Fillable Change of member details (Australian National University)

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Change of member details (Australian National University)

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Aware Super Pty Ltd (Trustee) ABN 11 118 202 672 AFSL 293340 Aware Super (Fund) ABN 53 226 460 365
page 1 of 5
FSS007 10/21
Change of member details
Use this form to change
your membership details
or the way you receive
information from the fund.
Please use a dark pen and
CAPITAL letters. Insert (✗)
when you have to choose
an option. You can also
ll in this form online,
print it and send it to
us. Forms are located
on our website at
aware.com.au/forms
If you have any
questions, please call
us on 1300 650 873.
1. Your current membership details
Please record your current membership details before you update information in Section 2.
Member number Date of birth (DD-MM-YYYY)
Title
Last name
Given name(s)
2. Information to be updated
IMPORTANT: If you have changed your name or need to correct your date of birth we have recorded for you,
you must provide certied proof of identity documents. See Information to be updated in the Notes.
Title Male Female Other Unspecied Date of birth (DD-MM-YYYY)
Last name
Given name(s)
Residential address
Suburb State Postcode
Postal address (if dierent from your residential address)
Suburb State Postcode
Daytime contact number Mobile number
Tax le number
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)
It isn’t compulsory
to provide your TFN
but if you don’t, you
may pay additional
tax and your
contributions may
not be accepted.
See the Notes.
You only need
to complete the
sections where
your details have
changed.
Aware Super Pty Ltd (Trustee) ABN 11 118 202 672 AFSL 293340 Aware Super (Fund) ABN 53 226 460 365
3. How would you like to receive information from us?
Please mark ✗ to indicate how you would like to receive information from us:
Electronically, via email and online
Paper copies, via mail.
Where we can, we will always provide information to you as you have requested however, there may be
some instances where this is not possible. We may also contact you by phone from time to time.
Our Annual Report is available on our website for review. If you would like to arrange to be sent a paper copy
you can contact us on 1300 650 873.
4. Proof of identity
Please complete ✗ one of the options below.
I have previously provided certied proof of identity documents or provided the electronic verication
information below to Aware Super and I am not changing my name, providing bank details for the rst
time or changing a previously nominated bank account.
I will provide electronic proof of identication for verication.
I authorise the use of my personal details, below, for the purpose of electronic data verication. I understand
that my information will be used to verify my identity electronically using independent data sources.
Please provide any TWO of the following:
1. Full name exactly as it appears on my Medicare card
My Medicare number is Valid to
My reference number
M
2 Y
M
0 Y
on this card is
Select your Medicare card colour Green
Blue Yellow
2. Full name exactly as appears on my driver’s licence
Licence number State of issue Expiry date
D M
2
YD M
0 Y
3. My Australian passport number is Place of birth (as shown on your passport)
Country of birth (not shown on your passport)
Family name at birth (not shown on your passport)
I will provide original, certied proof of identity (POI) documents. For a list of POI documents and
certication guidelines, refer to the Notes section. If my POI documents have not been certied
correctly, I understand Aware Super may use the information on the documents to verify my identity
electronically using independent data sources.
5. Privacy
The personal information provided on this form is collected by and held for Aware Super by the fund
administrator, Mercer Administration, in accordance with the Australian Privacy Principles of the Privacy
Act 1988 (Cth), for the purpose of administering accounts and providing services associated with fund
membership. For further information about how personal information is handled, please call us on
1300 650 873 or visit aware.com.au/privacy to view the privacy policy (a hard copy of the policy may
also be provided on request). The policy contains information about access to and correction of personal
information, how a complaint can be made about a privacy breach and other important information about
how personal information is collected, used and disclosed.
page 2 of 5
FSS007 10/21
Aware Super Pty Ltd (Trustee) ABN 11 118 202 672 AFSL 293340 Aware Super (Fund) ABN 53 226 460 365
Please sign and
date form here and
print your name.
Send the form to
this address.
6. Declaration
•
I have checked this form and conrm that it has been completed correctly and that the information
and instructions I have provided are correct and in accordance with my wishes.
•
I conrm that the information and instructions provided on this form are to replace any earlier
information and instructions and that they are to remain in eect until I provide further information
and instructions.
•
If I have provided my TFN, I have read and understand the tax le number information on page 4 of
this form.
•
I have read, understood and accept the privacy policy.
Signature Date signed (DD-MM-YYYY)
Name (print in CAPITAL letters)
7. Where to send your completed form
We require original copies of this form. Please post the completed form to Aware Super PO Box 1229
WOLLONGONG NSW 2500.
page 3 of 5
FSS007 10/21
Aware Super Pty Ltd (Trustee) ABN 11 118 202 672 AFSL 293340 Aware Super (Fund) ABN 53 226 460 365
page 4 of 5
FSS007 10/21
Notes
For information about your superannuation, you should read the current Member Booklet (Product Disclosure Statement) or the relevant
dened benet explanatory notes and our fact sheets. They are available on our website or call us and we’ll send you a copy.
All of our forms are located on our website at aware.com.au/forms. You can type data directly into these forms, print them and send
them to us. If you prefer to write on the forms, please use a dark pen and print clearly.
Information to be updated
Proof of identity
Any change of name, bank account information or correction to the date of birth we have recorded for you must be supported by proof
of identity (POI) documentation.
Providing electronic proof of your identity
To verify your identity electronically, you can provide two government-issued identication documents – such as your Australian
Passport, Driver’s Licence and Medicare Card within the proof of identify step of this form. Alternatively, you must provide certied proof
of identity document(s). Refer to the acceptable documents list below.
Providing certied proof of your identity 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.
2
Photocopy your originals
3
Have your copies certied
Take your copies and your original
documents to a person who can certify
documents. A list of authorised certiers
and certication guidelines is included
under Certication of personal documents.
Acceptable POI documents
To prove your identity, you can provide either:
ONE certied document from List A; OR
ONE certied document from List B PLUS ONE certied document from List C.
•
A current drivers licence
with a photograph, issued
in Australia or under the
authority of a foreign
country.*
•
An Australian passport
•
A current Australian state/
territory proof of age card
containing your photograph
•
A current passport, similar
travel document or national
identity card issued by
a foreign government
department, the UN or an
agency of the UN, containing
your photograph and either
your signature or a unique
identier*
•
A birth certicate issued
by a state or territory of
Australia, by a foreign
government, or by the
United Nations or an
agency of the United
Nations*
•
A citizenship certicate
issued by the
Commonwealth or a
foreign government*
•
A current Centrelink
pension card that entitles
you to receive nancial
benets
•
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 assessment
•
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 nancial benets to you e.g.
Centrelink letter
•
If you’re under 18, you can provide a student card,
or a letter from a school principal. The letter must
include the date it was issued (within three months
of providing your proof of ID), your name, residential
address and the dates you attended the school.
* If the document and/or the certication is not written in English, it must be accompanied by an English translation prepared by a translator accredited by the National
Accreditation Authority for Translators and Interpreters Ltd (NAATI). If you are unable to provide these documents, please call us to discuss alternatives.
List A List B List C
Aware Super Pty Ltd (Trustee) ABN 11 118 202 672 AFSL 293340 Aware Super (Fund) ABN 53 226 460 365
Have you changed your name?
If you have changed your name, you must also provide a certied copy of one of the following name change documents:
•
marriage certicate or certicate of registration (if you are on the relationship register) issued by the Births, Deaths and Marriages
Registration Oce (ceremonial certicate cannot be accepted)
•
deed poll or change of name certicate from the Births, Deaths and Marriages Registration Oce. If you have reverted to your maiden
name, we will require your marriage certicate (from the Births, Deaths and Marriages Registration Oce) showing your original
maiden name and your married name.
Change of bank account details
You need to provide proof of identity documents when setting up or updating the bank account you’re nominating to receive payments
into. You can provide your identication for electronic verication in the proof of identity step of this form. Alternatively, you can
provide certied proof of identity, refer to the acceptable documents list above.
page 5 of 5
FSS007 10/21
If you are outside Australia
The following people can certify copies of the originals:
•
consular sta at an Australia Embassy, High Commission or Consulate
•
a public notary or other person authorised to administer an oath or armation or to authenticate documents in the country you are
visiting or living in.
The professions listed under If you are in Australia can only certify documents outside Australia if they work or are registered in Australia.
Where your documents are certied outside Australia, the certier must quote their registration number or the relevant law that qualies
them to authenticate your documents.
Tax le number
Under the Superannuation Industry (Supervision) Act 1993, the trustee is authorised to collect, use and disclose your TFN. The trustee
may disclose your TFN to another superannuation provider when your benets are being transferred, unless you write to your super
fund and ask the trustee not to disclose your TFN to any other trustee. It is not compulsory to provide your TFN but if you don’t, you
may pay additional tax on your contributions and benet payments, and some contributions may not be accepted.
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.
Certication of personal documents
All copied pages of original personal identity documents (including any change of name documents) must be certied as true copies
by an authorised person with the appropriate qualications 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 the documents are identical, then certify each page by
writing “I certify that this document is a true copy of the original”, followed by their signature, printed name, address, qualication (e.g.
justice of the peace, Australia Post employee), registration number (if applicable) and date.
If you are in Australia
The following lists a subset of people who are
authorised to witness your signature on a statutory
declaration as well as certify copies of original
documents. For a complete list of authorised
witnesses/certiers, go to the Attorney-General’s
Department website at www.ag.gov.au.
•
Australia Post employee in charge of an oce
providing postal services (charges may apply)
•
chiropractor
•
dentist
•
Financial adviser or nancial planner
•
full-time or part-time teacher employed at a
school or tertiary institution
•
justice of the peace
•
legal practitioner
•
magistrate
•
medical practitioner
•
nurse
•
optometrist
•
pharmacist
•
physiotherapist
•
police ocer
•
psychologist
•
veterinary surgeon
I certify that this document is a
true copy of the original.
Name: Kate Anderson
Address: 6 Some St Suburb NSW 2000
Qualification: JP
Registration no: 123456
Date: 11 October 2021
Driver Licence
Samantha SAMPLE
123 ANY ST
SUBURB NSW 2000
Licence No.
12345678
Donor
A
Licence Class
C
Conditions
S
Date of Birth
01 JAN 1980
Expiry
01 JAN 2022
Card Number
2 123 456 789
SAMPLE
Details for the authorised person
to include are full name, address,
qualification, registration number
(if applicable), date and signature.
The authorised person has
sighted the original identification
and confirmed that the copy is a
true copy.
Samantha Sample has provided
a copy of her identification.
It includes her signature, full
name, date of birth and current
residential address.
Aware Super Pty Ltd (Trustee) ABN 11 118 202 672 AFSL 293340 Aware Super (Fund) ABN 53 226 460 365
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Change of member details (Australian National University)

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Completed 1 November 2021

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