Holden Employees Superannuation Fund
Lump sum voluntary additional
contribution deposit slip
Please complete this Deposit Slip if you wish to make a Lump Sum Voluntary Additional Contribution to the Fund which will
be credited to your account.
You must complete sections A, B and D (please use BLOCK letters) and send this completed deposit slip with your
cheque to:
The Fund Administrator
Holden Employees Superannuation Fund
GPO Box 4303
Melbourne VIC 3001
Please make your cheque payable to the Holden Employees Superannuation Fund. The Fund Administrator will confirm
receipt of your contribution by letter to your home address.
If you need help
For assistance call the Holden Super Helpline on 1800 700 995 or email the Fund’s Administrator at [email protected]
Section A - Complete your personal details
Title Mr / Mrs / Miss / Ms / Other: __________
Please print in black of blue pen, in uppercase
Date of birth __ __ /__ __/ __ __ __ __
Given names _________________________________________________________________________________________
Surname ____________________________________________________________________________________________
Residential address ____________________________________________________________________________________
Suburb __________________________________________________________
State _______ Postcode ___________
Postal address (if different from above) ______________________________________________________________________
Suburb __________________________________________________________
State _______ Postcode ___________
Payroll number (not applicable if you are in the Retained benefit Section) _____________________________________________
Membership number ________________________________
Section B - Declaration
Phone __________________________
Please print in black of blue pen, in uppercase
I wish to make a Lump Sum Voluntary Additional Contribution of $ ___________________ (minimum of $100.00)
2014/08
Section C - Privacy Statement
The Fund is administered by the Trustee with the assistance of our service provider, Mercer Outsourcing (Australia) Pty
Ltd (Mercer). We collect your personal information to identify you, process your lump sum voluntary additional
contribution and manage your superannuation benefits. Your details may also be used to send you information about
products and services that the Trustee considers may be of interest to you (including relevant third party products and
services). If you do not wish to receive this information, please contact us (details below).
Your personal information may be disclosed to third parties for these purposes, including the trustees of any other fund
you may transfer to, your employer, your financial advisor or other representative authorised by you, relevant
government bodies such as Centrelink (where required) and our service providers (such as information technology
providers, mail houses and professional advisors). Your personal information is likely to be disclosed to service providers
located overseas, including to Mercer's processing centre in India. Mercer's Privacy Policy, available at www.mercer.com
lists other relevant offshore locations.
The Trustee's Privacy Policy is available at www.superfacts.com/holdensuper or you can obtain a copy by contacting us on
1800 700 995. This Privacy Policy provides further information about:
• how you may access and correct the personal information we hold about you
• how you may complain about a breach of privacy and how we will deal with such a complaint.
If you have any queries about privacy, please contact us on 1800 700 995, or by email at [email protected].
Section D - Authorisation
By signing this form I confirm that:
•
•
I have read and understood this form
I have read and understood the Privacy Statement above and I consent to my personal information being
collected, used and disclosed in the manner it describes.
Signature ____________________________________________________________ Date _____ / ______ / ______
Issued by Holden Employees Superannuation Fund Pty Ltd ABN 26065656948, RSE Licence No. L0002301 as Trustee for Holden Employees Superannuation Fund
ABN 77289319006, Registration No. R1005592.
[2014/08]