NOTIFICATION TO SALARY SACRIFICE SUPER CONTRIBUTIONS THROUGH EMPLOYER (ExECUTIvES)
Form
Please complete all the details on this form and forward it to your payroll office.
1. PERSONAL DETAILS
Mr Surname Given name(s) Postal address Ms Miss Mrs Dr Prof
Step by step guide
This form only needs to be completed by Pension Scheme and Lump Sum Scheme Executives who need to open a Triple S account to commence salary sacrifice. Please read the following information carefully: – Complete sections 1, 2 and 3. – Give this form to your employer to complete section 4. Your employer must sign the Employer Declaration (section 4), and fax the form to Super SA on 8226 9790. – Super SA will process your application and advise your payroll to start deductions.
2. APPLICATION FOR TRIPLE S MEMBERSHIP
Postcode Super ID Email Telephone
WORK
Date of birth
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In order to salary sacrifice super contributions, you need to be a member of Triple S. If you are not already a member of Triple S, you will need to join by ticking the box below and signing the Employee Declaration (section 3). By doing this you agree to the following conditions. During your Triple S membership, you will only accrue the entitlement paid for by salary sacrifice contributions and that in particular, you will not be entitled to: – Contribute to Triple S from your after-tax salary via payroll. – Any additional employer contributions. Note: To maximise your final entitlement, you need to ensure that you continue making after-tax contributions to your main scheme at your standard rate.* I hereby apply for membership of Triple S as a salary sacrifice member, in accordance with Section 15B(5) of the Southern State Superannuation Act 1994.
*The standard rate for the Pension Scheme is between 5-7% and for the Lump Sum Scheme it is 6%.
HOME
MOBILE
Name of agency Employee no
3. EMPLOYEE DECLARATION
I understand that: – By signing this agreement, I am authorising my employer to contribute on my behalf into Triple S. – There is no limit on salary sacrifice for super contributions to a complying fund. I may elect to salary sacrifice up to 100% of my total annual earnings comprising my before-tax salary, as prescribed by my employment arrangement, and additional earnings derived from overtime, shift penalties and/or allowances. – An administration fee of $44.00 including GST is payable to my employer from my after-tax salary at the commencement of this Agreement. I understand that this Agreement can last up to three years and if I wish to change the amount or percentage of my salary sacrifice contribution I will need to enter into a new Agreement at an additional cost of $44.00. – I must complete a “Financial Advice Certification (Form 9)” acknowledging my responsibility to obtain independent financial advice before entering into this Agreement to salary sacrifice. Page 1 of 2 Form updated July 2008
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Contact details
Website www.supersa.sa.gov.au Email supersa@saugov.sa.gov.au Telephone (08) 8207 2094 (for calls from within the State Government Network) or 1300 369 315 Fax (08) 8226 9790 Mail GPO Box 48, Adelaide SA 5001 Visit Ground Floor (enter from Pulteney Street) 151 Pirie Street ADELAIDE SA 5000
Please complete all the details on this form and forward it to your payroll office.
– My employer is not liable, either directly or indirectly, in respect of any matter concerning my contributions, unless such liability cannot be abrogated by statute. – By signing below, I will indemnify my employer from and against: – Any income tax or any other taxation liability whatsoever (including any administrative penalty, fine or other amount) that may become payable pursuant to any relevant taxation legislation and rulings – Any other liability whatsoever not otherwise described above, in respect of the contributions by my employer, which includes any information supplied by my employer including but not limited to the amount of the contributions and any matter not otherwise described herein, and – All charges, costs, damages, disbursements, fees, losses suffered or incurred by my employer in relation to any matter associated with the contributions by my employer. Signature Date / /
Please note that this form cannot be processed until you have signed the Employee Declaration above and forwarded it to your HR branch for completion of the Employer Declaration.
4. EMPLOYER DECLARATION (This section needs to be signed by your employer.)
The employer agrees and acknowledges as follows: – That upon the employee signing and delivering this Agreement to the employer, the employer will commence making the deductions and contributions for salary sacrifice only, as outlined in the Employee Declaration (section 3), subject to acknowledgement of the employee as Triple S member for salary sacrifice by the Super SA Board. Employer salary sacrifice delegate signature Employing Agency Payroll contact name Date Date faxed to Super SA Fax
Please complete all the details on this form and return it to Super SA. A copy of Schedule 2 must also be forwarded to Super SA with this form.
5. SUPER SA APPROvAL (Super SA use only)
Name of delegated officer Super ID Date Signature Date faxed to payroll
6. PAYROLL ACTION (Payroll use only)
Date payroll actioned Deductions commence PPE
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Form updated July 2008