ANZ Superannuation Savings Account Withdrawal Form

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Page 1 of 7 OnePath MasterFund (Fund) ABN 53 789 980 697, RSE R1001525

OnePath Custodians Pty Limited (OnePath Custodians) ABN 12 008 508 496, AFSL 238346, RSE L0000673 OnePath Life Limited (OnePath Life) ABN 33 009 657 176, AFSL 238341, RSE L0000673

1 July 2015 Customer Services Phone 13 38 63 Fax 02 9234 6668

Email customer@onepath.com.au Website anz.com

This form is for existing investors in ANZ Superannuation Savings Account only.

INSTRUCTIONS

Complete the relevant sections, sign and return this form to the following address:

ANZ Superannuation Savings Account OnePath Life Limited

GPO Box 4028 Sydney NSW 2001 Member number Tax file number*

* If you have not provided your TFN, some contributions and the untaxed element of a rollover may attract further tax. Please refer to the ANZ Superannuation Savings Account PDS for further details on the collection of TFN’s.

1. MEMBER DETAILS Surname

Given name(s)

Date of Birth (dd/mm/yyyy) / / Residential address

(this cannot be a PO Box)

Suburb/Town State Postcode

Country Postal address (if different from above)

Country

Phone Home Business

Mobile Fax

Email

2. PROOF OF IDENTITY

You need to supply a certified copy for each form you send in.

I have attached a certified copy of my driver’s licence or passport or

I have attached certified copies of both:

• Birth/Citizenship Certificate or Centrelink Pension Card and

• Centrelink payment letter or Government or Local Council notice (less than one year old) with name and address.

A certified copy is a photocopy which has been compared with the original and endorsed as a true copy by an individual approved to do so, for example a Justice of the Peace, legal practitioner, Australia Post employee, etc. For more information on identification requirements and who can certify documents, please refer to the ‘Know your customer – identification requirements’ on page 5 of this form.

Note: We cannot accept original certified copies by fax, or photocopies of certified identification.

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Withdrawal Form

3. TAX QUESTIONNAIRE

If you intend to claim a tax deduction for your personal contributions or want to vary a previous notice of intent you gave your super fund, please ensure you have completed and returned a ‘Notice of intent to claim or vary a deduction for personal super contributions’ form (attached) and have received acknowledgement from the Trustee before you submit this Withdrawal Form.

Reason for benefit payment request

I have completed and submitted a choice of fund nomination to my employer, nominating another fund.

I am requesting a partial withdrawal only.

I am an ANZ Superannuation Savings Account member wishing to close my account.

For any other benefit payment requests (such as Severe Financial Hardship, Specified Compassionate Grounds or if you are a departed Temporary Australian Resident), please contact Customer Services on 13 38 63.

4. ROLLOVER Total rollover Partial rollover

If partial, please state amount required $ (net) Name of rollover institution

USI of the destination product

Superannuation Fund No. (SFN)* and/or

Australian Business No. (ABN)*

Contact name (if known) Cheque payable to Policy/Reference No.

Postal address

Country Phone (business)

Please attach a letter of compliance if the rollover is to a self-managed super fund.

* Either the SFN or ABN must be completed prior to your withdrawal being processed.

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5. ELIGIBILITY TO WITHDRAW A LUMP SUM CASH PAYMENT

Are you a permanent resident or citizen of Australia or New Zealand or a holder of a subclass 405 or 410 visa?

Yes – please continue to complete this section.

No – Please note that from 1 April 2009, an individual who has, at any stage, been a temporary resident and is not a permanent resident of Australia or is not a citizen of Australia or New Zealand and is not a holder of a sub class 405 or 410 visa, is only able to withdraw their preserved superannuation benefits under limited conditions of release, including: death, terminal medical condition, permanent incapacity, temporary incapacity, unclaimed money payment, and departed temporary resident. Exceptions apply to individuals who have satisfied a condition of release prior to 1 April 2009. Please speak to your financial adviser for more information.

I would like to withdraw a lump sum cash payment. I have met one of the conditions of withdrawal, as indicated by me below.

Please tick one of the following:

Retirement: I have reached my preservation age and have permanently retired from the workforce.

Retirement: I am aged 60 years or more and have ceased an arrangement of gainful employment since attaining age 60 years.

I am aged 65 years or more.

The amount to be withdrawn is unrestricted non-preserved.

I have left my ANZ Superannuation Savings Account participating employer and my date of ceased employment is / / Note: a benefit will only be payable under this rule if the member’s balance is less than $200.

or Other*

Severe financial hardship Compassionate grounds Departed temporary resident Permanent incapacity

* Do not use this form for withdrawals relating to death claims, a terminal medical condition or the Family Law Act 1975. Please phone Customer Services on 13 38 63 for claim requirements.

6. WITHDRAWAL INSTRUCTIONS a. Full withdrawal only

I would like to withdraw my total account balance. I am aware that any fees and any taxes will be deducted before payment is made.

b. Partial withdrawal only

I would like to make a partial withdrawal of: $ . Please indicate below whether this amount is to be net or gross.

Please tick one of the following:

Net: I would like my withdrawal to be net of fees and taxes. This means that the amount I have nominated is the exact amount that I will receive after any fees and taxes are deducted.

Gross: I would like my withdrawal to be gross of fees and taxes. This means that the amount I have nominated is before any fees and taxes are deducted.

7. DIRECT CREDIT FACILITY (CASH PAYMENTS ONLY)

Cash payments only, can be credited directly into your financial institution account. Please provide your full details below.

Note: Allow up to five days for clearance (direct crediting is not available on the full range of account types e.g. credit unions and building societies. Please check with your financial institution).

Name of financial institution Account name

Bank (BSB number) Account number

Note: ANZ will take care to ensure that your benefit payments are made in accordance with this authority. However, we accept no responsibility for any loss which occurs as a result of incorrect bank details you provide to us. If the bank rejects the payment of your benefits into the bank account you have provided, we will make the payment to you by cheque.

Date (dd/mm/yyyy)

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Withdrawal Form

8. CHEQUE PAYMENTS

Please send a cheque to my postal address below:

Name Address

State Postcode

9. DECLARATION AND SIGNATURE

Your final account balance cannot be calculated until the day payment is actually made. The amount that will be paid depends on the current value of your account, your employer forwarding any outstanding amounts, investment earnings or losses and any taxes and fees that may apply to your account.

If you have any concerns you should discuss these with your financial adviser.

By completing this form:

• I consent to the collection, use, storage and disclosure of my personal information (including health information) as described in ANZ’s Privacy Policy which is available at anz.com, or by calling Customer Services. If I have provided information about another person in this application (for example a beneficiary or life insured), I declare that I have the consent of that person to do so. I understand that OnePath requires me to inform the person concerned that I have done so and direct them to the Privacy Policy which is located at anz.com

• I consent to OnePath using and sharing my Tax File Number with members of the ANZ Group to provide services (including account consolidation) and products to me.

• I accept that OnePath may send me information about its products or services from time to time. I understand that I may notify OnePath of my decision not to receive further information by contacting OnePath directly.

• I authorise my financial adviser (where I have nominated financial adviser) to receive and access my personal information for the purposes of managing my investment. Where there is a change to this authority or relating to my adviser, I will notify OnePath of the change.

• I declare that I am not bankrupt or insolvent under administration and that the information provided by me in this form is true and correct.

I request the Trustee, OnePath Custodians Pty Limited (OnePath Custodians) and OnePath Life Limited (OnePath Life) to act upon and give effect to the directions given by me in this notice.

• I acknowledge that I am not aware and have no reason to suspect that my investment is derived from, related to or used to fund, money laundering, terrorism financing or other similar activities and my instructions in relation to my investment will not result in ANZ or any of its related group companies breaching any related laws or regulations in Australia or any other country.

• I acknowledge that should I, or my estate, receive a payment from OnePath Custodians in full satisfaction of my benefits under the policy and/or the Fund, OnePath Custodians will have fully discharged their obligations under the Trust Deed governing the Fund and the policy, and that any payment made to or in respect of me shall be net of any lump sum tax paid, as required by law, to the Australian Taxation Office.

• I declare that the information completed on this form is true and correct.

• I declare that I have read and understood the benefit payment rules in the PDS.

Name of member Signature of member Date (dd/mm/yyyy)

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1 July 2015

The Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (Cth) requires us to identify you and verify your identity before we make a payment of your super.

The information outlined below relates to individuals and sole traders only.

INDIVIDUALS/SOLE TRADERS

You can do one of two things to provide evidence of client identity verification to us:

Financial advisers only – complete the ANZ Identification Form which verifies you have collected sufficient identification from your client.

Note: you are not required to send in originals or copies of identification if you use this form.

or

Individuals not using the services of a financial adviser – send in original certified copies* (not original documents) of the following:

• one primary photographic identification document, or

• one primary non-photographic identification document and one secondary identification document.

Note: We cannot accept certified copies by fax or email.

Primary photographic identification document One of:

• Current Australian driver’s licence

• Australian passport (current or expired less than two years ago)

• Proof of Age document issued by a State or Territory

• Foreign government issued passport or similar travel document containing the person’s signature*.

Or, if none of these documents can be provided, both:

• Current foreign driver’s licence that contains the person’s date of birth* and

• Foreign government issued identity card containing the person’s signature*.

or

Primary non-photographic identification document

• Australian Birth Certificate or birth extract

• Australian Citizenship Certificate

• Foreign government issued birth certificate*

• Centrelink Pension Card

• Foreign government issued certificate of citizenship*.

and

Secondary identification document

• Commonwealth, State or Territory issued document dated within the last 12 months that records the provision of financial benefits to the person and which contains the person’s name and residential address.

• Australian Taxation Office issued document dated within the last 12 months that records an amount payable or owed to the person and which contains the person’s name and residential address.

• Local Government body or utilities provider issued document dated within the last three months that records the provision of services to that address or that person and which contains the person’s name and residential address.

• If the person is under the age of 18, a notice dated within the last three months from a school principal containing the person’s name and residential address and the period of attendance at that school.

* Documents not in English must be accompanied by an English translation prepared by an accredited translator.

A certified copy is a document that has been certified as a true copy of the original. Examples of who can certify documents are:

• a person enrolled on the roll of a Supreme Court or the High Court as a legal practitioner

• a judge, registrar or deputy registrar of a court

• a magistrate

• a chief executive officer of a Commonwealth court

• a Justice of the Peace

• a notary public

• a police officer

• an agent of Australia Post in charge of supplying postal services to the public

• a permanent employee of Australia Post with two years’ continuous service employed in supplying postal services to the public

• an Australian consular or diplomatic officer

• a bank or building society officer with two or more years of continuous service

• a finance company officer with two year’s continuous service

• an officer or authorised representative of an AFSL holder with two years’

continuous service

• a member of the Institute of Chartered Accountants in Australia, CPA Australia or Institute of Public Accountants.

Note: The person who is authorised to certify documents must make sure all pages have been certified as true copies by writing or stamping

‘certified true copy’ followed by their signature, printed name, contact details, qualification (e.g. Justice of the Peace, Australia Post employee, etc.) and date. The person certifying a document must be either an Australian citizen or a permanent resident of Australia. A full list of persons who can certify documents is available from Customer Services on 13 38 63.

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Notice of intent to claim or vary a deduction for personal super contributions

1 July 2015 Customer Services Phone 13 38 63 Fax 02 9234 6668

Email customer@onepath.com.au Website anz.com

1. MEMBER ACCOUNT NUMBER Member number

2. MEMBER DETAILS Surname

Given name(s)

Date of Birth (dd/mm/yyyy) / / Postal address

Country

Phone Home Business

Mobile Fax

Tax file number*

Note: You don’t have to provide your TFN to us. However, if we do not have your TFN, we may not be able to accept your contributions.

Providing your TFN will also assist us in correctly identifying you.

3. CONTRIBUTION DETAILS

You must complete and return this notice to the Trustee if you intend to claim a taxation deduction for part or all of your personal superannuation contributions.

Financial year ended 30 June 20

My personal contributions to this Fund covered by this notice $

Is this notice varying an earlier notice Yes No

The amount of these personal contributions I will be claiming as a tax deduction $

Note: A tax deduction for personal superannuation contributions may only be claimed by people in certain circumstances. Please refer to the ATO TaxPack, your financial adviser or Accountant to determine if you are eligible to claim a personal tax deduction.

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4. DECLARATIONS 4A. Declaration

Intention to claim a tax deduction

Use this declaration if you have not previously lodged a notice with the Fund for these contributions.

I am lodging this notice before both of the following dates:

• the day that I lodged my income tax return for the year stated in section 2 of this notice

• the end of the income year after the year stated in section 2 of this notice.

At the time of completing this notice:

• I intend to claim the personal contributions in section 2 of this notice as a tax deduction

• I am a member of the Fund

• the Fund still holds these contributions

• the trustee of the Fund has not begun to pay a superannuation income stream based in whole or part on these contributions

• I have not included these contributions in an earlier notice.

The information given on this form is correct and complete.

/ /

If you do not wish to claim a Tax Deduction, you do not have to complete part 4A.

or

4B. Declaration

Variation of previous deduction notice

Use this declaration if you have already lodged a notice with the Fund for these contributions and you wish to reduce the amount stated in that notice.

I intend to claim the personal contributions in section 2 of this notice, as a tax deduction.

I wish to vary my previous notice for these contributions by reducing the amount I advised in my previous notice.

I confirm that either:

• I have not yet lodged my income tax return for the relevant financial year and this variation notice is being lodged on or before the 30 June in the financial year following the year the contribution was made

• the Australian Taxation Office has disallowed my claim for a deduction for the relevant year and this notice reduces the amount stated in my previous notice by $

The information given on this form is correct and complete.

/ / If you do not wish to vary a Tax Deduction, you do not have to complete part 4B.

M3069/0715