ANZ SMART CHOICE SUPERWITHDRAWAL FORM

February 2024
Customer Services
Phone 13 12 87 (International +61 2 8366 1500)
Email smartchoice@insigniafinancial.com.au
Website anz.com.au/smartchoicesuperThis form is to be used for rollovers and lump sum cash withdrawals by existing members in ANZ Smart Choice Super.
INSTRUCTIONS
Please read the ‘Important Information’ section before you complete this form.
Complete and sign the form and return via either:
Option 1: Email* the completed form to smartchoice@insigniafinancial.com.au*Please note:• emails can only be accepted from the email address currently held on our records• emailed forms cannot be accepted if you are sending original certified copies of your ID documents
or
Option 2: Mail the completed form with original certified copies of your ID documents to
ANZ Smart Choice SuperGPO Box 5107
Sydney NSW 2001
1. MEMBER DETAILSMember number
Title

Mr

Mrs

Ms

Miss

Dr

Other

Last name
Given name(s) (including middle name)Date of birth

D

D

M

M

Y

Y

Y

Y



Tax file number (TFN)** Please refer to section 8 for further details on the collection of TFNs.

Residential address (this cannot be a PO Box)
Suburb/Town

State

PostcodeState

PostcodeCountry
Postal address (if different from above)
Suburb/Town
Country
Business phone

Mobile phone

Email
Primary citizenship

Secondary citizenship (Complete if you have dual citizenship)

Occupation (If you have fully retired from the workforce please write “Retired”)
If my withdrawal request requires any further queries, please contact me by:

Phone  

Email  Post

If you do not tick any box we will contact you by phone.

Retirement Portfolio Service (Fund) ABN 61 808 189 263 RSE R1000986
OnePath Custodians Pty Limited (OnePath Custodians) ABN 12 008 508 496 AFSL 238346 RSE L0000673
The Australia and New Zealand Banking Group Limited (ANZ) (ABN 11 005 357 522) brand is a trademark of ANZ and is used by OPC under licence from ANZ.
ANZ and the Insignia Financial Group of companies (including OPC) are not related bodies corporate. ANZ does not stand behind or guarantee these products.

Page 1

ANZ SMART CHOICE SUPERWITHDRAWAL FORM
2. TAX QUESTIONNAIRE
Do you intend to claim a tax deduction on personal contributions made during the financial year?
Yes – Complete the Notice of Intent to Claim a Tax Deduction Form attached to this form.
No – Please proceed to section 3.
Note: Where a partial withdrawal or rollover is made, a tax deduction for personal contributions may only be allowed on a proportional basis.
Generally, this affects personal contributions which are claimed as a tax deduction after a partial withdrawal or rollover has been made.
3. TYPE OF WITHDRAWAL REQUESTED
Please tick one of the following: I would like to rollover to another institution – please complete sections 5, 6b and 9.
 I would like to request a lump sum cash payment from my super account – please complete sections 4, 5, 6a and 9.
4. ELIGIBILITY TO WITHDRAW A LUMP SUM CASH PAYMENT
a. Residency
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 part b.
No – have you ever been a temporary Australian resident?
Yes – please refer to the ‘Important Information’ page and complete part b where applicable.
No – please continue to part b.
b. Conditions of withdrawal
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.
Please note: if you selected one of the above options and you have previously provided your proof of identity and your nominated bank account,
you may be able to arrange a cash payment over the phone and you may not need to complete this form. Please call Customer Services on 13 12 87.
orOther* – Please refer to the ‘Eligibility to withdraw a lump sum cash payment’ section on the ‘Important information’ page before completing
this section.
Compassionate groundTerminal medical condition

Departed temporary resident

Balances less than $200

Permanent incapacity* Do not use this form for withdrawals relating to death claims, Severe financial hardship or matters pertaining to the Family Law Act 1975. Please phone Customer Services on 13 12 87
for claim requirements.

Page 2

ANZ SMART CHOICE SUPERWITHDRAWAL FORM
5. 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.
I understand that a full withdrawal will close my account.
Note: If you choose to close your account before any insurance benefits are paid, you should be aware that any insurance will cease when theaccount is closed and you may no longer be entitled to an insurance benefit payment. If you wish to retain your insurance, you may choose to makea partial withdrawal so that sufficient funds are retained within your account to pay future insurance fees and other charges.
Please proceed to section 6 – ‘Payment instructions’.
b. Partial withdrawal only
Note: Your withdrawal will be made from your investments in the same proportion as your future contributions. The lesser of 15% of your accountbalance or $6,000 is required to keep the account open.
I would like to make a partial withdrawal of $Please indicate below whether this amount is to be net or gross: 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.
6. PAYMENT INSTRUCTIONS
a. Lump sum payment
Payments cannot be made to third-party bank accounts (you can only nominate an account which is held in your name, either solely or jointly).
It may take up to five days for funds to clear, depending on your financial institution.
Are you requesting payment to an Australian bank account:
Yes – Please complete the section below.
No – Please complete the International Funds Transfer Global Payment on page 12. Please note that we cannot send cheques overseas.
Name of financial institution
BranchBank account holder name(s)BSB number   Bank account number

b. Rollover
Name of receiving rollover institution
Australian Business Number (ABN)
Unique Superannuation Identifier (non-SMSF)
Account/Reference no.
Address of receiving rollover institution
Suburb/Town

State

Postcode

Contact no. of receiving rollover institution
Note: If your withdrawal is related to a Trans Tasman rollover, please complete the applicable Trans Tasman Application form for Whole Balance Transfers
available by clicking on “Find a Form” at anz.com.au/smartchoicesuper
For SMSFs only
Please transfer my benefit to the following fund (Receiving fund details):
Bank account name
BSB number
Fund ABN   Bank account number   Electronic Service Address (ESA)

If transferring to a Self Managed Super Fund (SMSF), OnePath Custodians must verify your SMSF as complying and that you are a member of the fund.
This is done through the SMSF Verification Service (SVS). If it is found that your information is incomplete you will be advised to contact the ATO.
Note: If you are rolling over to a Self Managed Super Fund (SMSF), the payment will be made via direct credit to an SMSF bank account. Please provide
a copy of your SMSF bank statement (must be an account held in the name of the SMSF) or Welcome Letter. We may request for further information/evidence about the SMSF bank account to confirm the payment destination.

Page 3

ANZ SMART CHOICE SUPERWITHDRAWAL FORM
7. PROOF OF IDENTITY
This step is only required if you have not previously supplied your proof of identity.
Please complete option 1 OR option 2 below as proof of identity for superannuation entitlements.
Option 1: Electronic verification
Please provide details for any TWO of the following forms of identification:
Driver licence
Full name (as it appears on your driver licence)
Last name
Given name(s) (including middle name)
Address (as it appears on your licence)
Suburb/Town

State

Licence number
Expiry dateD

Postcode

Card number*
D

M

M

Y

Y

Y

State of issue

Y* Card number is a series of numbers/letters and is separate to your driver licence number. You’ll find your card number on the front or back of your card (depending on your state).

Medicare card
Full name (as it appears on your Medicare card)
Last name
Given name(s) (including middle name)Card colour (please tick)Green  

Blue  

Yellow    Individual reference number (the number to the left of your name)

Medicare card number
Expiry date

D

D

M

M

Y

Y

Y

Y

Australian passport
Full name (as it appears on your passport)
Last name
Given name(s) (including middle name)
Passport number
Australian visa (foreign passport holders)
Full name (as it appears on your passport)
Last name
Given name(s) (including middle name)
Passport number

Country of issue

By providing my proof of identity details above, I consent to its use to electronically verify my identity. I understand that my personal information
will be shared with a secure external service provider in order to match my information with identification data sources. If my details do not match therecords held by the Illion Credit Reporting Agency I will be notified in writing by either the Product Issuer* or VixVerify on behalf of the Product Issuer.
VixVerify is product owner of GreenID, the Product Issuer’s electronic verification system.
Option 2 – Certified copies of identification
Please provide original certified copies of identification. Each page must be certified as a true copy. Please refer to ‘Important Information’ on pages 7–9.
 I authorise the use of my personal details for the purpose of electronically verifying my identity where possible if the paper copies of my certified
documents are incorrectly certified or unable to be read, or if I have submitted scanned copies of my certified documents via email. I understandthat my personal information will be shared with a secured external service provide in order to match my information with identification data sources.
If my details do not match the records held by the Illion Credit Reporting Agency I will be notified in writing by either the Product Issuer or VixVerify onbehalf of the Product Issuer VixVerify is product owner of GreenID, the Product Issuer’s electronic verification system.
* Product issued by OnePath Custodians Pty Limited

Page 4

ANZ SMART CHOICE SUPERWITHDRAWAL FORM
8. TAX FILE NUMBER (TFN) NOTIFICATION
Information you should know about providing yourtax file number

Otherwise your TFN will be treated as confidential. You are notrequired to provide your TFN. Declining to quote your TFN is not
an offence.

You or your employer may already have provided your Tax File
Number (TFN) to the Fund, if not, we are required to tell you thefollowing details before you provide your TFN.

However, if you do not give OnePath Custodians or the third party
administrator, your TFN, either now or later:Your TFN is confidential, and you should know the following before
you decide to provide it to OnePath Custodians or a third party
engaged by either OnePath Custodians or a related party of OnePath
Custodians to provide superannuation administration services(“third party administrator”) relating to this product:• Additional taxes will apply to concessional contributions(including compulsory employer contributions).

• OnePath Custodians and the third party administrator are
authorised to collect your TFN under the Taxation andSuperannuation Laws.

• It may be difficult to locate or amalgamate your superannuation
benefits in the future.

• If you do provide your TFN to OnePath Custodians or the third party
administrator, they will only use it for legal purposes. This includes
finding or identifying your superannuation benefits where otherinformation is insufficient, calculating tax on any superannuation
benefit payments you may be entitled to.

• They may not be able to accept personal contributions.

• You may pay more tax on your superannuation benefits when you
withdraw them than you have to (you may get this back at the endof the financial year in your income tax assessment).

The purposes for which OnePath Custodians or the third party
administrator can use your TFN and the consequences of notproviding it to them may change in the future as a result ofchanges to the law.

• If you do provide your TFN to OnePath Custodians or the third
party administrator, they may provide it to the trustee of anothersuperannuation fund or a Retirement Savings Account (RSA)
provider where the trustee or RSA provider is to receive yourtransferred benefits in the future.
• OnePath Custodians and the third party administrator will not passyour TFN to any other superannuation fund if you tell OnePath
Custodians or the third party administrator in writing that you do
not want them to pass it on.
• OnePath Custodians or the third party administrator may
quote your TFN to the Australian Taxation Office (ATO) whenreporting details of contributions for the purpose of lost member
reporting, monitoring contributions caps and administrationof the government co‑contribution and low income
superannuation contribution.

Page 5ANZ SMART CHOICE SUPERWITHDRAWAL FORM
9. DECLARATION AND SIGNATURE
Your withdrawal request will be processed as quickly as possible.
Your final account balance cannot be calculated until the day payment
is actually made. The amount that will be paid to you depends on thecurrent value of your account, investment earnings or losses and any
taxes and fees that may apply to your account.

• I accept that where my employer (or former employer) has
appointed a financial adviser for this plan, my personal information
will be provided to the financial adviser in order to undertake themanagement and administration of the plan.
• I authorise my financial adviser (where I have nominated a 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
Custodians of the change.

The balance of your account will remain invested in the investment
fund(s) you chose or in the default investment fund that applies toyour fund until your account is paid to you or you ask us to change theinvestment fund.

• I declare that I am not bankrupt or insolvent under administrationand that the information provided by me in this form is true andcorrect. I request the Trustee, OnePath Custodians Pty Limited(ABN 12 008 508 496, AFSL 238346, RSE L0000673) (OnePath
Custodians) to act upon and give effect to the directions
given by me in this notice.

If you have any concerns you should discuss these with yourfinancial adviser.
By completing this form:• I authorise the collection, use and disclosure of my personal
information (including health and other sensitive information)
for the purpose of the management and administration of those
OnePath Custodians products and services in which I have invested
or for which I wish to apply as outlined in the Privacy statementin the Additional Information Guide relevant to my ANZ Smart
Choice Super account, in ANZ’s Privacy Policy which is available atanz.com.au/privacy and OnePath Custodians’ Privacy Policy available
at onepath.com.au/superandinvestments/privacy-policy. I understandthat unless I consent to the collection, use and disclosure identified in
the Privacy statement, OnePath Custodians will not be able to process
my application or to deliver the relevant products or services.

• I acknowledge that should I, or my estate, receive a payment from
OnePath Custodians in full satisfaction of my benefits under theFund (including any relevant insurance benefits to which I havebecome entitled), OnePath Custodians will have fully discharged
their obligations under the Trust Deed governing the Fund,and thatany payment made to or in respect of me shall be net of any lumpsum tax paid, as required by law, to the Australian Taxation Office.
• If I provide my TFN, I have read and acknowledged the TFN
information in section 7.
• I acknowledge that during abnormal or extreme markets somenormally liquid assets may become illiquid, restricting OnePath
Custodians’ ability to sell them at short notice and to makewithdrawal payments without delays or loss in value.

• I consent to ANZ, OnePath Custodians and their related companies
using my personal information (including health and other sensitive
information) to send me information about their products orservices from time to time. I also consent to OnePath Custodians
disclosing my personal information (including health and othersensitive information) to organisations, including those in an
arrangement or alliance with OnePath Custodians or its relatedcompanies, to share information for marketing purposes and toenable those alliance partners to send me information about theirproducts and services. If I do not want OnePath Custodians, its
related companies or alliance partners using and disclosing myinformation for this purpose, I understand and agree that I mustphone 13 12 87 to withdraw my consent.

• I declare that I am aware I may ask my superannuation provider for
information about any fees or charges that may apply, or any otherinformation about the effect this transfer may have on my benefits,
and do not require any further information.
• If requesting a full withdrawal, I understand that my ANZ Smart
Choice Super account will be closed once the withdrawal has beenprocessed. I have considered where my future contributions will
be directed, if I will lose any benefits, in particular insurance cover,incur any investment costs, or will be changing my investment risk,
and whether I am eligible to obtain adequate insurance elsewhere.

Name of member
Signature of member*
Date

D

D

M

M

2

0

Y

Y

* If you have provided a signature bearing identification document to us in conjunction with this request, the signatures on the signature bearing ID document and on this request need tomatch. If they do not match please provide a signed statutory declaration explaining the difference in the signatures.

Page 6

IMPORTANT INFORMATIONANZ SMART CHOICE SUPER WITHDRAWALS
February 2024
ELIGIBILITY TO WITHDRAW A LUMP SUM CASH PAYMENT
If you are requesting a withdrawal for any of the reasons listed in this section, please note the requirements before proceeding with your request.
Temporary Australian residents
If you are a temporary resident or have at any stage have been a temporary resident and are not a permanent resident of Australia or a citizen ofAustralia or New Zealand and not a holder of a Subclass 405 or 410 visa, you are only able to withdraw your preserved superannuation benefits
under limited conditions of release, including: death, terminal medical condition, permanent incapacity, temporary incapacity, unclaimed money
payment, and Departing Australian Superannuation Payment. Exceptions apply to individuals who have satisfied a condition of release prior to
1 April 2009. Please speak to your financial planner for more information.
Severe financial hardship
You are required to complete and submit an ‘Application for Early Release of Benefits due to Severe Financial Hardship’ form. Please phone Customer
Services on 13 12 87 to obtain a form. Please do not complete this Withdrawal form if claiming under Severe financial hardship.
Compassionate groundYou must apply to the Australian Tax Office (ATO). Please phone the ATO on 13 10 20 for application requirements. If your application is approved,
please complete this withdrawal form.
Departed temporary resident
You must apply for a Departing Australia Superannuation Payment (DASP) from the Australian Taxation Office (ATO). Please phone Customer Services
or visit the ATO website at ato.gov.au/super or phone the ATO Superannuation Infoline on 13 10 20 for more information. Please note that we cannot
send cheques overseas.
Permanent incapacity
Please phone Customer Services on 13 12 87 for claim requirements.
Death
Please phone Customer Services on 13 12 87 for claim requirements.
Terminal medical condition
Please phone Customer Services on 13 12 87 for claim requirements.
Balance less than $200
You may be able to access your super if your balance is less than $200 and:• Your account was considered “Lost super”; or• Your account was opened by your employer and your employment has since been terminated (not applicable for members of ANZ Smart Choice
Super and Pension).

Page 7

IMPORTANT INFORMATIONANZ SMART CHOICE SUPER WITHDRAWALSCOMPLETING PROOF OF IDENTITY
The Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (AML/CTF Act) requires us to verify your identity before we make a paymentof your super.
To verify your identity please send in original certified copies (not original documents) of the following:
A certified copy of an original primary photographic document
OR
A certified copy of an original primary non-photographic document; AND a certified copy of an original secondary identification document
For more information about certified copies of documents, please refer to page 9.
List of acceptable documents
Primary photographic identification type
• Current Australian Passport• Expired Australian passport which has not been cancelled andwas current within the preceding two years• Current Australian driver’s licence• Proof of Age card issued by the Australian Government• Current Foreign passport issued by a foreign government or theUnited Nations*• A national identity card issued by a foreign government or theUnited Nations*• Australian Firearms/shooting licencePrimary non-photographic identification document type

Have you changed your name or are you signing on behalfof another person?
If you have changed your name or are signing on behalf of theapplicant, you will need to provide a certified linking document.
A linking document is a document that proves a relationship exists
between two (or more) names.
The following table contains information about suitable linking
documents:
PurposeSuitable linking documents

Change of name

Marriage certificate, deed poll or changeof name certificate from the Births,
Deaths and Marriages Registration OfficeSigned on behalfof the applicant

Guardianship papers or Powerof Attorney• Australian Visa
• A government issued concession card, such as a pensioner
concession card, a health care card, or a senior’s health care card
• Birth certificate or birth extract by an Australian state or Territory
government• Birth certificate issued by a foreign government, the UN or an
agency of the UN*• Citizenship certificate issued by the Commonwealth• Citizenship certificate issued by a foreign government*
Secondary identification document types• A Medicare card
• A municipal council rates notice or a utility bill (such as a water,
gas or electricity bill) that contains the person’s name andresidential address, issued in the past three months• Current Overseas driver’s license containing a photograph ofthe person*• Bank Statement issued in the past three months• Credit card
• Australian Government issued competency card
• Australian Government issued companion card
• Student ID card
• Aviation Security Identification card
• Maritime Security Identification card
• Australian Tax Office Assessment issued in the last twelve months• Rental agreement issued in the last three months• Professional or Trade Association card
* Please note: if a foreign document is written in a language other than English, pleaseattach a certified copy of the translation prepared by an accredited translator, either
an overseas Australian Embassy or Consulate or an approved translator listed in the
National Accreditation Authority for Translators and Interpreters (NAATI) – only available
within Australia.

Page 8

IMPORTANT INFORMATIONANZ SMART CHOICE SUPER WITHDRAWALS
CERTIFIED COPIES FOR AML KNOW YOUR CUSTOMER PURPOSES UNDER THE ANTI-MONEY LAUNDERINGAND COUNTER-TERRORISM FINANCING RULES
Certification of personal documents
All copied papers 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). In all cases, thecertification must not have taken place more than 12 months prior towhen the identification and verification procedure is being undertaken.
The person who is authorised to certify documents must sight theoriginal and the copy and make sure both documents are identical,
then make sure all pages have been certified as true copies by writingor stamping ‘certified true copy’ followed by their signature, printed
name, qualification (for example, Justice of the Peace or Bailiff ) theircontact details and date. If the document has more than one page,please ensure that the certification identifies the number of pages(for example, ‘I certify this document of [x] pages to be a true copyof the original’).
A certified copy means a document that has been certified as a true
copy of an original document by one of the following persons:Occupations• Chiropractor• Dentist• A legal practitioner, who is enrolled on the roll of the Supreme
Court of a State or Territory or the High Court of Australia• Medical practitioner• Nurse• Optometrist• Patent attorney• Pharmacist• Physiotherapist• Psychologist• Trade marks attorney• Veterinary surgeon
Other persons• Agent of the Australian Postal Corporation who is in chargeof an office supplying postal services to the public• *Australian Consular Officer or Australian Diplomatic Officer(within the meaning of the Consular Fees Act 1955)• Bailiff• Bank officer with two or more continuous years of service• Building society officer with two or more years of continuous
service• Chief executive officer of a Commonwealth court• Clerk of a court• Commissioner for Affidavits• Commissioner for Declarations• Credit union officer with two or more years of continuous service• *Employee of the Australian Trade Commission who is:a. in a country or place outside Australia
b. authorised under paragraph 3(d) of the Consular Fees Act 1955
c. exercising his or her function in that place• *Employee of the Commonwealth who is:a. in a country or place outside Australia
b. authorised under paragraph 3(c) of the Consular Fees Act 1955
c. exercising his or her function in that place• Fellow of the National Tax Accountants’ Association• Finance company officer with two or more years ofcontinuous service• Holder of a statutory office not specified in another item in this list
• Judge of a court• Justice of the Peace• Magistrate• Marriage celebrant registered under Subdivision C of Division
1 of Part IV of the Marriage Act 1961
• Master of a court• Member of Chartered Secretaries Australia• Member of Engineers Australia, other than at the grade of student• Member of the Association of Taxation and Management Accountants• Member of the Australian Defence Force who is:a. an officer
b. a non-commissioned officer within the meaning of the Defence
Force Discipline Act 1982 with two or more years of continuous service
c. a warrant officer within the meaning of that Act• Member of the Institute of Chartered Accountants in Australia,
the Australian Society of Certified Practising Accountants or the
National Institute of Accountants• Member of:a. the Parliament of the Commonwealthb. the Parliament of a Statec. a Territory legislatured. a local government authority of a State or Territory• Minister of religion registered under Subdivision A of Division
1 of Part IV of the Marriage Act 1961
• *Notary Public within Australia or a person authorised as Notary
Public in a foreign country• *An officer with, or authorised representative of, a holder of anAustralian financial services licence, having two or more years ofcontinuous service with one or more licences• Permanent employee of the Australian Postal Corporation with two
or more years of continuous service who is employed in an officesupplying postal services to the public• Permanent employee of:a. the Commonwealth or a Commonwealth authority
b. a State or Territory or a State or Territory authority
c. a local government authority
with two or more years of continuous service who is not specified
in another item in this list
• Person before whom a statutory declaration may be made under
the law of the State or Territory in which the declaration is made• Police officer• Registrar, or Deputy Registrar, of a court• Senior Executive Service employee of:a. the Commonwealth or a Commonwealth authority
b. a State or Territory or a State or Territory authority• Sheriff• Sheriff’s officer• Teacher employed on a full-time basis at a school or tertiary
education institution• Member of the Australasian Institute of Mining and Metallurgy* Denotes persons whose positions are held overseas and who are authorised tocertify documents

Page 9ANZ SMART CHOICE SUPERNOTICE OF INTENT TO CLAIM OR VARY A DEDUCTION FORPERSONAL SUPER CONTRIBUTIONS
February 2024
Customer Services
Phone 13 12 87 (International +61 2 8366 1500)
Email smartchoice@insigniafinancial.com.au
Website anz.com.au/smartchoicesuperComplete and sign the form if you intend to claim or vary a deduction for personal contributions and return to:
ANZ Smart Choice SuperGPO Box 5107
Sydney NSW 2001
1. MEMBER ACCOUNT NUMBER
Member number
2. MEMBER DETAILS
Date of birth

D

D

M

M

Y

Y

Y

Y

First name(s) (including middle name)Last nameResidential address
Suburb/Town

PostcodeHome phone

Business phone

Mobile phone
Tax file number (TFN)
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 DETAILSYou must complete and return this notice to us if you intend to claim a taxation deduction for part or all of your personal superannuation contributions.
Financial year ended 30 June

2

0

Y

Y

My personal contributions to this Fund in the above financial year:$
The amount of these personal contributions I will be claiming as a tax deduction:$
Is this notice varying an earlier notice

Yes  

No

Please note: A tax deduction for personal superannuation contributions may only be claimed by people in certain circumstances.
Please refer to the Australian Taxation Office (ATO) or your tax adviser to determine if you are eligible to claim a personal tax deduction.

Page 10

ANZ SMART CHOICE SUPERNOTICE OF INTENT TO CLAIM OR VARY A DEDUCTION FORPERSONAL SUPER CONTRIBUTIONS
4. DECLARATIONS
In signing one of the declarations on this form, you should be aware that the law has changed to expand the administrative penalty provisions
to include penalties for making false or misleading statements that do not result in a shortfall amount.
This may include making false or misleading statements to an entity other than the ATO if the statement is required or allowed to be made undertax law, for example, a notice of intent to deduct super contributions given to a super fund.
For more information about these penalties, refer to Superannuation and false or misleading statements which do not result in a shortfall amountat ato.gov.au
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 3, and• the end of the financial year after the year stated in section 3.
At the time of completing this notice:• I intend to claim the personal contributions in section 3 above as a tax deduction.
• I am a member of Retirement Portfolio Service.
• Retirement Portfolio Service currently holds these contributions and has not begun to pay a superannuation income stream based in whole orpart on these contributions.
• I have not included these contributions in an earlier valid notice.
The information given on this form is correct and complete.
Name of member
Signature of member
Date

D

D

M

M

2

0

Y

Y

or
4B. DECLARATION
Variation of previous valid deduction notice
Use this declaration if you have already lodged a valid notice with the Fund for these contributions and you wish to reduce the amount statedin that notice.
I confirm that:• I intend to claim the personal contributions in section 3 above as a tax deduction.
• I am a member of Retirement Portfolio Service.
• Retirement Portfolio Service currently holds these contributions and has not begun to pay a superannuation income stream based in whole orpart on these contributions.
• I wish to vary my previous valid notice for these contributions by reducing the amount I advised in my previous notice.
I confirm that either:• I have lodged my income tax return for the year in which the contribution was made, prior to the end of the following financial year and thisvariation notice is being lodged before the end of the day on which the return was lodged, or• 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 thefinancial year following the year the contribution was made, or• the Australian Tax Office has disallowed my claim for a deduction for the relevant year and this notice reduces the amount stated in my previous
valid notice by the amount that has been disallowed.
The information given on this form is correct and complete.
Name of member
Signature of member
Date

D

D

M

M

2

0

Y

Y

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ANZ SMART CHOICE SUPERINTERNATIONAL FUNDS TRANSFER GLOBAL PAYMENTThis section is only to be completed if you are arranging an international funds transfer and must be attached to the withdrawal form.

Date

D

D

M

M

2

0

Y

Y

Bank account holder’s nameCurrency

Bank name

Swift code (Note: Must be provided)

Bank address
Suburb/Town

State

PostcodeCountry
Bank account number
Sort code (Mandatory for UK)
Member IBAN no. (Mandatory for European countries)
Routing number (Mandatory for USA & Canada)
Reference/Invoice no. for Member

Total amount $Message for Member

Requisition by

Team

Extension no.

OFFICE USE ONLY
Bid number

AUD $Payment ID no.

PLA-29223 (54259_A3527) 0624

Rate

Retirement Portfolio Service (Fund) ABN 61 808 189 263 RSE R1000986
OnePath Custodians Pty Limited (OnePath Custodians) ABN 12 008 508 496 AFSL 238346 RSE L0000673
The Australia and New Zealand Banking Group Limited (ANZ) (ABN 11 005 357 522) brand is a trademark of ANZ and is used by OPC under licence from ANZ.
ANZ and the Insignia Financial Group of companies (including OPC) are not related bodies corporate. ANZ does not stand behind or guarantee these products.

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