years continuous service

n a permanent employee of a local government authority with

two or more years of continuous service

n a member of the Institute of Chartered Accountants in

Australia, CPA Australia, or the National Institute of

Accountants, with two or more years continuous membership.

WHERE DO I SEND THE FORM?

You can send your completed and signed form with your

certified proof of identity documents to your transferring fund.

MORE INFORMATION

For more information about super, visit the:

n Australian Securities & Investments Commission (ASIC)

website at moneysmart.gov.au

n ATO website at ato.gov.au/super

For more information about this form, phone the ATO

on131020.

Page 3

Sensitive (when completed)

Rollover initiation request to transfer whole

balance of superannuation benets to your

self‑managed super fund

under the Superannuation Industry (Supervision) Act 1993

NAT 74662‑06.2017

COMPLETING THIS FORM

n Read the important information pages

n Refer to instructions where indicated with a

n This form is only for whole (not part) balance transfers.

AFTER COMPLETING THIS FORM

n Sign the authorisation

n Send form and certified proof of identity documents to

eitheryour FROM (transferring) fund.

* Denotes mandatory field. If you do not complete all of the mandatory fields, there may be a delay in processing your request.

Authorisation

Day Month Year

*Date

*Signature

*Name (Print in BLOCK LETTERS)

By signing this request form I am making the following statements:

n I declare I have fully read this form and the information completed is true and correct.

n I am aware I may ask my superannuation provider for information about any fees or

charges that may apply, or any other information about the effect this transfer may have

on my benefits, and have obtained or do not require such information.

n I confirm that I am a member, trustee or director of a corporate trustee of the SMSF.

n I discharge the superannuation provider of my FROM fund of all further liability in

respect of the benefits paid and transferred to my TO fund.

n I request and consent to the transfer of superannuation as described above and

authorise the superannuation provider of each fund to give effect to this transfer.

I have attached a certified copy of my primary photographic identification document

a primary non‑photographic identification document and a secondary identification document.

I have attached certified copies of both:

*Proof of identity

See ‘Completing proof of identity’

Personal details

Residential address

*Suburb

*State/territory

*Postcode

*Address

*Family name

Title: Mr

Mrs Miss Ms Other

*Given names

Other/previous

names

*Date of birth

Day Month Year

Tax file number

*Gender

FemaleMale

Contact phone number

Under the Superannuation Industry (Supervision) Act 1993, you

arenotobliged to disclose your tax file number, but there may

betaxconsequences.

See ‘What happens if I do not quote my tax file number?’

Previous address

Suburb

State/territory

Postcode

Address

If you know that the address held by your FROM fund is

different to your current residential address, give details below.

Fund details

Fund phone number

*Membership or

account number

Unique superannuation

identifier

FROM (Transferring fund)

*Fund name

If you have multiple account numbers with this fund, you must

complete a separate form for each account you wish to transfer.

Australian business

number (ABN)

*Fund phone number

TO (Receiving fund)

*SMSF name

Australian business

number (ABN)

SMSF bank details

Account number

BSB

Account name

Indeterminate

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