Document ID: chunk:federal_register_of_legislation:F2023C01022:schedule:1:p3
Version: federal_register_of_legislation:F2023C01022
Segment Type: schedule
Provision Reference: sch 1 (pt 3/4)
Character Range: 264372–267207

to me.

DATED:

[signature of non‑member spouse]

*   Omit if not applicable

Form 4—Request to trustee by non‑member spouse for payment, as lump sum, of all or part of remaining base amount
(regulation 58)

REQUEST TO TRUSTEE BY NON‑MEMBER SPOUSE FOR PAYMENT, AS LUMP SUM, OF ALL OR PART OF REMAINING BASE AMOUNT

TO the trustee of [name of eligible superannuation plan]:

IN RELATION TO the payment split, of which you were notified on [date when superannuation agreement, flag lifting agreement or splitting order was served on the trustee], in respect of the superannuation interest of [name of member spouse], date of birth [date of birth of member spouse]

I, [name], the non‑member spouse in relation to the above superannuation interest, of [postal address], born on [date of birth], being entitled to be paid an amount under paragraph 57(2)(a) of the Family Law (Superannuation) Regulations 2001, request that I be paid, as a further lump sum, *the whole/*a specified proportion, being [specify the proportion that is to be paid as a lump sum], of the remaining base amount allocated to me in relation to the superannuation interest.

DATED:

     [signature of non‑member spouse]

*   Omit if not applicable

Form 5—Waiver notice in respect of payment split
(regulation 60)
Family Law Act 1975 subsection 90XZA(2) or 90YZQ(2)

WAIVER NOTICE

TO the trustee of [name of eligible superannuation plan]:

IN RELATION TO the payment split, of which you were notified on [date when superannuation agreement, flag lifting agreement or splitting order was served on the trustee], in respect of the superannuation interest of [name of member spouse], date of birth [date of birth of member spouse]

I, [name], of [postal address], born on [date of birth], give notice that I waive my entitlement to future payments under that payment split.

DATED:

[signature of non‑member spouse]

Form 6—Declaration to accompany application to trustee for information about a superannuation interest
(regulation 62)
Family Law Act 1975 subsection 90XZB(2) or 90YZR(2)

DECLARATION BY APPLICANT FOR INFORMATION ABOUT A SUPERANNUATION INTEREST

I, [name], of [postal address], born on [date of birth], make the following declaration in support of my application to the trustee of [name of eligible superannuation plan from which information is sought] (the plan) for information about:
        *(a) my superannuation interest.
        *(b) a superannuation interest of [full name of member], born on [date of birth of member], who is a member of the plan.
1. I am:
        *(a) a member of the plan.
        *(b) the spouse of [name], who is a member of the plan.
        *(c) intending to enter into a superannuation agreement under [Part VIIIB/Part VIIIC] of the Family Law Act 1975 with [name], who is a member of the plan.
    2. I require