Trustee 1 Name: Individual Trustee Director of Corporate Trustee Trustee 2 Name: Individual Trustee Director of Corporate Trustee Trustee 3 Name: Individual Trustee Director of Corporate Trustee Trustee 4 Name: Individual Trustee Director of Corporate Trustee SECTION D: DETAILS OF MEMBER RECEIVING BENEFIT Member Name: Address: SECTION E(I): INCOME STREAM COMMUTATION DETAILS – SPECIFIC COMMUTATIONS Complete this section for commutation of a single income stream or multiple income streams where you wish to specify how each income stream is to be individually commuted. Please select which income streams you wish to commute. If you are commuting multiple income streams which commenced on the same date, please note a unique identifier for each income stream. Pension Type Commencement Date | Unique Identifier Type of Commutation Date of Commutation 1 Account Pension Transition to Retirement Income Stream Commencement Date: / / OR Unique Identifier: Commute the amount of $ Commute such an amount that will result in the balance of the pension to be no greater than $1.6 million Commute such an amount that will result in the balance of the pension to be no greater than $ Fully commute the pension / / 2 Account Based Pension Transition to Retirement Income Stream Commencement Date: / / OR Unique Identifier: Commute the amount of $ Commute such an amount that will result in the balance of the pension to be no greater than $1.6 million Commute such an amount that will result in the balance of the pension to be no greater than $ commute the pension / / 3 Account Based Pension Transition to Retirement Income Stream Commencement Date: / / OR Unique Identifier: Commute the amount of $ Commute such an amount that will result in the balance of the pension to be no greater than $1.6 million Commute such an amount that will result in the balance of the pension to be no greater than $ Fully commute the pension / / Account Based Commencement Date: Commute the amount of $ / /
4 Pension Transition to Retirement Income Stream / / OR Unique Identifier: Commute such an amount that will result in the balance of the pension to be no greater than $1.6 million Commute such an amount that will result in the balance of the pension to be no greater than $ Fully commute the pension SECTION E(II): INCOME STREAM COMMUTATION DETAILS – TIERED COMMUTATIONS Complete this section if you wish to tier the commutation of a number of income streams, so that the income streams are commuted in a set order until the aggregate pension balance for the member is either $1.6 million or another specific dollar amount. If you are commuting multiple income streams which commenced on the same date, please note a unique identifier for each income stream. What date do you wish the commutations to be effective? Please specify date: / / 30 June 2017 (default) The purpose is to ensure the balance of the remaining income stream or the combined balance of the remaining income streams as at the date of commutation is no greater than: $1.6 million Please specify amount: $ Pension Type Commencement Date | Unique Identifier Order of Commutation 1 Account Pension Transition to Retirement Income Stream Commencement Date: / / OR Unique Identifier: First full or partial commutation 2 Account Pension Transition to Retirement Income Stream Commencement Date: / / OR Unique Identifier: Second full or partial commutation 3 Account Based Pension Transition to Retirement Income Stream Commencement Date: / / OR Unique Identifier: Third full or partial commutation 4 Account Based Pension Transition to Retirement Income Stream Commencement Date: / / OR Unique Identifier: Fourth full or partial commutation