How to complete the HESTA transfer/rollover form
TO REDUCE YOUR BASIC COVER:
OR
TO CANCEL ALL OF YOUR BASIC COVER, WRITE ‘I WISH TO CANCEL ALL INSURANCE COVER THROUGH HESTA’
IP Cover units: Death Cover units: Lump-Sum TPD Cover units:
The sooner you consolidate your old accounts into your HESTA account, the sooner you’ll stop losing hard-earned money on extra fees. Every dollar you save now could make a real difference when you retire.
By completing the form overleaf, you are requesting the transfer of the whole balance of your super benefits between funds. This form cannot be used to:
transfer part of the balance of your super benefits
t
change the fund to which your employer pays your
t
contributions; you must complete a Standard choice form if you want to change funds (your employer can give this to you)
Before you complete this form:
read the important information that follows
t
check that HESTA can accept this transfer
t
When completing this form:
refer to these instructions where a question shows an icon
t
like this:
print clearly in BLOCK LETTERS, using a black pen
t
Completing proof of identity
You will need to provide documentation with this transfer request to prove you are the person to whom the super entitlements belong.
Acceptable documents
The following documents may be used. EITHER
One of the following documents only:
driver’s licence issued under State or Territory law
t
passport
t
OR
One of the following documents:
Birth Certificate or Birth Extract
t
Citizenship Certificate issued by the Commonwealth
t
Pension Card issued by Centrelink that entitles the person to
t
financial benefits AND
One of the following documents:
letter from Centrelink regarding a government assistance
t
payment
notice issued by Commonwealth, State or Territory Government
t
or local council within the past 12 months that shows your name and residential address; for example: Tax Office Notice of Assessment or a rates notice from a local council.
Have you changed your name or are you signing on behalf of another person?
If you have changed your name or are signing on behalf of the applicant, you need to provide a certified linking document. This is a document that proves a relationship exists between two (or more) names.
Change of name – suitable linking documents include: Marriage Certificate, deed poll or change of name certificate from the Births, Deaths and Marriages Registration Office.
Signed on behalf of the applicant – suitable linking documents include: Guardianship papers or Power of Attorney
Certification of personal documents
All copied pages of original proof of identification documents (including any linking documents) need to be certified as true copies by an individual approved to do so (see below).
The person who is authorised to certify documents must:
sight the original and the copy and make sure both documents
t
are identical
make sure all pages have been certified as true copies by writing
t
or stamping ‘certified true copy’ followed by their signature, printed name, qualification (eg Justice of the Peace, Australia Post employee) and date
The following persons can certify copies of the originals as true and correct copies:
a permanent employee of Australia Post with five or more years
t
of continuous service
a finance company officer with five or more years of continuous
t
service (with one or more finance companies)
an officer with, or authorised representative of, a holder of an
t
Australian Financial Services Licence (AFSL), having five or more years continuous service with one or more licensees
a notary public officer
t
a police officer
t
a registrar or deputy registrar of a court
t
a Justice of the Peace
t
a person enrolled on the roll of a state or territory Supreme
t
Court or the High Court of Australia, as a legal practitioner an Australian consular officer or an Australian diplomatic officer
t
a judge of a court
t
a magistrate
t
a chief executive officer of a Commonwealth court
t
What happens if you do not quote your tax file number (TFN)?
You are not obliged to provide your TFN to HESTA. However, if you do not provide your TFN, your employer’s contributions may be taxed at the highest marginal tax rate plus the Medicare Levy, compared to the usual concessional tax rate of 15%. HESTA may deduct this additional tax from your account.
If we do not have your TFN, you will not be able to make voluntary after-tax contributions to your super account, which may also disqualify you from receiving government co-contributions. Supplying your TFN will make it easier to keep track of your super in the future.
HESTA is authorised by law to collect your TFN, which will only be used for lawful purposes. These purposes may change in the future as a result of legislative amendments. Your TFN may be disclosed to another super provider when your benefits are being transferred, unless you request in writing that your TFN must not be disclosed to any other fund.
Send your completed and signed form with your certified proof of identity documents to your previous fund or to:
HESTA PO Box 600 Carlton South Vic 3053
How to complete the HESTA transfer/rollover form
Have you lost touch with your old super?
At a time when every dollar counts, leaving old super accounts open could cost you money every day. Each extra account may charge you fees and insurance premiums — money that could be funding your future retirement.
Issued by H.E.S.T. Australia Limited ABN 66 006 818 695 AFSL No. 235249 Trustee of HESTA Super Fund ABN 64 971 749 321 SPIN HST0100AU
Contact HESTA Free call 1800 813 327 Fax 1300 368 636 www.hesta.com.au
New member application form
Please answer all questions on page 1 first.
Other insurance changes
Please send me Your HESTA insurance guide to upgrade
my cover.
PART B: PERSONAL HEALTH STATEMENT
Complete this section only if you are joining HESTA more than six months after starting with your current employer, or: - to enable you to choose Option 2 or 3, and/or
- to choose additional units of IP cover
YES, I declare that I:
a) am actively working as at the cover application date and am able to perform all my usual duties on a permanent full-time basis
b) am not currently receiving any form of medical treatment c) have not taken more than seven consecutive days off
work over the past 12 months due to illness or injury (other than colds or flu)
d) have never suffered from: a cancer/tumor of any type; chest pain; high blood pressure; heart/vascular complaint; back or joint disorder; paralysis; stroke; mental/nervous disorder, including stress, anxiety or depression
e) am not suffering from Acquired Immune Deficiency Syndrome (AIDS) or infected with the HIV virus or carrying antibodies to the HIV virus
OR
NO, I am unable to complete the above declaration,
but I am still interested in increasing my basic cover. Please send me Your HESTA insurance guide.
You may reduce or cancel your insurance at any time by providing written and signed instructions to HESTA.
t#ZDBODFMMJOHZPVSJOTVSBODF ZPVXJMMGPSGFJUBOZGVUVSFBDDFTT to cover without the need for satisfactory medical evidence. t*GZPVTVCTFRVFOUMZXJTIUPIBWFDPWFSUISPVHI)&45" ZPV
will need to complete a personal health statement and may be declined cover or have cover issued on
non-standard terms.
t:PVTIPVMEDPOTJEFSPCUBJOJOHmOBODJBMBEWJDFCFGPSF cancelling your insurance.
If you wish to reduce or cancel insurance cover with HESTA, please notify us in writing below. Sign here to acknowledge that you understand the consequences of cancelling your insurance and that you are aware you may be unable to obtain any cover in the future (for example, when your health deteriorates).
Issued by H.E.S.T. Australia Limited ABN 66 006 818 695 AFSL No. 235249 Trustee of HESTA Super Fund ABN 64 971 749 321 SPIN HST0100AU
New member application form
Please answer all questions on the previous pages first.
Contact HESTA Free call 1800 813 327 Fax 1300 368 636 www.hesta.com.au
Before you sign this application form, the Trustee is obliged to give you a Product Disclosure Statement (which is a summary of important information relating to the Fund). This material will help you to understand the product and decide if it is appropriate for your needs. Note: if you are under 18 years of age, a parent or guardian must also sign this form to enable your HESTA account to be created.
I have read and understood the Product Disclosure Statement to which this application was attached. I acknowledge that unless otherwise indicated on this form, I am at work on the date of joining HESTA and I agree to accept HESTA’s insurance cover as indicated in part 6. I acknowledge that I have read and understood the privacy statement as outlined on
page 45 and accept that the information requested on
this form (unless otherwise stipulated) is required in order for HESTA to accept my application for membership and for the ongoing administration of my membership by the fund administrator and other service providers. In consideration of my admission to membership I agree to abide by and be bound by the provisions of the Trust Deed. I acknowledge that I have read the duty of disclosure on page 32 and understand my obligations under the Insurance Contracts Act 1984.
Signature:
Date:
Signature of parent or guardian (if under 18 years of age):
10 Declaration and applicant’s signature
All your super will be invested in Core Pool if:
t ZPVEPOPUDPNQMFUFUIJTTFDUJPOPS
t ZPVSOPNJOBUFEQFSDFOUBHFTEPOPUUPUBM I want to place my super in the following investments:
Ready-Made Investment Pools
Cash Plus %
Core Pool (default) %
Shares Plus %
Eco Pool %
Overseas Share Pool %
Australian Share Pool %
Your Choice Asset Classes
Cash %
Fixed Interest %
Absolute Return Strategies %
Property %
Infrastructure %
International Shares %
Australian Shares %
Private Equity %
Total (must add up to 100%): %
When you have filled in and signed this form, please hand it to your employer or return it to:
HESTA, PO Box 600, Carlton South, Vic, 3053.
There are very good reasons to make after-tax contributions to your super. See page 9 for details or use our online HESTA super calculator to estimate how these after-tax contributions may affect your benefit when you retire. Please provide your TFN in part 2.
Yes, I want to make after-tax contributions to my super.
My preferred method of payment is:
employer deduction (please advise your employer) deposit book, please send me more information bank deduction authority (minimum $20 per month) please send me further information (free call 1800 813 327 to choose this option)
Please issue me with a PIN so I can access my account through Member Online.
Yes No
8 After-tax contributions
9 Online access to your account 7 Investment choice
You can choose how you want your super invested. See pages
13-20 and consider seeking financial advice before making a
decision. You may select any combination of options.
PAGE 2 Please proceed to part 7
D D M M Y Y Y Y
TO REDUCE YOUR BASIC COVER:
OR
TO CANCEL ALL OF YOUR BASIC COVER, WRITE ‘I WISH TO CANCEL ALL INSURANCE COVER THROUGH HESTA’
IP Cover units: Death Cover units: Lump-Sum TPD Cover units:
The sooner you consolidate your old accounts into your HESTA account, the sooner you’ll stop losing hard-earned money on extra fees. Every dollar you save now could make a real difference when you retire.
By completing the form overleaf, you are requesting the transfer of the whole balance of your super benefits between funds. This form cannot be used to:
transfer part of the balance of your super benefits
t
change the fund to which your employer pays your
t
contributions; you must complete a Standard choice form if you want to change funds (your employer can give this to you)
Before you complete this form:
read the important information that follows
t
check that HESTA can accept this transfer
t
When completing this form:
refer to these instructions where a question shows an icon
t
like this:
print clearly in BLOCK LETTERS, using a black pen
t
Completing proof of identity
You will need to provide documentation with this transfer request to prove you are the person to whom the super entitlements belong.
Acceptable documents
The following documents may be used. EITHER
One of the following documents only:
driver’s licence issued under State or Territory law
t
passport
t
OR
One of the following documents:
Birth Certificate or Birth Extract
t
Citizenship Certificate issued by the Commonwealth
t
Pension Card issued by Centrelink that entitles the person to
t
financial benefits AND
One of the following documents:
letter from Centrelink regarding a government assistance
t
payment
notice issued by Commonwealth, State or Territory Government
t
or local council within the past 12 months that shows your name and residential address; for example: Tax Office Notice of Assessment or a rates notice from a local council.
Have you changed your name or are you signing on behalf of another person?
If you have changed your name or are signing on behalf of the applicant, you need to provide a certified linking document. This is a document that proves a relationship exists between two (or more) names.
Change of name – suitable linking documents include: Marriage Certificate, deed poll or change of name certificate from the Births, Deaths and Marriages Registration Office.
Signed on behalf of the applicant – suitable linking documents include: Guardianship papers or Power of Attorney
Certification of personal documents
All copied pages of original proof of identification documents (including any linking documents) need to be certified as true copies by an individual approved to do so (see below).
The person who is authorised to certify documents must:
sight the original and the copy and make sure both documents
t
are identical
make sure all pages have been certified as true copies by writing
t
or stamping ‘certified true copy’ followed by their signature, printed name, qualification (eg Justice of the Peace, Australia Post employee) and date
The following persons can certify copies of the originals as true and correct copies:
a permanent employee of Australia Post with five or more years
t
of continuous service
a finance company officer with five or more years of continuous
t
service (with one or more finance companies)
an officer with, or authorised representative of, a holder of an
t
Australian Financial Services Licence (AFSL), having five or more years continuous service with one or more licensees
a notary public officer
t
a police officer
t
a registrar or deputy registrar of a court
t
a Justice of the Peace
t
a person enrolled on the roll of a state or territory Supreme
t
Court or the High Court of Australia, as a legal practitioner an Australian consular officer or an Australian diplomatic officer
t
a judge of a court
t
a magistrate
t
a chief executive officer of a Commonwealth court
t
What happens if you do not quote your tax file number (TFN)?
You are not obliged to provide your TFN to HESTA. However, if you do not provide your TFN, your employer’s contributions may be taxed at the highest marginal tax rate plus the Medicare Levy, compared to the usual concessional tax rate of 15%. HESTA may deduct this additional tax from your account.
If we do not have your TFN, you will not be able to make voluntary after-tax contributions to your super account, which may also disqualify you from receiving government co-contributions. Supplying your TFN will make it easier to keep track of your super in the future.
HESTA is authorised by law to collect your TFN, which will only be used for lawful purposes. These purposes may change in the future as a result of legislative amendments. Your TFN may be disclosed to another super provider when your benefits are being transferred, unless you request in writing that your TFN must not be disclosed to any other fund.
Send your completed and signed form with your certified proof of identity documents to your previous fund or to:
HESTA PO Box 600 Carlton South Vic 3053
How to complete the HESTA transfer/rollover form
Have you lost touch with your old super?
At a time when every dollar counts, leaving old super accounts open could cost you money every day. Each extra account may charge you fees and insurance premiums — money that could be funding your future retirement.
Issued by H.E.S.T. Australia Limited ABN 66 006 818 695 AFSL No. 235249 Trustee of HESTA Super Fund ABN 64 971 749 321 SPIN HST0100AU
Contact HESTA Free call 1800 813 327 Fax 1300 368 636 www.hesta.com.au
New member application form
Please answer all questions on page 1 first.
Other insurance changes
Please send me Your HESTA insurance guide to upgrade
my cover.
PART B: PERSONAL HEALTH STATEMENT
Complete this section only if you are joining HESTA more than six months after starting with your current employer, or: - to enable you to choose Option 2 or 3, and/or
- to choose additional units of IP cover
YES, I declare that I:
a) am actively working as at the cover application date and am able to perform all my usual duties on a permanent full-time basis
b) am not currently receiving any form of medical treatment c) have not taken more than seven consecutive days off
work over the past 12 months due to illness or injury (other than colds or flu)
d) have never suffered from: a cancer/tumor of any type; chest pain; high blood pressure; heart/vascular complaint; back or joint disorder; paralysis; stroke; mental/nervous disorder, including stress, anxiety or depression
e) am not suffering from Acquired Immune Deficiency Syndrome (AIDS) or infected with the HIV virus or carrying antibodies to the HIV virus
OR
NO, I am unable to complete the above declaration,
but I am still interested in increasing my basic cover. Please send me Your HESTA insurance guide.
You may reduce or cancel your insurance at any time by providing written and signed instructions to HESTA.
t#ZDBODFMMJOHZPVSJOTVSBODF ZPVXJMMGPSGFJUBOZGVUVSFBDDFTT to cover without the need for satisfactory medical evidence. t*GZPVTVCTFRVFOUMZXJTIUPIBWFDPWFSUISPVHI)&45" ZPV
will need to complete a personal health statement and may be declined cover or have cover issued on
non-standard terms.
t:PVTIPVMEDPOTJEFSPCUBJOJOHmOBODJBMBEWJDFCFGPSF cancelling your insurance.
If you wish to reduce or cancel insurance cover with HESTA, please notify us in writing below. Sign here to acknowledge that you understand the consequences of cancelling your insurance and that you are aware you may be unable to obtain any cover