Application to split superannuation contributions2010423225

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					Application to split
superannuation contributions
VALID FROM 1 NOVEMBER 2009


  Please complete this form in BLACK PEN and CAPITAL LETTERS.                  your member No.

  Complete this form if you wish to apply to split certain superannuation contributions with your spouse.
  Follow the steps to fill in the superannuation contribution splitting application:
  STEP 1: Fund member to complete Sections 1, 2, 3 and 4, and STEP 2: Receiving spouse to complete the declaration in Section 5.
  Please read ‘Notes to applicants’ overleaf for more detailed information.
  Complete the form carefully, sign and date the form and return it to the address below.


  Section 1: Fund member details
  Complete Section 1 in full with your details.
  Mr/Mrs/Ms/Miss/Dr                                        Gender                                              Date of birth (DD/MM/YYYY)

                                                                 Male         Female                                      /          /
  Surname


  Given names


  Postal address


                                                                                                                  State                  Postcode


  Daytime contact telephone number                              Email address
  (           )


  Section 2: Receiving spouse details
  Please complete Section 2 in full with your spouse’s details.
  Please note if your spouse is not currently a member of Media                  you lodge the superannuation contribution splitting application.
  Super and they would like to direct the contribution split payment             Entering the ABN or SFN of your spouse’s superannuation fund will help
  to Media Super, they must join Media Super. To join, your spouse               Media Super to identify the correct superannuation fund and account
  will need to complete a member application form, available in the              to receive the split contributions. The fund’s ABN and/or SPIN will be
  back of the member booklet (Product disclosure Statement). For                 shown on its Product Disclosure Statement or member statements.
  more information, visit www.mediasuper.com.au/joinmediasuper                   Fill in your spouse’s member account number. This is the account which
  or phone 1800 640 886.                                                         will receive the contributions. Please ensure that this account is active.
  Your spouse must have a superannuation account in place before                 Your spouse can check these details with their superannuation fund.
  Mr/Mrs/Ms/Miss/Dr                                        Gender                                              Date of birth (DD/MM/YYYY)

                                                                 Male         Female                                      /          /
  Surname


  Given names


  Postal address


                                                                                                                  State                  Postcode


  Daytime contact telephone number
  (           )
  Email address


  Name of spouse’s superannuation fund


  Spouse’s member number                                                  Fund’s Superannuation Fund No. (SFN)


  Fund’s Superannuation Product Identification No. (SPIN)                 Fund’s Australian Business No. (ABN)
                                                                                                                                                              MSUP 30298




Issued by the Trustee of Media Super, Media Super Limited, ABN 30 059 502 948, AFSL 230254

Please return completed form to:
                                                                                                                                               Page 1 oF 2
Media Super, Locked Bag 1229, Wollongong NSW 2500
Application to split super contributions (cont.)
 Section 3: Contributions splitting details
 Fill in the nominated details below.
 Please indicate the financial year applicable, and enter either the dollar amount or the percentage of concessional contributions you
 are applying to split to your spouse’s superannuation account.
 You cannot nominate to split more than 85% of the total concessional contributions made to your superannuation fund during the relevant
 financial year. If the nominated amount exceeds 85%, your application will be invalid.
 If you are self-employed and you intend to split any contributions, you must first lodge an ATO Section 290-170 form (you can only split
 concessional contributions) with the Media Super Trustee before you lodge an application to split contributions.

 Financial year ending                                Concessional contributions to be split*
  3    0 / 0        6 /                               Dollar amount: $                     .                .            OR Percentage                      %
 * You must split a minimum of $1,000, and your account balance must be not less than $5,000 after the split.


 Section 4: Fund member request and declaration
 Please complete the member declaration in full. Please have your spouse complete Section 5.
 Read the declaration. If it is correct, print your full name and sign and date the declaration below:
 •	 I have read and understood the Privacy Collection Statement in the Media Super Product Disclosure Statement and consent to the
    Trustee collecting, using, disclosing and storing my personal information in accordance with the Privacy Collection Statement.
 •	 I request that you split the contributions detailed in Section 3 to the superannuation account of my spouse, as detailed in Section 2.
 •	 I declare that the information provided on this form is correct.
 Member name


 Applicant’s signature
                                                                                                                    Date (DD/MM/YYYY)
  x                                                                                                                          /           /


 Section 5: Receiving spouse declaration
 Please have your spouse complete the receiving spouse declaration in full.
 •	 I have read and understood the Privacy Policy in the Media Super Product Disclosure Statement and consent to the Trustee collecting,
    using, disclosing and storing my personal information in accordance with the Privacy Collection Statement.
 •	 I declare that at the date of this application, I am the spouse of the applicant and I am aged less than my superannuation preservation
    age (currently 55), oR I am aged between my preservation age and 65 years and have not retired from the workforce.
 Spouse’s name


 Spouse’s signature
                                                                                                                    Date (DD/MM/YYYY)
  x                                                                                                                          /           /


 Notes to applicants
 What iS SuPeRaNNuatioN CoNtRibutioN SPlittiNg?                                     Please note that in order for your application to be accepted, your
                                                                                    spouse must:
 Superannuation contribution splitting is offered by Media Super. It means
 that a member can elect to split certain superannuation contributions              •	 be aged less than their preservation age, or
 with their spouse. Further information regarding superannuation                    •	 be aged between their preservation age and 65 years and have not
 contributions splitting can be found in the Media Super Product                      retired from the workforce.
 Disclosure Statement which is available from the Media Super website
 www.mediasuper.com.au or from Customer Service 1800 640 886.                       WheN do i Need to lodge my aPPliCatioN?
 You are able to nominate a maximum of 85% of the total concessional                Your application to split contributions for a particular financial year must
 contributions received on your behalf in the relevant period, which includes:      be received before the end of the following financial year.
 •	 employer contributions (including salary sacrifice contributions)               For example, you may apply to split contributions for the year 1 July
 •	 personal contributions for which an income tax deduction is to be claimed       2009 to 30 June 2010 any time up to 30 June 2011. However, if you elect
                                                                                    to transfer your full benefit to another fund during a financial year, you
 •	 superannuation holding accounts (SHA) special account amounts                   may request to split contributions made during that financial year at the
   transferred to your superannuation account by the Australian Taxation            time of requesting the transfer.
   Office on or after 1 January 2006, and
                                                                                    Please note that any contributions split amount transferred to a Media
 •	 allocated surplus contribution amounts.                                         Super account will not be subject to any fee. A withdrawal fee of $30
 Please note that your nominated amount of concessional contributions               will be applied only where the contribution split is to be transferred to a
 must not exceed the maximum 85% limit, or your application will be                 superannuation fund other than Media Super.
 invalid.                                                                           Both you and your spouse will be notified in writing once your
 Under Government legislation, you may only make one application to                 application to split contributions has been approved.
 split your superannuation contributions in any financial year.


Please return completed form to:
                                                                                                                                                     Page 2 oF 2
Media Super, Locked Bag 1229, Wollongong NSW 2500

				
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Description: Application to split superannuation contributions2010423225