Fillable Managed Funds Withdrawal Request - Individual/Joint (Accident Compensation Corporation New Zealand)

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Managed Funds Withdrawal Request - Individual/Joint (Accident Compensation Corporation New Zealand)

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Country of origin: NEW-ZEALAND
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FF622 - 09/20
1
FISHER FUNDS
MANAGED FUNDS
Who should complete this form?
Please use this form to apply for a withdrawal from your Fisher Funds Managed Funds account. You can select a full,
partial or regular withdrawal. If you wish to request both a partial and regular withdrawal, you can select both options on
this form.
If your account is in the name of an entity (e.g. trust, company, partnership or incorporated society) please complete the
Managed Funds Entity withdrawal request form. This can be located at fisherfunds.co.nz/forms
If you would like help in completing this form, please email enquiries@fisherfunds.co.nz or phone us on
0508 FISHER (0508 347 437).
You can complete this form on-screen by typing directly into each field. Once you have completed this form:
■
If you have selected Option 1 as your preferred identification method you can email your completed application to
enquiries@fisherfunds.co.nz
■
If you have selected Option 2 as your preferred identification method you must post your application and supporting
documents to Fisher Funds Management Limited, Private Bag 93502, Takapuna, Auckland 0740 or send by courier
to Fisher Funds Management Limited, Level 1 Crown Centre, 67-73 Hurstmere Road, Takapuna, Auckland 0622.
Managed Funds
Withdrawal Request - Individual/Joint
Section 1: Account Details
Investor 1
Title First Name(s)
Surname
IRD Number
Prescribed Investor Rate (PIR) (please tick one)
10.5% 17.5% 28%
Contact Phone
Email Address
Address
City
Country Postcode
Contact Phone
Email Address
Address
City
Country Postcode
Investor 2
Title First Name(s)
Surname
IRD Number
Prescribed Investor Rate (PIR) (please tick one)
10.5% 17.5% 28%
For a joint application we will use the highest PIR provided by the applicants.
To work out your PIR, or for more information, visit fisherfunds.co.nz/pircalculator or call us on 0508 347 437.
If your selected PIR differs to the rate we have on file, the change will require one business day to update before your withdrawal
can be processed. If you do not select a PIR, your withdrawal will be processed at the rate we hold on file for this account.
Fisher Funds Account Number
F I
( ) ( )
FF622 - 09/20
2
FISHER FUNDS
MANAGED FUNDS
Section 2: Identification Options
Your withdrawal request must be submitted with one of the identification options set out below (for each account
holder). We may have your identification documents on file, please contact us to confirm this. We may need to request
new identification documents from you.
Option 1 – Electronic identity verification (not available for minors)
Fisher Funds has the ability to electronically verify your identity and address. Once we have received your withdrawal
request we will send you an SMS via our third party partner to biometrically verify your identity. To complete this method
of verification you must have: a smartphone (with a front camera that is capable of taking a photo/video) and a current
(not expired) version of one of the following:
» New Zealand Passport
» New Zealand Drivers Licence
» Australian Passport
» Australian Drivers Licence
If this method of identification is unsuccessful you will be required to provide certified ID and proof of address.
Option 2 – Certified copies of identity documents and proof of residential address
Please provide a certified copy of your identity documents and proof of your residential address. Refer to Sections 3 and
4 for information on acceptable identity documents and who can certify them.
Investor 1: Preferred identification method — please select one of the following options:
Option 1 – I would like Fisher Funds to electronically verify my identity
Option 2 - I would like to provide Fisher Funds with certified copies of my identity documents
Investor 2: Preferred identification method — please select one of the following options:
Option 1 – I would like Fisher Funds to electronically verify my identity
Option 2 - I would like to provide Fisher Funds with certified copies of my identity documents
Identity documents for account holders under 18
Parents/Guardians of the minor are required to provide identification documents.
We require the following identification for the minor:
» Full Birth Certificate*, AND
» Proof of relationship for the parents/guardians of the minor (e.g. birth certificate* if not already provided, Adoption
papers, guardianship forms, court order).
* Birth certificates for minors are not required to be certified.
FF622 - 09/20
3
FISHER FUNDS
MANAGED FUNDS
Section 3: Certified Identity Documents
If you selected Option 2 as your preferred way for us to verify your identity please select one of the certified identification
options below. If you have selected Option 1 you do not need to provide certified ID now.
We are only able to accept original certified copies of certified ID (i.e. the copy that has been physically certified).
These documents must be posted to us, our postal address is on page 1.
I certify this to be a true copy of the original document
and confirm it represents the identity of Joe Smith.
Name:
Jane Doe
Occupation: Justice of the Peace
Date: 18/08/2020
Signature:
Please note: Certification is valid for three
months and must have been carried out
within three months of this application.
Your identity documents must be certified
by one of the following people: Justice of
the Peace, Registered Lawyer, Chartered
Accountant, Registered Teacher, Registered
Doctor, Police Officer, Notary Public,
Registrar/Deputy Registrar.
Photocopy ID at 150%
So the details are legible.
Please do not send in your physical
identity documents e.g. passport,
driver’s licence, birth certificate etc.
Passport (containing name,
date of birth, photograph
and signature)
OR
New Zealand Firearms
Licence
OPTION A: (preferred)
New Zealand Driver Licence
(front and back)
OR
18+ Card/Kiwi Access Card
AND one of the following
Full Birth Certificate
SuperGold Card
(front and back)
Bank Statement from a registered
bank dated within 12 months
Statement from a government
agency dated within 12 months
OPTION B:
New Zealand Driver Licence
(front and back)
AND
Valid credit or debit card
with embossed name and
signature (front and back)
(Do not blank out your
card details — we will do
this on your behalf once
the application has been
processed)
OPTION C:
Your photo identification must be current (not expired). If you’re unable to provide the above documentation please contact us
to discuss other options.
A Fisher Funds representative can verify your identity documents if you visit our office.
How to have your ID correctly certified
FF622 - 09/20
4
FISHER FUNDS
MANAGED FUNDS
Mr Joe Smith
58 Green Street
Takapuna
AUCKLAND 1023
New Zealand
19 XXXX 2020
Dated in the last 12 months, an invoice,
statement, letter or contract from:
» utility provider e.g. water, power, phone
» professionals e.g. accountant, doctor
» service providers e.g. Sky TV, insurance
» government e.g. IRD, WINZ, rates notice
» current employer e.g. payslip
» bank correspondence or statement
» tenancy agreement
Please note: We cannot accept a statement/correspondence
from Fisher Funds as proof of your address.
Current physical address
Can’t be a PO Box number.
Section 4: Proof of Address
If you have selected Option 2 as your preferred identification method please provide proof of your residential address
as set out below. Your proof of address doesn’t have to be certified. If you selected Option 1 you do not need to provide
proof of address.
Section 5: Payment Details
Please pay the withdrawal into my/our nominated bank account held on file.
If you have not previously provided your bank account details including proof of the bank account, or your bank account
has changed, please complete the section below and provide proof of your bank account (refer below) along with this
form.
We will only make payments in New Zealand dollars to either a New Zealand bank account or an international bank
account held in your name either individually or jointly (the cost of an international transfer is paid by the member). Any
payment will be adjusted for tax at the notified Prescribed Investor Rate (PIR) on your account.
Name of Account
Account Details
Bank Branch Account Number Suffix
Bank/Branch Address
Please provide proof of your bank account (one of the following)
» Bank statement
» Internet banking screenshot
» Over the counter receipt with a teller’s stamp
The proof of bank account must contain the account name, number and the logo of your bank.
FF622 - 09/20
5
FISHER FUNDS
MANAGED FUNDS
Section 6: Withdrawal Options
Full Withdrawal
Withdraw the full account balance and close the account
Partial Withdrawal
Make a partial withdrawal from the account as outlined below
(please note we require a minimum balance amount of $1,000)*
In accordance with my current Investment Allocation
Total amount of withdrawal $
Name of Fund/s Amount of withdrawal*
Income Fund units or $
Property & Infrastructure Fund units or $
New Zealand Growth Fund units or $
Australian Growth Fund units or $
International Growth Fund units or $
Conservative Fund units or $
Growth Fund units or $
Balanced Strategy (45% Conservative Fund, 55% Growth Fund) $
Total units or $
*If you would like to withdraw from one Fund entirely, please write “all” in front of units.
Regular Withdrawal
Set up a regular withdrawal from the account as outlined below (please note the minimum withdrawal amount is $100)*
In accordance with my current Investment Allocation
Total amount of withdrawal $
Name of Fund/s Amount of withdrawal*
Income Fund units or $
Property & Infrastructure Fund units or $
New Zealand Growth Fund units or $
Australian Growth Fund units or $
International Growth Fund units or $
Conservative Fund units or $
Growth Fund units or $
Balanced Strategy (45% Conservative Fund, 55% Growth Fund) $
Total units or $
*Regular withdrawals can only be paid into a New Zealand bank account.
Start Date Frequency
Weekly Fortnightly Monthly Quarterly Annually
*Please note this is the date your withdrawal will be priced, it will then be paid 3-5 working days after this date.
Please bear this in mind if you want to receive the funds by a certain date.
OR
OR
FF622 - 09/20
6
FISHER FUNDS
MANAGED FUNDS
Section 7: Declaration
I/we agree that Fisher Funds Management Limited and the Supervisor (and related entities of either) may collect and
use the information set out in (or in connection with) this form for the purpose for which it is provided. Additionally, they
may use that information to promote to me/us other products and services. Fisher Funds will provide me/us (on request)
with the name and address of any entity to which information has been disclosed. If I/we do not provide the information
required by this form, Fisher Funds and/or the Supervisor may not be able to process my/our request. I/we have the right
to access all personal information held about me/us. If any of the information is incorrect, I/we have the right to have
it corrected. The information set out in this form will be collected and held by Fisher Funds Management Limited and
Trustees Executors Limited whose respective addresses are Level 1, Crown Centre, 67-73 Hurstmere Road, Takapuna,
Auckland 0622 and Level 5, 10 Customhouse Quay, Wellington 6140.
I/we hereby request the following withdrawal to my/our investment in accordance with the provisions of the Fisher Funds
Managed Funds product disclosure statement and Governing Document.
SignatureName Date
/ /
SignatureName Date
/ /
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Completed 15 May 2022

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