Shared Services
ACT Treasury Directorate GPO Box 158
Canberra City ACT 2601 Or
Level 6, Eclipse House 197 London Circuit Canberra City ACT 2600
Contact: Salary Packaging Team Telephone: (02) 6205 5444
Facsimile: (02) 6207 6008
Annex B E-1
SHARED SERVICES
SALARY PACKAGING - EMPLOYEE PAYMENT CLAIM FORM/DEDUCTION AUTHORITY Circle one of the following: NEW AMEND STOP
Employee Name:___________________________________________ AGS Number:______________
Employer : __________________________________________ Payment Start Date: ______________
Select one of the Approved Benefit Types (please circle)
402 Notebook(Laptop Computer)* 403 Electronic Diary* 404 Briefcase*
406 Airport Lounge Membership 410 Financial Advice 411 Newspapers & Periodicals*
Other (please specify): __________________________________________________________________
*A Business Declaration must be completed for these benefit items to confirm they will be used for predominantly work purposes
Total Cost of Item $_______________ (invoice and all relevant documentation MUST be attached, including loan documentation if applicable)
Select one of the following (please circle):
• $25 one-off fee for reimbursements spanning 1 pay only
• $50 one-off fee for reimbursements spanning 2 or more pays
Payment by Electronic Funds Transfer:
Bank BSB Number (Must be 6 Digits)
Bank Account Number (Up to 9 Digits)
Account in the Name of _____________________________________________
Employee Signature: ________________________________ Date: _________________
Deliver together with confirmation documentation to:
Payroll and Personnel Services (Attention: Salary Packaging Team), Shared Services, ACT Treasury Directorate , GPO Box 158, CANBERRA CITY ACT 2601 or by Fax to 02 6207 6008Attention: Salary Packaging Team.
PAYROLL USE ONLY:
Payday:______________ Payday:______________ Payday:______________
Amount: $______________ Amount: $______________ Amount: $______________
Chris21 updated (date):_____________ Prepared:____________ Checked:____________
Salpack updated (date):_____________ Prepared:____________ Checked:____________
E-2
SHARED SERVICES
SUPERANNUATION SALARY PACKAGING DEDUCTION AUTHORITY Circle one of the following: NEW AMEND STOP
Employee Name:_________________________________________ AGS Number:_____________
Employer : ____________________________________________Payment Start Date: _____________
Fortnightly Superannuation Contribution (excl. fee)$______________ OR ______________%of gross salary
• $10 admin fee per fortnight for cheque payments
• $5 admin fee per fortnight for EFT payments
Superannuation Fund Name: __________________________________________
Account Number/Client Code: __________________________________________
Please complete if your Super Fund accepts payment via Electronic Funds Transfer:
Bank BSB Number (Must be 6 Digits)
Bank Account Number (Up to 9 Digits)
Account in the Name of _____________________________________________
Please complete if your Super Fund accepts payment via Cheque:
Make Cheque Payable to : ____________________________________________
Mail Cheque To Name: ____________________________________________
Address: ____________________________________________
Suburb _____________________ Post Code: _____________
Employee Signature:________________________________ Date:_________________
Deliver together with confirmation documentation to :
Payroll and Personnel Services (Attention: Salary Packaging Team), Shared Services, ACT Treasury Directorate, GPO Box 158, CANBERRA CITY ACT 2601 or by Fax to 02 6207 6008Attention: Salary Packaging Team.
PAYROLL USE ONLY:
Payday:______________ Payday:______________ Payday:______________
Amount: $______________ Amount: $______________ Amount: $______________
Chris21 updated (date):_____________ Prepared:____________ Checked:____________
Salpack updated (date):_____________ Prepared:____________ Checked:____________
SHARED SERVICES (SS) E–3 SALARY PACKAGING - EMPLOYEE MAINTENANCE FORM
Employee Name: _____________________________________ AGS Number: ______________
Address: ________________________________________________________________________
Suburb: _______________________________ Post Code: ______________________
Date of Birth: ___________________
Work Phone Number: ___________________ Work Fax Number: ______________________
Home Phone Number: ___________________ Home Fax Number ______________________
Mobile Phone Number: ___________________ Email Address: ______________________
Work Location: _____________________________________________________________
Employer (please circle): CMCD ED JCSD
ESDD CSD HD
TD ETD TMSD
SS
Other (please specify):______________________
PLEASE NOTE:
• Payment frequency will be fortnightly
• Quarterly statements will be sent to the address specified above
• When packaging more than one item, only the highest continuing fee will apply
Employee Signature :________________________________ Date: ______________
Deliver together with confirmation documentation to :
Payroll and Personnel Services (Attention: Salary Packaging Team), Shared Services, Treasury Directorate, GPO Box 158, CANBERRA CITY ACT 2601 Or by Fax to 02 6207 6008 Attention: Salary Packaging Team.
.
E–4
SHARED SERVICES
REIMBURSEMENT CLAIM FORM
Employee Name:_____________________________________ AGS Number:______________
Employer: _____________________________________________________________________
Please make the following reimbursement(s) from my salary packaging account:
Benefit: ________________________________________________________________________
Amount to be reimbursed: $______________________
Payment due date: _____________________________
PLEASE NOTE:
• Original tax invoice(s) MUST be attached to this claim form
• Reimbursements will be made via Electronic Funds Transfer (EFT) to your nominated bank account. If you have changed these details, please provide the new details below:
Bank BSB Number (Must be 6 Digits)
Bank Account Number (Up to 9 Digits)
Account in the Name of _____________________________________________
Employee Signature :________________________________ Date: ______________
Deliver together with confirmation documentation to :
Payroll and Personnel Services (Attention: Salary Packaging Team), Shared Services, ACT Treasury Directorate, GPO Box 158, CANBERRA CITY ACT 2601 or by Fax to 02 6207 6008 Attention: Salary Packaging Team.
PAYROLL USE ONLY:
Payday:______________ Payday:______________ Payday:______________
Amount: $______________ Amount: $______________ Amount: $______________
Salpack updated (date):_____________ Prepared:____________ Checked:____________
E-5
SHARED SERVICES
SALARY PACKAGING – PBI ITEMS ONLY
Circle one of the following: NEW AMEND STOP
Employee Name:_____________________________________________ AGS Number:____________
Payment Start Date: ______________________________Optional End Date : ___________________
Select one of the Approved PBI Benefit Types (please circle)
601 Own Home Mortgage 602 Private Home Rental 603 HECS/School Fees 604 Investments Schemes 605 Personal Loan Repayments 606 Club/Asso. Memberships 607 Child Care Fees 608 Utilities Charges 609 Life Insurance
610 Private Health Insurance 611 House & Contents Insurance Other (please specify):
___________________________________________________________________
Annual Cost of Item $________________ (invoice and all relevant documentation MUST be attached,
OR including loan documentation if applicable) F/nightly Cost of Item $_______________
Reference Number(s) :_______________________________________________________________
NB: The above figure is exclusive of the $10 admin fee per fortnight Payment by Electronic Funds Transfer:
Bank BSB Number (Must be 6 Digits)
Bank Account Number (Up to 9 Digits)
Account in the Name of _____________________________________________
Employee Signature: ________________________________ Date: _________________
Deliver together with confirmation documentation to :
Payroll and Personnel Services (Attention: Salary Packaging Team), Shared Services, ACT Treasury Directorate, GPO Box 158, CANBERRA CITY ACT 2601 or by Fax to 02 6207 6008 Attention: Salary Packaging Team.
PAYROLL USE ONLY:
Payday:______________ Payday:______________ Payday:______________
Amount: $______________ Amount: $______________ Amount: $______________
Chris21 updated (date):_____________ Prepared:____________ Checked:____________
Salpack updated (date):_____________ Prepared:____________ Checked:____________
E–6
SHARED SERVICES
REIMBURSEMENT OF EXCESS FBT CONTRIBUTIONS
Employee Name:_____________________________________ AGS Number:______________
Employer: _____________________________________________________________________
Please make the following reimbursement for my FBT Excess for the FBT year 01 April……… ending 31 March………
Amount to be reimbursed: $______________________
Payment due date: _____________________________
PLEASE NOTE:
• Reimbursements will be made via EFT (Electronic Funds Transfer) to your nominated bank account. If you do not provide these details below you will not receive your reimbursement. This account MUST be in your name.:
Bank BSB Number (Must be 6 Digits)
Bank Account Number (Up to 9 Digits)
Account in the Name of _____________________________________________
Employee Signature :________________________________ Date: ______________
Deliver together with confirmation documentation to :
Payroll and Personnel Services (Attention: Salary Packaging Team), Shared Services, ACT Treasury Directorate, GPO Box 158, CANBERRA CITY ACT 2601 or by Fax to 02 6207 6008 Attention: Salary Packaging Team.
PAYROLL USE ONLY:
Payday:______________ Payday:______________ Payday:______________
Amount: $______________ Amount: $______________ Amount: $______________
Chris21 updated (date):_____________ Prepared:____________ Checked:____________
Salpack updated (date):_____________ Prepared:____________ Checked:____________
E-7
SHARED SERVICES
CASUAL EMPLOYEE SUPERANNUATION SALARY SACRIFICE FORM
Employee Name:__________________________________________ AGS Number:_____________
Employer : ____________________________________________Payday: _____________
• Please complete this form each fortnight to salary sacrifice your salary. Forms must be received by COB every Wednesday of off pay week. Late forms will not be accepted.
Superannuation Contribution (excl. fee) $_______________ OR _______________% of gross salary
• $10 admin fee per fortnight transaction
• I have confirmed that sufficient casual claims have been entered into CRS to cover above amount
• I am aware that if there are not sufficient funds I will not be able to salary package or receive any pay for this fortnight
Superannuation Fund Name: __________________________________________
Account Number/Client Code: __________________________________________
Please complete if your Super Fund accepts payment via Electronic Funds Transfer:
Bank BSB Number (Must be 6 Digits)
Bank Account Number (Up to 9 Digits)
Account in the Name of _____________________________________________
Please complete if your Super Fund accepts payment via Cheque:
Make Cheque Payable to : ____________________________________________
Mail Cheque To Name: ____________________________________________
Address: ____________________________________________
Suburb _____________________ Post Code: _____________
Employee Signature: ________________________________ Date:_________________
Daytime contact number: __________________________
Deliver together with confirmation documentation to :
Payroll and Personnel Services (Attention: Salary Packaging Team), Shared Services, ACT Treasury Directorate, GPO Box 158, CANBERRA CITY ACT 2601 or by Fax to 02 6207 6008 Attention: Salary Packaging Team.
PAYROLL USE ONLY:
Payday:______________ Payday:______________ Payday:______________
Amount: $______________ Amount: $______________ Amount: $______________
Chris21 updated (date):_____________ Prepared:____________ Checked:____________
Salpack updated (date):_____________ Prepared:____________ Checked:____________
The Delegate
Human Resources Manager
………..……(Directorate name)
SALARY PACKAGING
REQUEST FOR WAIVER OF INDEPENDENT FINANCIAL ADVICE
I,………..………..(Full Name)
AGS Number……….,
Intend to salary package ………... (please enter item you will be packaging) and hereby request a waiver to obtain Independent Financial Advice as required under Section 2.1 of the ACTPS Salary Packaging Policy and Procedures, dated 12 April 2007, which became effective from 12 April 2007.
I make this request on the understanding that any decision to proceed with an offer of Salary Package is made without this advice and in accordance with the provisions as stated in the ACTPS Salary
Packaging Policy and Procedures.
Signed………. Date……….
(Print Name)………
Waiver Approved/Not Approved
Delegate
…./…./…..