Completing the rollover initiation request to transfer whole balance of superannuation benefits to your self-managed super fund form

By completing this form, you will request the transfer of the whole balance of your super benefits to your self-managed super fund. This form can not be used to transfer part of the balance of your super benefits.

This form will not change the fund to which your employer pays your contributions. The Standard choice form must be used by you to change funds.

BEFORE COMPLETING THIS FORM n Read the important information below.

n 

WHEN COMPLETING THIS FORM
n Refer to these instructions where a question shows a message like this:

n Print clearly in BLOCK LETTERS.

AFTER COMPLETING THIS FORM n Sign the authorisation.

n Attach the appropriately certified proof of identity documents. n Review the checklist below.
n Send the request form to your FROM fund.

IMPORTANT INFORMATION

This transfer may close your account (you will need to check this with your FROM fund).

This form can not be used to:
n transfer part of the balance of your super benefits
n transfer benefits if you don’t know where your super is

n transfer benefits from multiple funds on this one form – a separate form must be completed for each fund you wish to transfer super from

n change the fund to which your employer pays contributions on your behalf
n open a super account

n transfer benefits under certain conditions or circumstances – for example, if there is a super agreement under the
Family Law Act 1975 in place.

CHECKLIST
Have you read the important information?

Have you considered where your future employer contributions will be paid?

Have you completed all of the mandatory fields on the form?

Have you signed and dated the form?

Have you attached the certified documentation including any linking documents if applicable?

WHAT HAPPENS TO MY FUTURE
EMPLOYER CONTRIBUTIONS?

Using this form to transfer your benefits will not change the fund to which your employer pays your contributions and may close the account you are transferring your benefits FROM.

If you wish to change the fund into which your contributions are being paid, you will need to speak to your employer about choice. For the appropriate forms and information about whether you are eligible to choose the fund to

which your employer contributions are made, visit www.superchoice.gov.au or call the Australian Taxation Office (ATO) on 13 10 20.

THINGS YOU NEED TO CONSIDER WHEN TRANSFERRING YOUR Super
When you transfer your super, your entitlements under that fund may cease. You need to consider all relevant information before you make a decision to transfer your super. If you ask for information, your super provider must give it to you. Some of the points you may consider are:

n	Fees – your FROM fund must give you information about any exit or withdrawal fees. If you are not aware of the fees that may apply, you should contact your fund for further information before completing this form. The fees could include administration fees as well as exit or withdrawal fees. 

n	Death and disability benefits – your FROM fund may insure you against death, illness or an accident which leaves you unable to return to work. If you choose to leave your current fund, you may lose any insurance entitlements you have. Other funds may not offer insurance or may require you to pass a medical examination before they cover you. When considering a new fund, you may wish to check the costs and amount of any cover offered. 

WHAT HAPPENS IF I DO NOT QUOTE MY TAX FILE NUMBER (TFN)?
You are not obligated to provide your TFN to your super fund. However, if you do not provide your TFN, your fund may be taxed at the highest marginal tax rate plus the Medicare levy on contributions made to your account in the year, compared to the concessional tax rate of 15%. Your fund may deduct this additional tax from your account.

If your super fund does not have your TFN, you will not be able to make personal contributions to your super account. Choosing to quote your TFN will also make it easier to keep track of your super in the future.

Under the Superannuation Industry (Supervision) Act 1993, your super fund is authorised to collect your TFN, which will only be used for lawful purposes. These purposes may change in the future as a result of legislative change. The TFN may be disclosed to another super provider when your benefits are being transferred, unless you request in writing that your TFN is not to be disclosed to any other trustee.

TRANSFERRING TO YOUR SELF-MANAGED SUPER FUND

You must use this form to transfer your benefits to your own self‑managed super fund (SMSF).

You should be aware that SMSFs are subject to the same rules and restrictions as other funds regarding when benefits are to be paid out. In particular, super benefits in a SMSF are required to be ‘preserved’, meaning they are not generally able to be accessed until you are over age 55 and retired.

The trustee of your FROM fund may be able to request further information from you about your status as a member, a trustee or a director of a corporate trustee of your SMSF. Penalties may apply for providing false or misleading information.

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IN-CONFIDENCE – when completed	Page 1		

Completing proof of identity
You will need to provide documentation with this transfer request to prove you are the person to whom the super entitlements belong.

Acceptable documents
The following documents may be used.

EITHER

One of the following documents only:		
n driver’s licence issued under state or territory law		
n passport				
				
OR				
One of the following		One of the following		
documents:		documents:		
n birth certificate or		n letter from Centrelink		
birth extract		regarding a government		
n citizenship		assistance payment		
		n notice issued by federal,		
certificate issued by				
the Commonwealth		state or territory government		
n pension card	AND	or local council within the		
		past twelve months that		
issued by				
				
		contains your name and		
Centrelink that				
		residential address.		
entitles the person				
		For example:		
to financial benefits				
		–  notice of an ATO		
				
		assessment		
		–  rates notice from a		
		local council		

Have you changed your name or are you signing on behalf of another person?
If you have changed your name or are signing on behalf of the applicant, 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.

Purpose	Suitable linking documents	
		
Change of	Marriage certificate, deed poll or change	
name	of name certificate from the Births, Deaths	
	and Marriages Registration Office	
		
Signed on	Guardianship papers or Power of Attorney	
behalf of the		
applicant		

Certification of personal documents
All copied pages of original proof of identification documents (including any linking documents) need to be certified as true copies by any individual approved to do so (see below).

The person who is authorised to certify documents must sight the original and the copy and make sure both documents are identical, then make sure all pages have been certified as true copies by writing or stamping ‘certified true copy’ followed by their signature, printed name, qualification (eg Justice of the Peace, Australia Post employee etc) and date.

The following can certify copies of the originals as true and correct copies:

n a permanent employee of Australia Post with five or more years of continuous service

n a finance company officer with five or more years of continuous service (with one or more finance companies)

n an officer with, or authorised representative of, a holder of an Australian Financial Services Licence (AFSL), having five or more years continuous service with one or more licensees

n a notary public officer n a police officer

n a registrar or deputy registrar of a       court 
n a Justice of the Peace

n a person enrolled on the roll of a state or territory Supreme Court or the High Court of Australia as a legal practitioner

n an Australian consular officer or an Australian diplomatic officer
n a judge of a court

n a magistrate

n a Chief Executive Officer of a Commonwealth court.

Where do I send the form?

You can send your completed and signed form with your certified proof of identity documents to your from fund.

More information

For more information about super, visit the:

n Australian Securities and Investments Commission website at www.moneysmart.gov.au

n ATO website at www.ato.gov.au/super

For more information about this form, phone the ATO on 13 10 20.

IN-CONFIDENCE – when completed	Page 2

	Rollover initiation request to transfer whole balance of superannuation benefits to your self managed super fund. 			
				
	under the Superannuation Industry (Supervision) Act 1993			
							
	completing this form			After completing this form			
	n Read the important information pages			n Sign the authorisation			
	n Refer to instructions where indicated with a			n Send form and certified proof of identity documents to 			
	n This form is only for whole (not part) balance transfers.		your FROM fund.			

Personal details						

Title:	Mr		Mrs		Miss		Ms		Other	

*Family name *Given names
Other/previous   names

Day	Month	Year

*Date of birth

Tax file number

Under the Superannuation Industry (Supervision) Act 1993, you are not obliged to disclose your tax file number, but there may be tax consequences.

See ‘What happens if I do not quote my tax file number?’

*Gender	Male		Female	

*Contact phone number

Residential address

*Address   

*Suburb

*State/territory	*Postcode

Previous address

If you know that the address held by your FROM fund is different to your current residential address, give details below.

Address

Suburb

State/territory	Postcode

Fund details

FROM	To		
*Fund name	*SMSF name		
				
*Fund phone number  		
Fund phone number				
Membership or			
account number			
Australian business		Australian business		
					
number (ABN)		number (ABN)		
					
Superannuation product				
					
identification number (SPIN)				

	If you have multiple account numbers with this fund, you must					
	complete a separate form for each account you wish to transfer.					

*Proof of identity

See ‘Completing proof of identity’

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

OR

I have attached certified copies of both:

Birth/Citizenship certificate or Centrelink pension card

AND

Centrelink payment letter or government or local council notice (<1 year old) with name and address

Authorisation

By signing this request form I am making the following statements:

n	I declare I have fully read this form and the information completed is true and correct. 

n	I am aware I may ask my superannuation provider for information about any fees or charges that may apply, or any other information about the effect this transfer may have on my benefits, and do not require any further information. 

n	I confirm that I am a member, trustee or director of a corporate trustee of the SMSF. 

n	I discharge the superannuation provider of my FROM fund of all further liability in respect of the benefits paid and transferred to my TO fund. 

I request and consent to the transfer of superannuation as described above and authorise the superannuation provider of each fund to give effect to this transfer.

*Name (Print in BLOCK LETTERS)

*Signature

Day	Month	Year

*Date

* Denotes mandatory field. If you do not complete all of the mandatory fields, there may be a delay in processing your request.

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