Rollouts or Member Balance Requests

Name of Person Completing this Form*

First Last

Email Address*

A confirmatory email will be sent to this address on successful submission of this form.

Are you completing this form on behalf of the adviser?*

Yes
No

Adviser Name*

The adviser will receive a copy on submission.

First Last

Adviser Email*

Fund Name*

PLEASE NOTE: We can only complete this request for funds we are the administrator for.

Member Name*

Request:

Rollover Benefit Statement (rollout)
Member Statement

Date the Rollover Benefit Statement or Member Statement is required*

Do you require a Centrelink Schedule as at this date also?*

Yes
No

Receiving Fund Name*

Receiving Fund ABN*

Receiving Fund USI*

Member Number in receiving Fund*

Receiving Fund postal address*

Full or Partial Rollover*

Full account balance
Partial account balance

Check*

You must ensure that, if there is a pension in force, the minimum amount has been paid and/or if a personal deductible contribution has been made, that a Notice of Intent has been lodged and responded to.

Acknowledged

If partial, please provide amount to be rolled over:*

Is this member ceasing as member and Trustee/ Director for the fund?*

There may be additional costs if a Change of Trustee is required.

Yes
No

We may need additional items*

Have you reviewed and supplied the following where missing. Details of any unmatched cash items, bank statements for any non-feeding bank accounts for the requiste period, or for any share platforms/wrap accounts, income reports from 1 July, investment transaction history, realised and/or unrealised capital gains reports, that all contributions, pensions or lump sums have been correctly allocated.

Yes, to the best of my knowledge.
No, information is being provided shortly.

Rollouts or Member Balance Requests

If you have any questions please do not hesitate to contact us on 1300 809 933.

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