Lump sum withdrawal form - SUPERANNUATION LUMP SUM WITHDRAWAL AGED

							                                                                                                     Complete and return this form to:
                                                                                                     P O Box 182 Forest Hill VIC 3131
                                                                                                     Telephone: 1800 625 644
                                                                                                     Fax: 03 9877 7729
                                                                                                     Email: pension@superconcepts.com.au
                                                                                                     Online: www.superconcepts.com.au


                     SUPERANNUATION LUMP SUM WITHDRAWAL
                     AGED UNDER 60 ONLY
                     PLEASE USE BLOCK CAPITAL LETTERS WHEN COMPLETING THIS FORM




FUND NAME

____________________________________________________________________________________Superannuation Fund


Was the existing trust deed established or amended by Super Concepts?           If YES, Super Concepts Reference No: I___I___I___I___I___I___I


FUND TAX FILE NO.                 _________________________________                  FUND ABN           _________________________________



PAYG

Is the fund registered with the ATO for PAYG withholding tax?                  Yes         No



TRUSTEES


Full Name: Mr/Mrs/Ms ________________________________________________________________________________________________

Individual Trustee          or     Director of Trustee Company*


Full Name: Mr/Mrs/Ms ________________________________________________________________________________________________

Individual Trustee          or     Director of Trustee Company*


Full Name: Mr/Mrs/Ms ________________________________________________________________________________________________

Individual Trustee          or     Director of Trustee Company*


Full Name: Mr/Mrs/Ms ________________________________________________________________________________________________

Individual Trustee          or     Director of Trustee Company*



TRUSTEE COMPANY                   *if a Company acts as Trustee for the fund



Full Company Name: ___________________________________________________________________ ACN: _______________________



MEMBER WITHDRAWING LUMP SUM

Full Name: Mr/Mrs/Ms ____________________________________________________________________ Date of Birth: _____/_____/_____

Residential Address: _________________________________________________________________________________________________

Male                  Female                                    Tax File Number: ___________________________________________________


WITHDRAWAL DETAILS

Date of Payment: ___________/___________/___________                      Amount of Withdrawal: $ ______________________________________

Please indicate whether this is the sum you wish to receive:         Before tax is deducted        or       After tax is deducted


                                                    Attach separate sheet if insufficient space
INFORMATION TO BE PROVIDED
Superannuation lump sums consist of a tax-free and taxable component which is calculated as a percentage of the total value of a member’s
superannuation interest (member balance).

To establish the member balance, you will need to do one of the below:

            Have interim accounts prepared to the date of the withdrawal to establish the balance. (Super Concepts year end client only)
            OR
            Provide a member’s statement at the date of the withdrawal

Once this balance is calculated, the percentage of the two components will be applied to the withdrawal.


PAYMENT CONDITIONS
Please indicate which of the following conditions apply. A condition MUST be indicated. Penalties apply to improper early access to superannuation benefits

       The member is 55 years of age and under 60 and has                                                   The member wishes to comply with a Court Order or
       permanently ceased employment (including self-employment)                                            agreement as part of a family law property settlement.
       and does not intend to ever take up employment for ten or more                                       (Note: additional information will be required.
       hours per week;

       The member wishes to access the unrestricted non-preserved                                           The member has a transitional release order;
       portion of their benefit;

       The member is temporarily incapacitated;                                                             The member has a terminal illness;

       The member is permanently incapacitated;                                                             The member has died;

       Other (please specify): ________________________________________________________________________________________


EXPLANATORY NOTES
•     If the member is 55 years and under 60, the first $145,000 (2008/09 financial year) of a taxable component received by a member is tax
      free. Should the member’s required payment exceed the threshold, then the trustees are required to deduct and remit tax on the amount
      above the threshold to the Australian Taxation Office at the rate of 21.5%. Tax may be assessed by the ATO as a result of benefits already
      received but not required to be taken into account in our calculations.
•     Tax is payable at the rate of 21.5% or 31.5% for lump sum death benefits that are paid to non-dependants of any age. The rate of tax
      payable on the taxed component of the death benefit depends on whether it is from a taxed and untaxed source. No tax is payable where
      a lump sum death benefit is paid to dependants.


FEES                     Fees include GST

Super Concepts will provide documentation to deal with Lump Sum Withdrawals at a cost of:
•     Per benefit payment                                                                                                                                       $198
•     PAYG Withholding Tax Registration (if Registration not already in place)                                                                                   $77

PRIMARY CONTACT DETAILS
We will use the primary contact details below for billing, delivery and future contact purposes. If you wish to vary the contact details for either billing or delivery
please provide particulars separately.


Is the primary contact:      Trustee/Member                    Accountant                  Adviser                  Other        ____________________________

Name: Mr/Mrs/Ms ___________________________________________________________________________________________________

Company/Business (if applicable): _______________________________________________________________________________________

Dealer Group (if applicable): ____________________________________________________________________________________________

Address: __________________________________________________________________________________________________________

Phone: (     ) ___________________ Fax: (             ) _____________________ Email: __________________________________________________


NAME AND SIGNATURE OF PERSON AUTHORISING LUMP SUM WITHDRAWAL


Name: ____________________________________________ Date: _____/_____/_____ Signature: __________________________________


PRIVACY
Super Concepts Pty Ltd (ABN 67 007 437 907), a member of the ING group is committed to ensuring the confidentiality and security of your
personal information. Our Privacy Policy detailing how we manage personal information is available on request. If you wish to obtain a copy,
contact Super Concepts on 1800 625 644. Alternatively, you can visit our website at www.superconcepts.com.au
Oct08