Preserved benefit Age claim form and information leaflet

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PBA
05/11       Preserved benefit
            Age claim form and information leaflet

            Before completing this benefit application form, you are advised to read the PSS Product Disclosure
            Statement at www.pss.gov.au or call 1300 000 377.
            The attached benefit application form should be completed by preserved benefit members of the Public
            Sector Superannuation (PSS) Scheme who are claiming payment of their preserved benefit having both
            reached age 55 and retired from the workforce.

        Your Government Super at Work
        Any financial product advice in this document is general advice only and has been prepared without taking account of your personal objectives, financial situation or needs.
        Before acting on any such general advice, you should consider the appropriateness of the advice, having regard to your own objectives, financial situation or needs. You may wish
        to consult a licensed financial advisor. You should obtain a copy of the PSS Product Disclosure Statement and consider its contents before making any decision regarding your super.
        Commonwealth Superannuation Corporation (CSC) ABN: 48 882 817 243 AFSL: 238069
        RSEL: L0001397 Trustee of the Public Sector Superannuation Scheme (PSS) ABN: 74 172 177 893 RSE: R1004595

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Explanatory notes                                        The benefit application form
                                                           Your accurate completion of the benefit
                                                           application form allows us to process the
  Read this first!                                         application as soon as possible after a claim has
                                                           been made. Take care when completing this form.
  These explanatory notes are intended to assist           If you do not complete the benefit application
  you to complete the attached benefit application         form correctly, the processing of your benefit will
  form. They are not intended to provide a detailed        be delayed, or may be paid incorrectly.
  explanation of your benefit options.
  It is suggested that you separate the notes from the
  form (if joined) so that you can refer to them as        Section A – Personal details
  you complete the application form.
                                                           Please complete all the boxes in this section. It
                                                           enables us to identify you and any other potential
                                                           beneficiary, and tells us where we can contact you.
  Where can you find out
                                                           Relationship details
  more about your benefit
                                                           Details of your relationship status, including same
  entitlements?                                            sex or opposite sex de facto relationships, should
  There are many publications provided by the              be provided. You may wish to include a copy of
  Commonwealth Superannuation Corporation                  your marriage certificate or registered relationship
  (CSC) that explain the various benefit options           certificate with your application. This would speed
  which are available to you. Before completing this       up the process in the event that a spouse’s benefit
  benefit application form, you are advised to read        becomes payable.
  the PSS Product Disclosure Statement available
                                                           For the definition of a spouse for death benefits, see
  at www.pss.gov.au or call 1300 000 377.
                                                           the Death benefits fact sheet at www.pss.gov.au.
  There are also fact sheets on Tax and your PSS
  benefit and Preservation of benefits which you           Contact details
  should read. These are available from us or from         The postal address you provide is where all
  the PSS website at www.pss.gov.au                        correspondence will be sent.
  Other sources of information include                     A contact phone number is also required in case
  the following:                                           we need to contact you regarding the payment of
   >> Our Call Centre can provide details of your          your benefit.
      benefit entitlement, explain the benefit options     If you have an email address, inclusion of your
      and provide information on the value of your         current email address will be helpful.
      prospective benefits. For more information:

     Telephone: 1300 000 377
     Facsimile: (02) 6272 9613
                                                           Section B – Identification
     Email: members@pss.gov.au                             requirements
   >> It is in your interest to seek professional advice   To protect against fraud, money laundering,
      before you make a decision on a benefit.             terrorism financing and safeguard your benefit, we
      We cannot provide you with financial advice.         need you to provide documentation to prove your
                                                           identity before we can process your benefit request.
                                                           You need to provide certified copies of four
  Forms you need to complete                               identifying documents listed in Section 2 on
  when claiming your PSS                                   the application form. The person certifying the
                                                           documents must attest that the documents are
  preserved benefit                                        true copies, and that you are the valid holder of the
                                                           identification.
   >> the attached benefit application form
                                                           We will store copies of identification electronically
   >> If you have chosen to receive all or part of your
                                                           in a secure environment and securely destroy the
      benefit as a pension and you wish to claim
                                                           paper copies. We will use all copies only for the
      the tax free threshold and/or any available
                                                           purpose of confirming your identity.
      offsets and deductions against your pension
      benefit, you should complete a Tax file              If you are providing copies of bills or statements,
      number declaration form, obtainable from the         you should black out any personal financial
      Australian Taxation Office (ATO), or designated      information or details of transactions in order to
      newsagents that distribute ATO forms.                protect your privacy.

Your Government Super at Work
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Section C – Employment                                  The claim date for payment of your preserved
                                                          benefit must be a date that occurs after you have
  details                                                 met both of the eligibility requirements set out
                                                          above. You must claim your benefit once you
  You must sign the Employment status declaration
                                                          reach age 65.
  in all cases. Note: There are penalties for making
  false declarations in respect of claims for benefits.   The date of claim cannot be earlier than the
                                                          date you complete this application and must be
  ‘Retiring from the workforce’                           a date NO LATER than 60 days after the date of
  Members who are ‘gainfully employed’ within             completing this application.
  the meaning of the Superannuation Industry              Section 5 is where you nominate the date from
  (Supervision) Act 1993 (SIS Act) for at least           which you would like to claim your PSS preserved
  10 hours per week, are taken as having remained         benefit on age grounds. Any pension benefit
  in the workforce.                                       commences with effect from the day after the
                                                          claim date.

  Section D – Information                                 What are your entitlements?
  acknowledgment                                          If the full value of your benefit remains preserved
                                                          in the PSS, you are entitled to claim your benefit as:
  Please complete this acknowledgment that
  you have received and understood sufficient             >> a fully indexed pension
  information to be able to make an informed choice       >> a pension and lump sum combination
  of how you would like your benefit paid and that
  you have been advised to read the PSS Product              or
  Disclosure Statement before completing                  >> a lump sum benefit.
  this form.
                                                          If you have previously elected for a refund of part
  You are making a formal election under the              of your PSS benefit, you are only entitled to receive
  provisions of the Superannuation Act 1990.              your preserved benefit as a lump sum amount.
  This election is binding and cannot normally
  be changed, although CSC may, at its absolute           Transfer amounts paid to the PSS
  discretion, agree to cancel an election in
  certain circumstances.                                  The treatment of your transfer value amount paid
                                                          into the PSS is dependent upon when it was paid.
  Information sources are shown at the start              A transfer amount paid after 31 December 1995 is
  of these explanatory notes and it is strongly           treated differently to an amount paid before that
  recommended that you make use of them before            date, unless it is related to:
  proceeding to complete this application form.
                                                          >> employment during a period of LWOP
  You should also note that, if your benefit has been        that commenced
  changed and you then change your mind about
  the benefit payment arrangements, a fee will be            or
  charged by us for the reissuing of the payment.         >> prior employment that ceased, before
                                                             1 January 1996.

  Section E – Eligibility                                 Transfer value amounts paid to the PSS before
                                                          1 January 1996
  requirements, claim date and                            Generally, your transfer amount will be treated as
  overview of entitlements                                part of your total benefit and will be paid exactly as
                                                          you have elected. For example:
  Eligibility
                                                          >> if you choose to receive your total benefit as a
  To be eligible to claim your PSS preserved benefit         pension (Option 1), any transfer amount(s) will
  you must have both:                                        also be paid as a pension
   >> attained 55 years of age                            >> if you choose a pension/lump sum
   >> retired from the workforce.                            combination (Option 2), we will pay your
                                                             transfer amount(s) in the same ratio of pension
  Claim date                                                 to lump sum as the rest of your benefit,
  You must provide a claim date when completing              or
  your benefit application form. If you do not
                                                          >> if you choose to receive your total benefit as a
  nominate a date the benefit application form
                                                             lump sum, any transfer amount(s) will also be
  will be returned to you.
                                                             paid as a lump sum.

Your Government Super at Work
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If you want to receive your transfer amount in any      It is therefore, strongly recommended that you
  other form or combination (i.e. the main benefit        read the PSS fact sheet Tax and your PSS benefits
  as a pension and transfer amount as a lump sum)         and/or consult a licensed financial adviser to assist
  you should contact us, before completing the            you in making a decision as to which arrangement
  application form attached to this leaflet, to obtain    suits your situation.
  an SR-Supplement.
                                                          If you have an outstanding surcharge debt, you
  The supplement contains additional elections for        will have to make an election on the repayment
  transfer amounts and should be completed and            option to apply. If deducted from your lump sum,
  attached to the main application form.                  the surcharge is deducted before tax is applied.
                                                          If deducted from the pension, there will be a
  Transfer value amounts paid to the PSS after            reduction in the amount of pension payable for
  31 December 1995                                        the life of the pension.
  Most transfer amount payments made to the PSS           Your benefits will be paid in accordance with your
  after 31 December 1995 are not included in the          instructions at Section 8. You should also complete a
  calculation of your final benefit accrual and remain    Tax file number declaration form (see Section I).
  identified as a separate lump sum, referred to as
  an Accumulated Transfer Amount. This amount             Option 3—lump sum only, no pension
  cannot be converted to pension. This amount can         If you want to take your entire benefit as a
  either be rolled over or taken in cash.                 lump sum, either in cash or as a rollover to another
  Unless you advise us otherwise, we will pay             fund or retirement savings account (RSA), select
  the transfer value to the bank account you              this option.
  have nominated for your pension or lump sum             Any outstanding surcharge debt will be deducted
  payment. If you have elected to rollover your           from the lump sum before it is paid.
  benefit, we will pay the transfer value to your
  rollover fund.                                          The benefit will be paid in accordance with your
                                                          instructions in Section H.

  Section F – Benefit options
                                                          Section G – Election for
  Option 1—pension only, no lump sum (only
  available if all of your benefit remains preserved in   reduced initial pension benefit
  the PSS)
                                                          in return for increased spouse
  If you want to receive your entire benefit as a
  pension, select this option.                            and/or children’s pension
  Any outstanding surcharge debt will be deducted         benefit
  from your pension entitlement through the               This section only applies to you if you are claiming
  application of pension reduction factors.               all or some of your benefit as a pension (ie Benefit
  The result will be a reduction in the amount of         Options 1 or 2).
  pension payable for the life of the pension.
                                                          The PSS Rules give contributing and preserved
  Your benefits will be paid into the bank account        benefit members a choice of rate for the
  nominated by you in Sections H.3 to H.7. You            reversionary pension payable on death.
  should also complete and forward a Tax file
  number declaration form (see Section I).                If you elect to take all or part of your benefit as a
                                                          pension then, should a spouse’s pension become
  Option 2—part pension and part lump sum                 payable, your spouse will be entitled to 67% of your
  (only available if all of your benefit remains          pension entitlement at date of death.
  preserved in the PSS)
                                                          You may, however, elect to receive a reduced
  If you want to receive your benefit as a                pension now in return for your spouse receiving
  combination of pension and lump sum,                    an increased pension should a spouse’s pension
  select this option.                                     become payable.
  This option allows you to convert at least 50% of       If you elect for the reduced pension, your pension
  your total PSS benefit to pension. The balance of       will be reduced to 93% of that payable had you not
  your PSS benefit is then paid as lump sum.              elected for this option. In return, an eligible spouse
  You can tell us which part of your benefit should       would be entitled to a pension of 85% of your
  be used up first when buying a pension. You can         reduced pension benefit.
  choose between the taxed or untaxed amounts.            Benefits to eligible children/orphans would also be
  If you do not tell us which to use, we will use the     increased under this option.
  untaxed amount first.
                                                          You need to complete this section to therefore
  This may not, however, be the best arrangement          advise us that you either:
  for your particular circumstances.

Your Government Super at Work
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a) do not wish to take a reduced pension of 93% of
     your initial pension entitlement
                                                         Section J – Taxation matters
                                                         J1 Start date for taxation purposes
    or
                                                         For taxation purposes, your lump sum benefit is
  b) elect to take a reduced pension of 93% of your
                                                         called a superannuation lump sum payment.
     initial pension entitlement.
                                                         The start date relates to the date your eligible
  You should ensure that you are fully aware of the
                                                         service period (ESP) commenced and is used
  future implications in relation to this choice. In
                                                         to calculate the various components of your
  particular, you should be aware that you cannot
                                                         superannuation lump sum payment for
  change your choice should your situation change
                                                         taxation purposes.
  in relation to your spouse and/or children after
  your election is made.                                 Generally, your ESP is the number of days
                                                         between the date you commenced your current
  If you need more information before making your
                                                         employment (which may be earlier than the date
  choice you can contact our Contact Centre for
                                                         you joined the CSS or PSS), and the date your
  further details.
                                                         payment is made. If you were formerly a CSS
                                                         member who commenced membership before
                                                         1 July 1983 and you have a long service leave start
  Section H – Benefit payment                            date that is earlier than your CSS start date, that
  arrangements                                           earlier start date applies as your ESP start date.
                                                         Earlier periods of employment for which you paid
  Lump sum payments                                      a transfer value into the CSS or PSS are added to
                                                         your ESP. If this is the case, please fill in the start
  H1 Lump sum cash payment                               date of that earlier period of service.
  We can only pay your lump sum into an Australian       If you do not show a date in this section, we will
  account held in your name. If it’s a joint account,    use the date on which you joined the PSS Scheme
  one of the names listed must be yours.                 as your start date (unless you transferred from the
  Taxation legislation states that once an amount        CSS Scheme, in which case your CSS start date will
  has been paid to you or deposited in your bank         be used).
  account, you cannot subsequently roll it over.         J2 Your tax file number (TFN)
  H2 Rollover fund nominations                           In accordance with the Taxation Laws Amendment
  You need to check that you can rollover your           (Tax File Numbers) Act 1988, we are required to
  benefit to a complying super fund, rollover fund,      deduct PAYG tax at the top marginal rate plus the
  RSA, or use it to purchase an annuity.                 Medicare levy from benefits if a person does not
                                                         provide a tax file number (TFN).
  You can nominate up to two rollover funds or RSAs
  to receive all or part of your lump sum benefit.       If you have not been issued a TFN you should
                                                         lodge a Tax file number application or enquiry
  We will make all rollover cheques payable to your      for an individual form with the Australian
  nominated rollover funds and unless you specify        Taxation Office (ATO). Forms are available at
  otherwise, we will send them directly to your          www.ato.gov.au or all ATO branches. You must
  nominated fund(s).                                     provide proof of identity at the time you lodge
                                                         the form.

                                                         J3 Approval to advise your TFN to
  Section I – Superannuation                             rollover funds
  contributions surcharge                                We will provide your TFN to the receiving fund
  You only need to fill in this section if you have an   unless you instruct us not to. Please note that there
  outstanding surcharge debt. Please refer to the        are consequences for not supplying your TFN
  Superannuation contributions surcharge fact sheet      to a fund.
  for more information.
                                                         J4 Tax file number declaration
                                                         If you have chosen to receive all or part of your
                                                         benefit as a pension (Section G, options 1 or 2)
                                                         and you wish to claim the tax free threshold
                                                         and/or available offsets and deductions against
                                                         your pension benefit, you should complete this
                                                         ATO declaration form and attach it to your
                                                         benefit application.

Your Government Super at Work
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Documents you may receive                                Privacy
  from us                                                  CSC and its Administrator, ComSuper are
                                                           collecting the information on this form for the
  After your benefit is paid you will receive some         following reasons:
  documents associated with your entitlements.
  Depending on which benefit you choose, these             >> to confirm your identity
  documents may include:
                                                           >> to assess your eligibility for payment of
   >> a benefit payment letter, advising you of your          the benefit
      benefit entitlement and when your payment
                                                           >> to pay your benefit
      will be made
                                                           >> to contact you
   >> a rollover benefits statement, in duplicate for
      each rollover nominated in Section H, which          CSC and ComSuper are committed to protecting
      shows the breakup, for taxation purposes of          any personal information we hold about you. Your
      each rollover you nominate                           information will not be used for any other purpose
                                                           or disclosed to another party unless:
   >> a PAYG payment summary, in duplicate, for
      any lump sum cash payment paid to you                >> you authorise us to do so
   >> a rollover payment cheque (or cheques), made         >> the disclosure is authorised by law. This may
      payable to your nominated rollover fund(s)              include disclosing your personal information
                                                              to other government agencies that have specific
     and
                                                              legislative authority to collect this information
   >> a pension payment summary and annual                    as required by policy and legislation. We will
      pension increase advice (which are sent to you          not disclose your personal information to these
      in July each year if you are receiving a pension).      agencies unless it is lawful to do so.
  Do NOT lose these documents. They may be
  required to complete tax returns, lodge rollovers,       Change of address
  or apply for Centrelink benefits, etc. It will take      If you receive a pension it is very important that
  some time to issue replacements.                         you advise us of any change in your postal address
                                                           or your bank account details. This will enable us
  Rollover requirements                                    to forward information to you each year regarding
                                                           your benefit.
  Rollover cheques are sent to you at the postal
  address you nominate on your benefit application         All enquiries: 1300 000 377
  form. It is your responsibility to lodge them
  with the rollover fund with a copy of the
  rollover benefits statement.
  Note: Do not send any rollover forms to us.

  What next?
  When you have completed your benefit
  application form, the completed form should
  be sent to us.
  Note: We cannot process the payment of your
  benefit until after the date you have nominated
  as the date from which your preserved benefit
  is to be paid. You may, however, submit your
  application form before this date. This will allow us
  to check that all documentation and information
  has been provided.
  Remember, the sooner we get your correctly
  completed application form, the less likelihood
  there is of any delay in the processing of
  your benefit.

Your Government Super at Work
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PBA
05/11         Preserved benefit
              Age claim form
              Hints for using this form
              >> read the explanatory notes and each section of the form carefully before filling it in
              >> use CAPITAL LETTERS and a black or blue pen
              >> sign your name where needed. If you don’t sign the relevant sections of the form, it will be returned to you.

SECTION A Personal details
              Reference number (AGS)
                                                          D     D          M    M           Y    Y     Y    Y
              Cessation date
                                                                      /               /

              Salutation                                      Mr                  Mrs                 Ms                  Miss                Other
                                                         GIVEN NAME(S)
              Your name

                                                         SURNAME

                                                          D     D          M    M           Y    Y     Y    Y
              Date of birth
                                                                      /               /

              Previous memberships                       1
              Have you had any other
              periods of PSS membership?                 2
              If so, please list the reference
              (AGS) number(s) for each of                3
              those memberships.
                                                         4
                                                         RESIDENTIAL ADDRESS
              Address

                                                         SUBURB                                                                            STATE                 POST CODE

                                                         POSTAL ADDRESS

                                                         SUBURB                                                                            STATE                 POST CODE

                                                                                                                                 Section A continued on next page

          Your Government Super at Work
          Any financial product advice in this document is general advice only and has been prepared without taking account of your personal objectives, financial situation or needs.
          Before acting on any such general advice, you should consider the appropriateness of the advice, having regard to your own objectives, financial situation or needs. You may wish
          to consult a licensed financial advisor. You should obtain a copy of the PSS Product Disclosure Statement and consider its contents before making any decision regarding your super.
          Commonwealth Superannuation Corporation (CSC) ABN: 48 882 817 243 AFSL: 238069
          RSEL: L0001397 Trustee of the Public Sector Superannuation Scheme (PSS) ABN: 74 172 177 893 RSE: R1004595

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BUSINESS HOURS
  Phone number

                           AFTER HOURS

                           MOBILE NUMBER

  Email address

                           @
  Relationship                  Married        Single          De facto
                           GIVEN NAME(S)
  Spouse’s name

                           SURNAME

                            D   D          M   M       Y   Y   Y   Y
  Spouse’s date of birth
                                     /             /
                            D   D          M   M       Y   Y   Y   Y
  Start date of
  de facto relationship              /             /
  (if applicable)

                                               Please go to Section B Identification requirements on next page

Your Government Super at Work
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SECTION B     Identification requirements
              To protect against fraud, money laundering,                   For example, you could supply a copy of your birth
              terrorism financing and safeguard your benefit,               certificate (from column A) and copies of your
              we need you to supply documentation to prove                  Medicare card, a phone bill and an electricity bill
              your identity. Under some circumstances we may                (from column B).
              request further information from you.
              You will need to supply certified copies of one                 If you are supplying copies of bills or
              document from column A in the table below AND                   statements, you should black out any personal
              certified copies of three documents from column B.              financial information or details of transactions
                                                                              in order to to protect your privacy. We will
                                                                              store copies of identification electronically in
                            A                              B
                                                                              a secure environment and securely destroy the
               Passport (current or           Medicare card                   paper copies. We will use all copies only for the
               expired by less than                                           purpose of confirming your identity.
               two years)
               Birth certificate or           A current statement from
               extract, issued by an          a financial institution       Certification must appear on the front of the
               Australian or foreign          with the same address         documents. All copies of documents supplied
               government (either in          and name as on the            must be certified as true and correct copies of the
               English or accompanied         application and not more      original by one of the following:
               by an English translation      than three months old.
               prepared by an accredited      This statement must be        >> a legal practitioner enrolled on the roll of a
               translator)                    the account that you are         supreme court or the high court of Australia
                                              requesting payment into       >> a judge or magistrate of a court
               Birth card issued by a state   Copy of an electricity bill   >> a chief executive officer of a Commonwealth court
               registry of births, deaths     with the same address         >> a registrar or deputy registrar of a court
               and marriages                  and name as on the
                                              application                   >> a Justice of the Peace (JP)
               Australian citizenship         Copy of a telephone bill
                                                                            >> a notary public
               certificate                    with the same address         >> a police officer
                                              and name as on the            >> an agent or a permanent employee of the
                                              application                      Australian Postal Corporation with two or
               Current drivers licence        Copy of a gas bill with          more years of continuous service in an office
               or permit issued by            same address and name as         supplying postal services to the public
               state or territory or          on the application
                                                                            >> an Australian consular officer or an Australian
               foreign government
                                                                               diplomatic officer
               Current identification         Copy of a rates bill with     >> a finance company officer with two or more
               card issued to a public        same address and name as
                                                                               years of continuous service with one or more
               sector employee                on the application
                                                                               finance companies
               An identification card         Valid credit card
                                                                            >> a person employed by, or an authorised
               issued to a student at
               a tertiary education                                            representative, of the holder of an Australian
               institution                                                     financial services licence with two or more
                                                                               continuous years of service
               Pension or other social        A document from column
               security benefit card          A not yet provided            >> a member of the Institute of Chartered
                                                                               Accountants of Australia (ICA), Certified
               Proof of age card issued by    Copy of a tax return
                                                                               Practicing Accountants (CPA Australia)
               a state or territory,          letter from the Australian
               containing your                Taxation Office with the
                                                                               or National Institute of Chartered
               photograph                     same address and name as         Accountants (NIA ) with two or more years of
                                              on the application               continuous membership.
               A national identity            A letter from Centrelink      For a full list of certifying authorities, visit the
               card, containing your          or Department of              Comlaw website at www.comlaw.gov.au.
               photograph, issued by a        Veterans’ Affairs with the
               foreign government (either     same address and name as      The certifying authority also must confirm
               in English or accompanied      on the application            in writing that you are the valid holder of the
               by an English translation                                    identification that you are presenting and that any
               prepared by an accredited                                    copies are true copies of the original.
               translator)
               Citizenship certificate                                        The certification must include the name, address,
               issued by a foreign country                                    occupation, phone number and registration
               (either in English or
                                                                              number (if applicable) of the certifying authority.
               accompanied by an English
               translation prepared by an
               accredited translator)

            Your Government Super at Work
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SECTION C Employment status declaration
                                               I have ‘retired from the workforce’ (See definition in Section C of the
                                               Explanatory notes).
                                           SIGNATURE
              Signature and date                                                           Date signed
                                                                                            D   D       M   M       Y   Y   Y   Y

                                                                                                    /           /

SECTION D Information acknowledgement
              (Benefit processing may be delayed if this acknowledgment is NOT completed)
              I have been given enough information to make an informed decision about how I would like my
              benefit to be paid.
              I also understand that, by choosing a benefit option in Section F, I am making a formal election under
              the provisions of the PSS legislation and this benefit election cannot be changed except in certain
              circumstances approved by CSC.
                                           SIGNATURE
              Signature and date                                                           Date signed
                                                                                            D   D       M   M       Y   Y   Y   Y

                                                                                                    /           /

              I declare that the information I have provided is true and correct to the best of my knowledge. I acknowledge
              that it may be a criminal offence to knowingly provide false or misleading information or documents.

              If you need more information, or would like to talk about the options you have, please call an
              Information Officer on 1300 000 377, facsimile (02) 6272 9613, or email members@pss.gov.au.
              You should also note that, if after your benefit has been paid, you wish to change your mind about the
              payment arrangements, a fee will be charged by us to re-issue the payment.

SECTION E     Claim date
                                          FULL NAME
              I,

              whose reference
              number (AGS) is
                                          hereby give written notice to CSC
                                           D    D       M     M       Y   Y   Y   Y
              that I wish to claim my
              preserved benefit on                  /             /
                                          INSERT CLAIM DATE

              I understand the preserved benefi t will become payable on the day after the claim date.
                                           SIGNATURE
              Signature and date                                                           Date signed
                                                                                            D   D       M   M       Y   Y   Y   Y

                                                                                                    /           /

            Your Government Super at Work
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SECTION F       Benefit options
                Please ensure that only ONE benefit option is completed

   Option 1     Pension only, no lump sum
                                           FULL NAME
                I,

                whose reference
                number (AGS) is

                elect to take my entire benefit as a pension.
                                           SIGNATURE
                Signature and date                                                        Date signed
                                                                                           D   D       M   M       Y   Y   Y   Y

                                                                                                   /           /

                You have now completed this section. You must now go to Bank account details to tell us where you
                would like your pension benefit paid.

   Option 2     Part pension and part lump sum
                                           FULL NAME
                I,

                whose reference
                number (AGS) is

                elect to to take part of my preserved benefit as a pension and part as a lump sum.
                                                I wish to convert

                                                       %
                                           of my preserved benefit (cannot be less than 50% of the total preserved benefit)
                                           to an preserved pension, with the balance of my benefi t to be paid to me as a
                                           lump sum.
                                                I wish to be paid a lump sum benefit of

                                            $
                                           GROSS

                                           (cannot be more than 50% of the total benefit), with the balance to be paid to
                                           me as a pension.
                                           SIGNATURE
                Signature and date                                                        Date signed
                                                                                           D   D       M   M       Y   Y   Y   Y

                                                                                                   /           /

                You have now completed this section. You must now go to Section G, to tell us how you would like
                your lump sum benefit paid.

   Option 3     Lump sum only, no pension
                                           FULL NAME
                I,

                whose reference
                number (AGS) is

                elect to take my entire benefit as a lump sum.

                                                                                          Section F continued on next page

              Your Government Super at Work
                                                                                                                                   11 of 14
SIGNATURE
              Signature and date                                                        Date signed
                                                                                         D   D       M    M       Y   Y   Y   Y

                                                                                                 /            /

              You have now completed this section. You must now go to Section H, to tell us how you would like
              your lump sum benefit paid.

SECTION G Election for reduced initial pension benefit in return
          for increased spouse’s and or children’s pension benefit
              Only complete this section if you have chosen Benefit Options 1 or 2.
              I have read the information contained in Section G of the Explanatory notes, and

                   advise that I do not wish to take a reduced pension of 93% of my initial pension entitlement
              OR

                   elect to take a reduced pension of 93% of my initial pension entitlement
                                          SIGNATURE
              Signature and date                                                        Date signed
                                                                                         D   D       M    M       Y   Y   Y   Y

                                                                                                 /            /

              You have now completed this section. You must now go to Section H to tell us how you would like your
              benefit to be paid.

SECTION H Benefit payment arrangements
              Lump sum payments
         H1   Complete this to tell us how much of your lump sum you would like as a cash payment
              Lump sum cash payment, comprising: (See also Section H3 for bank account details)

              Either: A gross             $
              dollar amount:
              Or                                      %
              A percentage of
              my lump sum:
              Or
              My non-concessional
              contributions
              Or                              (This will be the balance of your preserved benefit after
              The benefit balance             you elect to have any part rollover)
              after any rollovers

              Rollover details
         H2   Rollover fund or retirement savings account (RSA) nominated to receive all or part of your lump sum

                                              my entire lump sum benefit

                                   OR         only part of my lump sum benefit (please choose one):
                                                       a gross dollar amount of
                                                        $
                                              OR       a percentage of lump sum
                                                                  %
                                   OR         balance after lump sum cash payment

                                                                                         Section H continued on next page

           Your Government Super at Work
                                                                                                                                  12 of 14
Rollover fund or RSA nominated to receive all or part of your lump sum
     Name of fund or RSA

                              AUSTRALIAN BUSINESS NUMBER
     ABN of fund or RSA

     Membership number
     for fund or RSA
                              OR

     SPIN of fund or RSA
                              SPIN = superannuation product identification number

     Postal address of fund

                              SUBURB                                                             STATE               POST CODE

     Bank account details
H3   Please provide the account details for the payment of any cash lump sum and/or pension.

     Type of financial             Savings bank              Building                  Trading bank                  Credit union
     institution                                             society

     Name of institution

     Name of account
     holder

     Branch location

     Branch (BSB) number                    -

     Account number
                              Note: Unless you specify in writing, your taxed components will be released first.
                              If the BSB number or account number you have provided is incorrect, the payment will not be
                              accepted by your financial institution. If you have any doubts what your correct BSB number or
                              account number is, you should confirm these details with your financial institution before including
                              them in this form.

                              The information I have supplied is true and correct.

                              SIGNATURE
     Signature                                                                         Date signed
                                                                                        D    D           M   M        Y   Y   Y   Y

                                                                                                  /              /

                                                                                         Section I continued on next page

 Your Government Super at Work
                                                                                                                                      13 of 14
SECTION I   Superannuation contributions surcharge
            I would like my outstanding superannuation contributions surcharge debt deducted from either:
                                                 my pension
                                                 OR
                                                 my lump sum.

SECTION J   Taxation matters
            What is your
            tax file number?
            ComSuper, acting on behalf of CSC, is authorised to collect your tax file number (TFN) under the
            provisions of the Superannuation Industry (Supervision) Act 1993. The legal uses of your TFN are
            summarised in Section I of the Explanatory notes.
            Important Note: If you have already provided your TFN to us you are under no obligation to provide it again when making an
            application for benefits. However, if your TFN is NOT recorded by us, payment of your benefits may be delayed.

            Can we give your                     Yes
            TFN to the rollover
                                                 No
            fund(s) / RSA(s)
            nominated above?
            Tax file number declaration
            Pension recipients should also obtain and complete a Tax file number declaration form (obtainable
            from the ATO) in order to claim any available tax rebates and deductions. Attach the completed
            declaration to this application form.

SECTION K Checklist
            Have you:
               >> read all the Explanatory notes, received a benefit estimate and any other information
                  you require ?
               >> made an informed choice?
               >> filled in all the sections applicable to you?
               >> signed the Information acknowledgment at Section D?
               >> signed an election option in Section F?
               >> completed any rollover details in Section G?
               >> completed the bank account details in Section G?
               >> provided your TFN in Section H?
               >> attached your completed Tax file number declaration form (for pension recipients only)?
               >> attached certified copies of documents requested in Section B to prove your identity?

            You have now completed this form
            Please return it, with any attachments to:
                      PSS
                      GPO Box 2252
                      Canberra City ACT 2601

                                                           END FORM

              email                            phone                            tty                              post

              members@pss.gov.au               1300 000 377                     (02) 6272 9827                   PSS
                                                                                                                 GPO Box 2252
              web                              overseas callers                 fax
                                                                                                                 Canberra City ACT 2601
              www.pss.gov.au                   +61 2 6272 9622                  (02) 6272 9613
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