QSuper Form
Please complete in block letters, in blue or black ink.
1
Notice to the QSuper
Board of Trustees
Claim or
vary a tax
deduction.
Notice of intent to claim or vary a deduction for
personal super contributions
When should I use this form?
You’ll need to use this form if you want to claim a tax deduction (section 2) or vary a previous deduction notice (section 3) for any personal
contributions you have made to your QSuper account for the current or previous financial year.
Not sure if you’re eligible to claim a tax deduction on your personal contributions? You can find the full list of criteria and more info in our
Personal Contributions Guide. Just head to qsuper.qld.gov.au or call us and we’ll send you a copy.
If you spot this symbol check out the Additional Information section on the back page of this form.
Personal details
1
Client number
You can find your client number on your annual statement
or by logging in to Member Online.
Title
Notice of intent to claim a tax deduction
2
You’ll need to complete this section if you want to claim a tax
deduction and you haven’t previously lodged a tax deduction
notice with QSuper for your personal contributions. Once we receive
and acknowledge your notice of intent to claim a tax deduction, you
can’t remove or cancel it, but you can apply to reduce it.
The total personal contributions I,
Given names
Given names
Surname
Surname
Previous name (if we know you by another name)
Home phone number
Date of birth (dd/mm/yyyy)
made to QSuper for the year ended 30 June
were $
I want to claim
$
of these personal contributions as a tax deduction.
Work phone number
Mobile phone number
Declaration
I’m lodging this notice before both of the following dates:
Email address
•
Residential address
The day that I lodged my income tax return for the year stated
in section 2, and the end of the income year after the year
stated in section 2.
At the time of completing this notice:
State
Postcode
Before giving us your tax file number, please read the
Additional information about the form on page 2.
Tax file number (TFN)
If you’ve already given us your TFN, you don’t need to give it to us again.
•
I intend to claim the personal contributions stated in section 2
as a tax deduction.
•
I’m a QSuper member.
•
The contributions given in section 2 are still held by QSuper.
•
QSuper hasn’t begun to pay me a super income stream based
in whole or part on these contributions.
•
I haven’t included these contributions in an earlier notice.
The information given on this notice is correct and complete.
Name
Signature
Date (dd/mm/yyyy)
2
Notice to the QSuper Board of Trustees
Notice to vary a previous deduction notice
3
You’ll need to complete this section if you’ve already given us a
notice to claim a tax deduction and you want to vary the amount to
be claimed. Just remember that you can only reduce the amount
you want to claim a tax deduction for.
The total personal contributions I,
Given names
Additional info about the form
Do we have your tax file number (TFN)?
You don’t have to give us your TFN, but if you do, we’ll be able to
accept all types of super contributions from you and you’ll be able
to take advantage of benefits such as paying a lower tax rate on
your contributions.
If you do give us your TFN, we’ll of course only ever use it for lawful
purposes related to your super. Just so you know, we may disclose
your TFN to another super provider when your benefits are being
transferred, unless you write to us and ask us not to.
Surname
Financial advice
made to QSuper for the year ended 30 June
were $
I want to claim
$
On my previous notice I claimed
$
Declaration
Before you claim a tax deduction you may want to speak to a
financial adviser. And just so you know, contributions you claim a
tax deduction for don’t qualify for the Australian Government’s
super co-contribution.
as a tax deduction.
I want to claim the personal contributions stated in section 3 as a
tax deduction.
Are you eligible to claim a tax deduction?
Just remember the Notice to the QSuper Board of Trustees
form can’t:
•
Be submitted if you’re no longer a QSuper member.
I want to reduce the amount that I stated in my previous notice to
the amount stated in section 3.
•
Be submitted once we’ve begun to pay a super income stream
based on any part of the contribution.
I confirm that:
•
Be used to vary a previous deduction notice if we’ve begun
to pay you a super income stream based on any part of the
contribution.
•
Refer to a contribution no longer held by QSuper.
•
Refer to any part of a contribution claimed in a previous notice,
except to reduce the amount you claimed.
•
Be submitted if you’ve already made a contribution splitting
application to QSuper for the same contributions.
•
I’m still a QSuper member.
•
QSuper hasn’t begun to pay me a super income stream based
on any part of the contribution.
•
This variation doesn’t refer to any part of a contribution
claimed in a previous notice, except to reduce the amount
I claimed.
•
This variation doesn’t refer to a contribution that QSuper no
longer holds.
•
This variation is not being submitted if I’ve already made
a contribution-splitting application to QSuper for the
same contributions.
The information given on this notice is correct and complete.
Name
Signature
Need more information?
To find new ways to get more out of your super, have a
play around with the tools and calculators on our website
at qsuper.qld.gov.au. You can experiment with as many
different inputs and scenarios as you like.
And we’re always here to help on the phone too. Just call us
on 1300 360 750 to get in touch.
Date (dd/mm/yyyy)
Member Centres 70 Eagle Street Brisbane and 63 George Street Brisbane
Telephone 1300 360 750 (+617 3239 1004 if overseas)
Monday – Friday 8.30am to 5.00pm Queensland time
Postal address GPO Box 200 Brisbane Qld 4001
Fax (07) 3239 1124
Website qsuper.qld.gov.au
ABN: 60 905 115 063
SFN: 2610 419 41
8743 01/07/2015 FO27
Just quickly, we need to let you know that this form is issued by the QSuper Board (ABN 32 125 059 006). All QSuper products are issued by the QSuper Board as trustee for the QSuper Fund
(ABN 60 905 115 063). We take the privacy of your personal information very seriously. We’re collecting this information to administer your superannuation account and are authorised to do this under
the Superannuation (State Public Sector) Act 1990. We may pass your information on to your employer, authorised service providers (e.g. external insurers), other superannuation funds and government
departments or agencies. We may also disclose this information to third parties if we need to, if you’ve given consent to the disclosure, or if we’re required to by law. If you want to know more about
our privacy policy, you can download QSuper’s Your Privacy factsheet from our website or call us on 1300 360 750 and ask for a copy. © QSuper Board of Trustees 2015
20150701FO27