Commonwealth Superannuaon Corporaon (CSC) ABN: 48 882 817 243, AFSL: 238069, RSEL: L0001397
Defence Force
Rerement and Death
Benets Scheme
ABN: 39 798 362 763
Australian Defence
Force Superannuaon
ABN: 90 302 247 344
RSE: R1077063
Commonwealth
Superannuaon Scheme
ABN: 19 415 776 361
RSE: R1004649
Public Sector
Superannuaon
accumulaon plan
ABN: 65 127 917 725
RSE: R1004601
Military Superannuaon
and Benets Scheme
ABN: 50 925 523 120
RSE: R1000306
Australian Defence
Force Cover
ABN: 64 250 674 722
Public Sector
Superannuaon Scheme
ABN: 74 172 177 893
RSE: R1004595
1922 Scheme
DFRB Scheme
PNG Scheme
DFSPB
CSC rerement income
1 of 10
EAFR02
Benefit application form
and information
Things you need to note:
Before you complete this form please read the Product Disclosure
Statement for your scheme(s) and the Early access to your super
benefits factsheet.
Who should use this form
Use this application form if you are an eligible member of our schemes,
and wish to apply for early release of your benefit on the grounds of
severe financial hardship, as defined under the Superannuation Industry
(Supervision) Regulations 1994.
What you need to provide with
your application
For your application to be processed, Commonwealth Superannuation Corporation (CSC) requires
evidence of income support payments you are receiving, which can be provided by:
completing and signing the Centrelink consent in Section C (confirming receipt of
Commonwealth income support)
or
a statement from the Department of Veterans’ Affairs (DVA) outlining your receipt of income
support under the Veteran’s Entitlements Act 1986 (Cth).
Additionally, CSC requires:
a bank statement from the last three months, in your name or a joint bank account showing the
current account balance in your everyday transactions account. If you have multiple everyday
accounts, please provide statements for all accounts;
your identity be verified (refer to Identification requirements on page 7).
Note: An incomplete application, or applications without supporting documents, will delay the
processing of your benefit.
Your privacy is important to us
We’re committed to protecting your privacy. We collect your personal information for the purposes of providing
superannuation services to you, improve our products and to keep you informed. We will only share your personal
information where necessary for providing superannuation services to you. This may include disclosing your personal
information to our scheme administrator, service providers or government or regulatory bodies. Your personal information
may be accessed overseas by our service providers. Please see our privacy policy for full details. Your personal information
will not be otherwise used or disclosed unless required or permitted under law. A full copy of our privacy policy as well as
the privacy complaint process is available at csc.gov.au
Early access –
severe nancial hardship
EAFR02
05/20
This form is for...
CSS, PSS, MilitarySuper,
ADF Super and PSSap members.
If y
ou have any questions regarding
this form please refer to the contact
details on the last page.
Any nancial product advice provided in this document is general advice only and has been prepared without taking account of your personal objecves, nancial situaon or needs. Before acng on any such general
advice, you should consider the appropriateness of the advice, having regard to your own objecves, nancial situaon and needs. You may wish to consult a licensed nancial advisor. Before making any decision in
relaon to a scheme or nancial product referred to in this document, you should obtain a copy of the Product Disclosure Statement for that scheme or product.
EAFR02
This page has been
left blank on purpose
2 of 10
Commonwealth Superannuaon Corporaon (CSC) ABN: 48 882 817 243, AFSL: 238069, RSEL: L0001397
Defence Force
Rerement and Death
Benets Scheme
ABN: 39 798 362 763
Australian Defence
Force Superannuaon
ABN: 90 302 247 344
RSE: R1077063
Commonwealth
Superannuaon Scheme
ABN: 19 415 776 361
RSE: R1004649
Public Sector
Superannuaon
accumulaon plan
ABN: 65 127 917 725
RSE: R1004601
Military Superannuaon
and Benets Scheme
ABN: 50 925 523 120
RSE: R1000306
Australian Defence
Force Cover
ABN: 64 250 674 722
Public Sector
Superannuaon Scheme
ABN: 74 172 177 893
RSE: R1004595
1922 Scheme
DFRB Scheme
PNG Scheme
DFSPB
CSC rerement income
3 of 10
EAFR02
A
Your Details
Please complete all fields in this section.
A contact phone number and email address is requested in case we need to contact you about your application.
Supplying these details may help avoid delays in processing.
Which scheme are you
applying for a release from?
CSS PSS MilitarySuper ADF Super PSSap
Reference number
Title
Mr Mrs Ms Miss Other
Surname
Given name(s)
Date of birth
D D M M Y Y Y Y
/ /
Residential address
SUBURB STATE POSTCODE
Postal address
(leave blank if same as
residential address)
SUBURB STATE POSTCODE
Phone
BUSINESS HOURS AFTER HOURS
MOBILE NUMBER
Email
@
Early access –
severe nancial hardship
Form start
EAFR02
05/20
Section A continued on next page
EAFR02
Commonwealth
income support
To qualify for early access to your super
benefit, at the date of application you must
have been in receipt of Commonwealth
income support payments for a continuous
period of 26 weeks, or for 39 weeks
since reaching your preservation age.
Tax File Number
Under the Superannuation Industry (Supervision) Act 1993, CSC is authorised to collect, use and disclose your
tax file number. We may disclose your tax file number to another superannuation provider when your benefits
are being transferred, unless you request to us in writing that your tax file number not be disclosed to any other
superannuation provider. Declining to quote your tax file number is not an offence, however giving your tax file
number to us will have the following advantages:
we will be able to accept all permitted types of contributions to your account/s;
other than the tax that may ordinarily apply, you will not pay more tax than you need to - this affects
both contributions to your superannuation and benefit payments when you start drawing down your
superannuation benefits; and
it will make it much easier to find different superannuation accounts in your name so that you receive
all your superannuation benefits when you retire.
B
How much do you need released?
Please enter the amount you need to meet your reasonable and immediate family living expenses. We can only approve
one release in any 12 month period. The maximum amount that can be released is $10,000 (before tax).
The amount I am requesting to be released is
Or
I am over Preservation Age, have been in receipt of Commonwealth income support payments for at least
39 weeks since reaching my Preservation Age, and request
To find out your preservation age, refer to the Early Access factsheet.
C
Centrelink consent
Complete this section if you are in receipt of Commonwealth
income support payments through Centrelink.
Note: You are not required to complete this
section if you are supplying a DVA income
statement with your application. Proceed to Section D.
I,
Customer Reference
Number (CRN)
authorise:
Commonwealth Superannuation Corporation (CSC) and/or Mercer Administration Services to use Centrelink
Confirmation eServices to perform a Centrelink enquiry of my customer details;
Services Australia (the agency) to provide the results of that enquiry to CSC and/or Mercer Administration Services.
I understand that:
the agency will disclose information to CSC and/or Mercer Administration Services based on whether I have been
in receipt of a qualifying Centrelink payment for a specified period to confirm my eligibility for early release of
superannuation on financial hardship grounds;
the agency will disclose to CSC and/or Mercer Administration Services my personal information, including my name,
date of birth and payment status;
this consent, once signed, remains valid while I am a customer of CSC, unless I withdraw it by contacting CSC,
Mercer Administration Services or the agency;
I can get proof of my circumstances/details from the agency and provide it to CSC and/or Mercer Administration
Services so that my eligibility for early release of superannuation on the grounds of financial hardship can
be determined;
if I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may not be eligible
for the early release of superannuation on the grounds of financial hardship provided by CSC or Mercer
Administration Services.
SIGNATURE
Date signed
D D M M Y Y Y Y
/ /
$
net (after tax) to be released.
Sign
$
net (after tax).
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EAFR02
D
Bank details
Please provide your bank account details below. We can only pay your benefit into an Australian account held in your
name. If its a joint account, one of the names listed must be yours.
Name of institution
Name of account holder
Branch location
Branch (BSB) number
-
Account Number
Note: If the BSB number or account number you have provided is incorrect, the payment may not be accepted by your financial institution.
E
Statutory declaration
I,
of
Address
SUBURB STATE POSTCODE
Email (optional)
@
Phone (optional)
Qualification
hereby apply for the early release of my benefit on the grounds of severe financial hardship and make the following
declaration under the Statutory Declarations Act 1959:
I have been in receipt of Commonwealth income support payments for:
at least 26 weeks
OR
for at least 39 weeks, after reaching preservation age and am not gainfully employed on a full time or part time
basis (PSSap/PSS/CSS members only).
I am unable to meet reasonable and immediate family living expenses and require a release of the specified amount
to alleviate my financial hardship.
I declare:
that the amount requested (after tax) is no more than the amount I need to meet my reasonable
and immediate family living expenses;
and
the information I have provided in relation to this application, including the information in the
attachments to this application and any documentary evidence provided, is true and correct
to the best of my knowledge.
Section E continued on next page
5 of 10
EAFR02
I understand that a person who intentionally makes a false statement in a Statutory Declaration is guilty of an offence
under section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in
every particular.
Signature of person making the declaration
SIGNATURE
Date signed
D D M M Y Y Y Y
/ /
Declared at
SUBURB STATE POSTCODE
Optional: Email and/or
telephone number
Details and signature of person before whom the declaration is made
Title
Mr Mrs Ms Miss Other
Surname
Given name(s)
Qualification
Address
SUBURB STATE POSTCODE
Optional: Email and/or
telephone number
SIGNATURE
Date signed
D D M M Y Y Y Y
/ /
Note 1: A person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the punishment for which is imprisonment
for a term of 4 years—see section 11 of the Statutory Declarations Act 1959.
Note 2: Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959—see section 5A of the Statutory Declarations Act 1959.
Note 3: For a full list of certifying authorities refer to Schedule 2 of the Statutory Declarations Regulations 2018 available at legislation.gov.au/Details/F2018L01296.
Sign
Sign
6 of 10
EAFR02
F
Identification requirements
To confirm your identity, we need some information from you—this is to protect your benefit against
fraud, money laundering and terrorism financing, under the Anti-Money Laundering and Counter-Terrorism
Financing Act 2006.
Verifying your documents
You can authorise us to verify your identification electronically using the Document Verification
Service (DVS). DVS is a national online system that allows approved government agencies and
organisations to compare a members identifying information with a government record. It is
not a database and does not store any personal information. Requests to verify a document
are encrypted and sent via a secure communications pathway to the document issuing
authority for checking.
If you don’t provide authorisation to have documents verified electronically or your
documents are incompatible with DVS, you will need to provide certified copies of
required documents. Please also refer to the section Certifying your documents.
DVS is only compatible
with some identification
documents, these have
been listed below.
An electronic copy of your identification documents will be stored in a secure environment and hard
copies will be securely stored off-site. All copies will only be used for the purpose of confirming your
identity. You need to send in identification with every application.
Certifying your documents
If youre providing certified documents, the certifying authority must confirm in writing you are the
valid holder of the identification you are presenting, and any copies are true copies of the original.
IMPORTANT: The certification must include the name, signature, qualification and registration number
of the certifying authority (if applicable), and the date of the certification.
The following sample of certifying authorities can certify your documents in Australia:
Dentist
Employee of a Commonwealth authority engaged on a permanent
basis with five or more years of continuous service who is not specified
elsewhere in this document
Financial Adviser or Financial Planner
Justice of the Peace (JP)
Legal Practitioner
Medical Practitioner
Member of the Australian Defence Force who is:
an Officer
or
a Non-Commissioned Officer within the meaning of the Defence Force
Discipline Act 1982 with five or more years of continuous service
or
a Warrant Officer within the meaning of that Act.
Midwife
Notary Public
Nurse
Occupational therapist
Physiotherapist
Psychologist.
Please note:
We require a copy of
both sides of your
identification document.
For a full list of certifying authorities refer to Schedule 2 of the Statutory Declarations
Regulations 2018 available at legislation.gov.au
Section F continued on next page
7 of 10
EAFR02
How can I meet the identification requirements?
You only need to provide one document from the Primary photographic identification category.
If you can’t provide any Primary photographic identification you will need to provide one secondary
identification document from List A AND one secondary identification document from List B. We can
only accept documents that are listed below for identification purposes.
If the name we hold on file for you is different to the name on your identification, or two pieces of
identification are in different names, please provide a certified copy of your Marriage or Change of
Name certification.
If you would like us to use DVS to verify your identification, please provide authorisation below.
I confirm that I am authorised to provide the personal details presented and I consent to the
information being checked with the document issuer or official record holder via 3rd party systems
for the purposes of confirming my identity.
You must provide a copy* of one of the following:
Primary photographic identification
DVS compatibility is shown as or
A current Australian Drivers Licence.
A current Australian Passport (or one which has expired within the last two years).
A current Australian Proof of Age card (issued under a State or Territory law).
Secondary identification requirements
Only provide these documents if you’re unable to provide one of the Primary photographic
identification documents.
List A
Your Australian Birth Certificate or extract issued by a State or Territory.
Please note: Birth Certificate extracts and Birth Certificates issued
before 1970 may not be verified by DVS.
Your Citizenship Certificate issued by the Commonwealth.
Your current Pensioner Concession Card.
List B
Your notice issued by the Australian Taxation Office (ATO) within the last 12 months that shows
your name, current residential address, and records an amount payable either to or from the ATO.
Your notice issued by a local council or utilities provider in the last three months showing the
provision of services and current residential address. For example: rates notice, electricity or
water bill.
Your 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 a financial
benefit. For example: a Centrelink letter.
Certifying your documents overseas
If you live overseas and need to have documents certified, it needs to be done by a person authorised
as a notary public in a foreign country, or by a person who is on a list of persons before whom a
statutory declaration may be made and who has a connection to Australia. For example: a doctor who
is registered in Australia and working overseas, or an Australian Consular Officer. Refer to ag.gov.au and
dfat.gov.au for more information. Documents provided in a foreign language must be accompanied by a
certified translation completed by an accredited translator.
Persons residing overseas and foreign residents may need to contact us.
*Please, don’t send original documents.
If your documents are
incompatible with DVS,
don’t forget to provide
certified copies.
8 of 10
EAFR02
G
Declare and sign this form
I declare that:
the information I have provided is true and correct to the best of my knowledge;
I acknowledge it may be a criminal offence to knowingly provide false or misleading
information or documents;
I have read the relevant PDS for my scheme and I understand the options available for
my retirement;
I understand that supplying my TFN is optional and that if I have not provided my TFN,
tax will be deducted at the highest marginal tax rate (plus Medicare levy);
the TFN I have provided is the same number advised to me by the ATO;
I understand that if I have not provided all the required information, this application may be returned to me for
completion and payment will be delayed.
Your name
FULL NAME
SIGNATURE
Date signed
D D M M Y Y Y Y
/ /
I do not want my contact details passed to a commissioned independent research firm for the purpose of participating
in research on the service provided by CSC.
H
Checklist
I have read all the information in this form, the PDS and Early access to your superannuation benefits factsheet,
and any other information I require to make an informed decision.
I have completed all sections of this form.
I have attached my bank statement(s) for my everyday account(s) showing my current account balance(s).
I have signed the Statutory Declaration at Section E and had it witnessed by a qualified person.
I have included my bank account details at Section D.
I have included my DVA letter which is dated within 21 days of this application, or I have provided my Centrelink
CRN in Section C.
I have attached certified copies of documents to prove my identity, or I have completed Section F and agreed to have
my documents verified electronically.
I
Lodgement
Send your completed application to
For PSSap members
formsandapplications@pssap.com.au
or
PSSap
Locked Bag 9300
Wollongong NSW 2500
All other Schemes
(ADF Super, CSS, PSS and
MilitarySuper)
formsandapplications@csc.gov.au
or
GPO Box 2252
Canberra ACT 2601
Sign
9 of 10
EAFR02 10 of 10
End Form
EMAIL members@css.gov.au
PHONE 1300 000 277
FAX (02) 6275 7010
MAIL CSS
GPO Box 2252,
Canberra ACT 2601
WEB csc.gov.au
EMAIL members@pss.gov.au
PHONE 1300 000 377
FAX (02) 6275 7010
MAIL PSS
GPO Box 2252,
Canberra ACT 2601
WEB csc.gov.au
EMAIL members@pssap.com.au
PHONE 1300 725 171
FAX 1300 364 144
MAIL PSSap
Locked Bag 9300
Wollongong NSW 2500
WEB csc.gov.au
EMAIL members@adfsuper.gov.au
PHONE 1300 203 439
FAX 1300 204 314
MAIL ADF Super
Locked Bag 9400
Wollongong DC NSW 2500
WEB csc.gov.au
EMAIL members@enq.
militarysuper.gov.au
PHONE 1300 006 727
FAX (02) 6275 7010
MAIL MilitarySuper
GPO Box 2252
Canberra Act 2601
WEB csc.gov.au
How can I get more information?
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