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March 2020
*56520-10660-0320*
56520-10660-0320
Member’s Signature
Date
FOR BANK USE ONLY
Date stamp
Method of identification - Customer
2.
1.
Branch
Accepted by
Actioned by
Please return this completed form together with the Statutory Declaration, a pre-printed deposit slip and certified copies of identification to:
FreePost Authority ASB, ASB KiwiSaver Scheme, ASB Group Investments, PO Box 35, Shortland Street, Auckland 1140.
For assistance please call 0800 ASB RETIRE (0800 272 738) or +64 9 306 3000, email retire@asb.co.nz
ASB Bank Limited 56520 10660 0320
7. Declarations and authorisations
Pursuant to the Privacy Act 1993, please note that the purpose of collecting this personal information is to determine your eligibility for the retirement
benefit you have requested (or may request in the future) from your ASB KiwiSaver Scheme account. In addition, this information may be used to keep you
informed about other financial opportunities, products or services offered by ASB Group Investments Limited the (“Manager”) or its related companies.
It may also be used for purposes related to customer surveys and research carried out by research and direct marketing companies employed by the
Manager or its related companies. If you do not want to receive promotional material from the Manager or its related companies, you can tell the Manager
and the promotional material will not be sent.
The intended recipients of the information are ASB Bank Limited and ASB Group Investments Limited. The information is being collected and will be held
by ASB Bank Limited and ASB Group Investments Limited, FreePost Authority ASB, PO Box 35, Shortland Street, Auckland 1140. You have rights of access
to, and correction of, the information collected.
• I agree to the use of my personal information for the purposes set out above.
• I understand that my retirement benefit withdrawal request is subject to the Manager being satisfied that I am entitled to a retirement benefit.
• I understand that my withdrawal value will be based upon the unit price (s) at the date my request is processed.
• I acknowledge that, if I make a full withdrawal, on the receipt of my funds, the Manager of the ASB KiwiSaver Scheme will be released from all liabilities
in respect of my membership of the ASB KiwiSaver Scheme.
• I understand that my membership of the ASB KiwiSaver Scheme will cease upon notice from the Manager that my membership is terminated.
• I understand that, if I request either a partial or regular withdrawal, a minimum balance must be maintained. If a withdrawal will result in my account
balance falling below the minimum balance, I understand the Manager will make no payment unless I elect to withdraw the remaining balance.
• I understand that if I have reached the age of NZ Superannuation Eligibility, but have not yet been a member of a KiwiSaver Scheme or complying
superannuation fund for 5 years, that this request serves as notice of my election that the definition of ‘grandparented member’ under schedule
1, clause 4(6) of the KiwiSaver Act 2006 does not apply to me, and that by making this election I forgo my right to any remaining entitlement to
Government or compulsory employer contributions I may have following the date that this request is accepted.
• I understand that if I have mainly resided outside of New Zealand at any time during my period of membership, then any excess member tax credits
paid into my ASB KiwiSaver Scheme account will be deducted from my account prior to paying my withdrawal.
6. Identity and address verification (continued)
Certifying your identity and address documents
If you are submitting this form at an ASB Branch, an ASB Staff member can sight your original documents and take copies to attach to the form.
Alternatively, all evidence provided must be certified photocopies of your original documents.
*This list is not exhaustive, please contact ASB for further guidance
**Additional requirements exist for some overseas countries, please contact ASB for further guidance.
The eligible person who certifies your documents must include:
• Their full name, signature, the date and their qualification or occupation which makes them eligible to certify.
• The following statement on all certified copies of photographic identity: “I certify this is a true copy of the original document and the document provided
presents a true and correct likeness of the individual named”.
• The following statement on certified copies of all other forms of evidence: “I certify that this is a true copy of the original documents”.
Eligible persons with the legal authority to certify documents*
Important notes
• A lawyer (as defined in the Lawyers and Conveyancers Act 2006)
• A chartered accountant (within the meaning of section 19 of the New Zealand
Institute of Chartered Accountants Act 1996)
• A notary public
• A justice of the peace
• A registered medical doctor
• An Honorary Consul at a New Zealand Consular office
• If Overseas, a person authorised by law in that country to take statutory
declarations or equivalent.**
• Certified documents may be posted to ASB or presented to a branch.
• Electronic scans can be accepted only if sent directly from the eligible
person performing the certification.
• Certifications must be carried out no earlier than three months prior
to the date the form is completed.
• The eligible person must be over 16 years of age, and must not be
related to the customer and must not live at the same address as the
customer, and must not be involved in the transaction or business
requiring certification.
