Withdraw or transfer your income stream
Use this form if you wish to:
• make a withdrawal from
your income stream
• transfer your income
stream to another
provider
• transfer your balance to
your First State Super
accumulation account.
Please use a dark pen and
CAPITAL letters. Insert ✗
when you have to choose
an option. You also can
type data directly into
this form, print it and
send it to us. Forms are
located on our website at
firststatesuper.com.au/
forms.
The Notes at the back
will help you complete
this form. If you have any
questions, call us on
1300 650 873.
1. Your personal details
Member number
Account number
Title
F
S
I
Date of birth
N
Last name
Given name(s)
Residential address
Suburb
State
Daytime contact number
Postcode
Mobile number
M
F
Email (for security reasons, please ensure that your nominated email address is your personal email address and not a
role-based email address such as [email protected])
Please mark (✗) in one box only:
IMPORTANT:
If you are terminally
ill or permanently
incapacitated and
wish to access your
benefit, call us and
we’ll send you the
form you need to
complete.
I am currently receiving a transition to retirement income stream go to section 2 OR
I am currently receiving a retirement income stream go to section 3.
2. Cashing declarations
If you have a transition to retirement income stream, you must meet one of these eligibility conditions
before you can withdraw your benefits. Please cross (✗) the box that applies to you:
I declare that I have turned age 65; or
I declare that I am aged 60-64 years and have ceased a paid employment arrangement since turning
age 60*; or
I declare that I have permanently retired; or
I declare that I have ceased paid employment with an employer who contributed to First State Super
on my behalf and I wish to withdraw my restricted non-preserved benefit; or
I wish to access an existing unrestricted non-preserved benefit; or
I am receiving less than the maximum allowed as a regular income stream and wish to withdraw the
amount (up to the maximum allowed) shown in Section 3 as an irregular income stream payment.
* Please provide the details below if you have turned 60 and ceased a paid employment arrangement.
Date ceased paid employment (if the date is more than five years ago, please record the year only)
Employer name
FSS Trustee Corporation (Trustee) ABN 11 118 202 672 AFSL 293340 First State Superannuation Scheme (Fund) ABN 53 226 460 365
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FSS040 03/17
If you are receiving
a retirement income
stream and do not
specify, we will
treat your partial
withdrawal as a lump
sum withdrawal.
If you have a
transition to
retirement income
stream and want to
make a lump sum
withdrawal, please
see Amount to be
withdrawn/transferred
in the Notes.
3. Amount to be withdrawn/transferred
If you are withdrawing funds, please also complete Section 4. If you are transferring funds, please also
complete Section 5.
I would like to make a (please select (✗) one only):
Full withdrawal or transfer
Partial withdrawal or transfer of
$
,
,
.
Type of partial withdrawal
You can take your partial withdrawal as either a lump sum withdrawal or an irregular income stream
payment (see Amount to be withdrawn/transferred in the Notes for an explanation of the difference).
I would like my partial withdrawal to be:
a lump sum withdrawal
an irregular income stream payment
Withdrawal choice if you have more than one investment option
If you invest in more than one investment option, you can choose how your withdrawal is deducted from
these options. The three choices are shown below. If you don’t make a choice, your withdrawal will be
deducted ‘pro-rata’.
Pro-rata
Your withdrawal will be deducted from each investment option in the same proportion that your
balance is invested.
Priority
Your withdrawal will be deducted in the order you nominate under Priority in the table below. When
your first choice has been fully drawn, we will draw from your second choice and so on. Only number
options in which you are currently invested.
Percentage
Your withdrawal will be deducted according to the percentages you nominate under Percentage in the
table below. Your nominations must add up to 100%. Only include percentages for options in which
you are currently invested.
Pre-mixed options
Priority
Percentage
High Growth
%
Growth
%
Diversified SRI
%
Balanced Growth
%
Conservative Growth
%
Single asset class options
Australian Equities
%
Australian Equities SRI
%
International Equities
%
Property
%
Australian Fixed Interest
%
International Fixed Interest
%
Cash
%
Total must add up to
1 0 0 %
Payments from a transition to retirement income stream will be made in the following order:
1. unrestricted non-preserved
2. restricted non-preserved
3. preserved.
FSS Trustee Corporation (Trustee) ABN 11 118 202 672 AFSL 293340 First State Superannuation Scheme (Fund) ABN 53 226 460 365
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FSS040 03/17
To ensure the
security of your
benefits we require
a copy of your
bank statement
that contains your
full name and
account details
(as nominated)
including BSB and
account number.
(unless you have
already provided it).
Transaction details
are not required.
4. Details of your bank/financial institution
You can only nominate an account that is held in your name or is a joint account including your name.
Cheque payments are not available.
Name(s) in which bank account is held
Name of bank or financial institution
Name of branch
BSB number
Account number
IMPORTANT:
Unless you are
transferring to an
SMSF, please ensure
that you include
your TO fund’s full
address, Unique
Superannuation
Identifier (USI) and
member number
or we may not be
able to process your
request.
5. Details of the fund you are transferring to
Record the details of the rollover fund you wish to transfer to OR your First State Super accumulation
account if you are rolling money to that account.
Payment will be made to the rollover fund you nominate to an account in your name. A payment to a selfmanaged superannuation fund will be made to the fund’s registered name and mailed to the registered
address recorded on the government’s Super Fund Lookup website at www.superfundlookup.gov.au.
Where the SMSF fund status is not clear, we may require additional documentation to process the rollover.
Are you transferring money to a self-managed super fund (SMSF)? Yes
No
IMPORTANT: If you wish to roll over amounts to more than one fund, you must complete a separate form for
each fund.
Name of the other fund (your TO fund)
Address of other fund
Suburb
State
Fund ABN
Postcode
Unique Superannuation Identifier (USI)
Member number
Contact number
6. Proof of identity
If your name or residential address have changed since you provided copies of your proof of identity (POI)
documents, you will need to submit updated POI document(s).
We may request updated and/or additional certified copies of POI document(s) at any time if we consider
this is necessary for the security of our members’ benefits.
See Proof of identity on page 5 of the Notes for more information.
7. Privacy
The personal information provided on this form is collected by and held for First State Super by the fund
administrator, Pillar Administration, in accordance with the Australian Privacy Principles of the Privacy
Act 1988 (Cth), for the purpose of administering accounts and providing services associated with fund
membership. For further information about how personal information is handled, please call us on
1300 650 873 or visit firststatesuper.com.au/privacy to view the privacy policy (a hard copy of the policy
may also be provided on request). The policy contains information about access to and correction of personal
information, how a complaint can be made about a privacy breach and other important information about
how personal information is collected, used and disclosed.
FSS Trustee Corporation (Trustee) ABN 11 118 202 672 AFSL 293340 First State Superannuation Scheme (Fund) ABN 53 226 460 365
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FSS040 03/17
8. Declaration
•
•
I declare that the information I have provided in this form is true and correct.
•
I understand that a $36 exit fee will apply if I withdraw my entire account balance, unless I am
transferring my balance to a First State Super accumulation account.
•
I declare that I am the member of First State Super who is signing this declaration or I have been given
Power of Attorney by the member and this Power of Attorney remains valid. A certified copy of the Power
of Attorney has been provided.
•
•
I understand that if I am under 60 years of age tax may be deducted from my benefit.
I declare that I have sufficient information to make an informed decision about the payment/transfer of
my benefit from First State Super.
I have read and understand the First State Super privacy policy.
Signature
Please sign and
date form here.
Date signed
Name (print in CAPITAL letters)
Send the form to
this address.
9. Where to send your completed form
Return the completed form to First State Super PO Box 1229 WOLLONGONG NSW 2500. If you have any
questions, please call us on 1300 650 873.
Save form
Print form
Clear form
FSS Trustee Corporation (Trustee) ABN 11 118 202 672 AFSL 293340 First State Superannuation Scheme (Fund) ABN 53 226 460 365
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FSS040 03/17
Notes for completing the income
stream withdrawal form
You should read the current Member Booklet (Product Disclosure Statement) for income stream members. The Member Booklet is available
on our website and it is also available free of charge from customer service.
Forms are located on our website at firststatesuper.com.au/forms. You can type data directly into these forms, print and sign them and
send them to us. If you prefer to write on the forms, please use a dark pen and print clearly.
Amount to be withdrawn/transferred
Irregular income stream payment or lump sum withdrawal
A withdrawal from your income stream may be treated as:
•
an irregular income stream payment – in this case, if you are aged less than 60, you may pay income tax on the payment but you may
also be eligible for a 15% tax offset1. An irregular income stream payment may affect your Centrelink entitlements. Talk to a financial
planner or Centrelink for more information; or
•
a lump sum withdrawal – this is treated as a superannuation benefit payment and, if you are aged less than 60, may be subject to
lump sum tax1.
1
If you are aged 60 or more any payments made to you are tax free.
For more information, please refer to the section on taxation in the current Member Booklet for income stream members, or the fact
sheet Super taxes, caps, payments, thresholds and rebates on our website.
Transition to retirement income stream and lump sum withdrawals
Generally, you cannot make lump sum withdrawals from your First State Super transition to retirement income stream unless you
have satisfied a condition of release, or have unpreserved money or the resulting lump sum is to pay a debt required to be paid under
superannuation law. However, you can commute a transition to retirement income stream in order to transfer the lump sum to another
superannuation product.
You can also elect to withdraw the difference between the maximum income stream payment (calculated as 10% of your account
balance at commencement in the first year, then on 1 July) and the amount you have elected to receive as a regular income stream for
the financial year. You can do this by selecting this option in Section 2 and then nominating an amount up to the maximum in Section 3.
This amount must be paid as an irregular income stream payment. If you have elected to receive this amount as a lump sum withdrawal
in Section 3, we will automatically pay it as an irregular income stream payment.
Payment details
Under superannuation law, we must pay your income stream payments into an account in your name (or a joint account in your name).
We can’t make payments to a third party bank account under this same law. To verify that the account meets this condition, you must
provide us with a copy of the part of your financial institution statement or passbook that contains your full name, address and your
financial account details, including account number and BSB number. The easiest way to do this it to photocopy the account details
section on your bank statement, or to provide us with a pre-printed deposit slip showing your account details. This confirmation helps
prevent payments being made to the wrong account.
Proof of identity (POI)
If you have already provided a certified copy of your POI document(s), you do not have to provide it again, as long as your name or
residential address have not changed. If either your name or residential address has since changed since providing certified documents,
you must provide evidence of the change(s).
If you have changed your name, you must provide a certified copy of one of the following name change documents:
•
marriage certificate or certificate of registration (if you are on the relationship register) issued by the Births, Deaths and Marriages
Registration Office (ceremonial certificates cannot be accepted)
•
deed poll or change of name certificate from the Births, Deaths and Marriages Registration Office. If you have reverted to your maiden
name, we will require your marriage certificate (from the Births, Deaths and Marriages Registration Office) showing your original
maiden name and your married name.
If you have changed your residential address, you must provide a certified copy of a POI document showing your new residential
address. If it’s more convenient, you can provide the original (rather than a certified copy) of a recent notice issued by your local council
or a recent utilities bill addressed to you at your current residential address.
FSS Trustee Corporation (Trustee) ABN 11 118 202 672 AFSL 293340 First State Superannuation Scheme (Fund) ABN 53 226 460 365
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FSS040 03/17
Providing certified POI is a three-step process
1 Collect your originals
Collect your proof of identity
document(s). We have listed the
documents you can use below.
2 Photocopy your originals
3 Have your photocopies certified
Take your photocopies and your original
documents to a person who can certify
documents. A list of certifiers, and
how documents are to be certified, is
provided below.
To prove your identity, you can provide either:
ONE certified document from List A; OR
ONE certified document from List B PLUS ONE certified document from List C.
List A
55Current Australian state/territory
driver’s licence with your
photograph
55Australian passport
55Current card issued under an
Australian state or territory law
for the purpose of proving your age
and containing your photograph
55Current foreign passport or similar
travel document containing your
photograph and signature*.
List B
List C
55An Australian birth
55A notice issued by the ATO within the last
55A citizenship certificate
55A notice issued by a local council or utilities
certificate or extract
issued by a state or
territory
issued by the
Commonwealth
55A current Centrelink
pension card that entitles
you to receive financial
benefits
12 months that shows your name and current
residential address and records an amount
payable to or by you e.g. your last tax return
provider in the last three months showing
the provision of services to you and your
current residential address e.g. rates notice,
electricity or water bill
55A notice issued by the Commonwealth or a
state or territory government within the last
12 months showing your name and current
residential address and the provision of
financial benefits to you e.g. Centrelink letter
* If the document is not in English, it must be accompanied by an English translation prepared by a translator accredited by the National Accreditation Authority for
Translators and Interpreters Ltd (NAATI).
Certification of personal documents
All copied pages of original POI documents need to be certified as true copies by an authorised person with the appropriate Australian
qualifications or registration (see below) who cannot be the owner or addressee of the document. The authorised person must sight the
original and the copy to ensure both documents are identical, then make sure all pages have been certified by writing ‘I certify that this
document is a true copy of the original’, followed by their signature, printed name, qualification (e.g. justice of the peace, Australia Post
employee, etc.), registration number (if applicable) and date. The following people can certify copies of the originals:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
police officer
Australia Post employee in charge of an office
providing postal services (charges may apply)
Officer or an authorised representative of an
Australian Financial Services Licensee (AFSL)
with two or more years continuous service
Samantha Sample has provided
a copy of her identification
that includes her signature,
full name, date of birth and
current residential address.
Driver Licence
Samantha SAMPLE
E
L
P
AM
123 ANY ST
SUBURB NSW 2000
Licence No.
12345678
Licence Class
C
medical practitioner
Card Number
2 123 456 789
S
Donor
A
Conditions
S
Date of Birth
legal practitioner
01 JAN 1980
Expiry
01 JAN 2020
pharmacist
justice of the peace
magistrate
nurse
optometrist
The authorised person
has sighted the original
identification and confirmed
that the copy is a true copy.
"I certify that this document is a true
copy of the original."
dentist
chiropractor
physiotherapist
psychologist
veterinary surgeon
full-time teacher employed at a school or
tertiary institution.
Name: Kate Anderson
Details for the authorised
person to include are full
name, qualification, registration
number (if applicable), date
and signature.
Qualification: JP
Registration no: 123456
Date: 31 March 2016
FSS Trustee Corporation (Trustee) ABN 11 118 202 672 AFSL 293340 First State Superannuation Scheme (Fund) ABN 53 226 460 365
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FSS040 03/17