1 MEMBER DETAILS
Name Account number
2 EMPLOYMENT DECLARATION (ELIGIBILITY TO MAKE OR RECEIVE VOLUNTARY SUPER CONTRIBUTIONS)
If you are aged 67 or over but under age 75
1
, please declare that you satisfy the ‘work test’ or ‘work test exemption’ for the 2021–22
nancial year, by placing an (X) in one of the boxes below.
I have met the work test in 2021–22
This means:
I have been gainfully employed for at least 40 hours in a period of 30 consecutive days or less during the 2021–22 nancial
year (1 July 2021 – 30 June 2022).
OR
I have met the work test exemption in 2021–22
This means:
• I have not been gainfully employed for at least 40 hours in a period of 30 consecutive days or less during the 2021–22
nancial year (1 July 2021 – 30 June 2022) and
• I was gainfully employed for at least 40 hours in a period of 30 consecutive days or less during the 2020–21 nancial year
(1July 2020 – 30 June 2021) and
• My total superannuation balance at 30 June 2021 was less than $300,000 and
• I have not used the ‘work test exemption’ in any previous nancial year.
Your total superannuation balance can be found in your ATO online account at my.gov.au or by phoning the Australian Taxation
Ofce on 13 10 20.
3 SIGNATURE
Signature Print name
Date signed
dd/mm/yyyy
Please sign and date this form and return in the enclosed reply paid envelope.
Please send the completed form to:
Colonial First State
Reply Paid 27, Sydney NSW 2001
or via the secure online system (e-Post) with FirstNet Investor and FirstNet Adviser
WHO SHOULD USE THIS FORM
If you are aged 67 or over (but under 75
1
), and wish to make or receive voluntary super contributions during the 2021–22 nancial
year, you should use this form to declare that you meet either the ‘work test’ or ‘work test exemption’.
If you are 67 or over, but under 75
1
and you cannot make one of the two declarations below, you will not be permitted to make
voluntary super contributions in 2021–22.
Voluntary super contributions include:
• personal member contributions (whether or not a tax deduction is claimed)
• spouse contributions
• salary sacrice contributions and
• contributions of eligible small business sale proceeds under the lifetime CGT cap.
When contributing eligible small business proceeds under the lifetime CGT cap, you must also provide us with a ‘Capital gains
tax cap election’ form (available from www.ato.gov.au) at or before the time of your contribution.
Do not use this form for the following contributions:
• contributions you make or receive when you are under the age of 67
• downsizer contributions (note, you must provide us with a ‘Downsizer contribution to superannuation’ form
(available from www.ato.gov.au) at or before the time of your contribution)
• mandated employer contributions at any age.
Mandated employer contributions are: Superannuation Guarantee contributions, payments of Superannuation Guarantee
shortfall amounts or employer contributions made to satisfy an employer’s obligation under a certied agreement or industrial
award. These contributions may be made at any age without meeting a work test.
Employment Declaration Form
Please complete this form using BLACK INK and print well within the boxes in CAPITAL LETTERS.
Mark appropriate answer boxes with across like the following
X
. Start at the left of each answer
space and leave a gap between words.
1 Less than age 75 means up to 28 days after the end of the month in which you turn 75.
Colonial First State Investments Limited ABN 98 002 348 352, AFS Licence 262468 (Colonial First State) is the issuer of interests in FirstChoice Personal Super, FirstChoice
Wholesale Personal Super, FirstChoice Pension, FirstChoice Wholesale Pension and FirstChoice Employer Super from the Colonial First State FirstChoice Superannuation
Trust ABN 26 458 298 557 and interests in the Rollover & Superannuation Fund and the Personal Pension Plan from the Colonial First State Rollover & Superannuation Fund
ABN88854 638 840. 27891/FS4534/0721
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THIS IS AN INTERACTIVE FORM
