CSCriCSCretirementincome

Your Government Super at WorkAny financial product advice in this document is general advice only and has been prepared without taking account of your personal objectives, financial situation or needs. Before acting on any such general advice, you should consider the appropriateness of the advice, having regard to your own objectives, financial situation or needs. You may wish to consult a licensed financial advisor. You should obtain a copy of the CSCri and PSSap Product Disclosure Statement (PDS) and consider its contents before making any decision regarding your super.Commonwealth Superannuation Corporation (CSC) ABN: 48 882 817 243 AFSL: 238069 RSEL: L0001397 Commonwealth Superannuation Corporation retirement income (CSCri) is offered by CSC, the Trustee of the Public Sector Superannuation accumulation plan (PSSap) ABN: 65 127 917 725 RSE: R1004601 Industry Fund Services (IFS) ABN 54 007 016 195 AFSL 232514

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Apply for CSC retirement incomeFor CSS, PSS and PSSap members (including Ancillary)Use this form to apply to join Commonwealth Superannuation Corporation retirement income (CSCri) and receive a standard retirement income stream or a transition to retirement income stream.

Please complete this form using BLACK ink, in clear BLOCK LETTERS, and mark answers in boxes with an X.

Before making any decision you should read the CSCri Product Disclosure Statement (PDS) and the CSCri Financial Services Guide (FSG) issued by Commonwealth Superannuation Corporation (CSC), available at cscri.gov.au. As you may be set up as a PSSap member (for the purpose of consolidating multiple amounts), you should also read the PSSap Product Disclosure Statement (PDS) and the PSSap Financial Services Guide (FSG) issued by CSC, available at pssap.gov.au

Important information regarding your application > To join CSCri, you must be a member of Commonwealth Superannuation Scheme (CSS), Public Sector

Superannuation Scheme (PSS) or Public Sector Superannuation accumulation plan (PSSap) (including Ancillary) and meet a condition of release for your super savings.

> The minimum initial investment is $20,000. > We are required by law to collect and verify proof of identity documentation from you. These requirements

are explained in Section K of this form. > If you need help to complete this form, please call us on 1300 736 096. > For PSS and CSS members applying for a standard retirement income stream, we suggest you complete this

form when you complete your CSS or PSS benefit application form.

Consolidation of other super accountsIMPORTANT: If you are starting your CSCri account with multiple sources of funds or using personal funds only your amounts will be consolidated in PSSap and invested in the Cash Option. If you are not already a PSSap member, you will be set up with a temporary PSSap Ancillary membership for the purpose of accepting these amounts. You should also note that administration fees may apply to this account whilst open. More information is available in the PSSap PDS at pssap.gov.au. If you need to consolidate additional monies after your CSCri account has been established, please call us on 1300 736 096.

Expert financial advice for your situationBefore you make any decision about joining CSCri, we recommend you seek professional advice from a licensed financial planner, which takes into account your own objectives, financial situation and needs.

Commonwealth Superannuation Corporation has partnered with experienced financial planners from Industry Fund Services to make an advice service available to you.

For more information about this service, or to book your first advice appointment please call 1300 277 777 during business hours or visit csc.gov.au/advice

Checklist for your application > Have you provided your source of funds details for your starting balance? See Section C. > Have you provided your completed PSSap Transfer form if you wish to roll over from another super fund?

See Section C > Have you provided your Tax File Number? See Section H. > Have you attached your completed ATO Tax File Number Declaration form if under the age of 60? See Section I. > Have you nominated beneficiaries? See Section G. > Have you nominated a third party authority to enquire on your behalf? See Section J. > Have you attached your certified proof of identity? See Section K. > Have you signed and dated your application? See Section L. > Have you nominated to claim a tax deduction for contributions if required? See Section C.

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Section A – Provide your personal details

Title Mr Mrs Ms Miss Other

Surname

Given name(s)

Date of birthD D M M Y Y Y Y

/ /

Gender Male Female

PhoneBUSINESS HOURS AFTER HOURS

MOBILE

Residential address

SUBURB STATE POSTCODE

Postal address (if the same as your residential address, mark ‘AS ABOVE’)

SUBURB STATE POSTCODE

Email

@

Communication preference Post Email

Note: By nominating email you agree to receive the following via email: > electronic notification to access secure information (including your

Member Statement) electronically via CSCri Member Services Online at cscri.gov.au

> information about our products and services

and > notification to participate in member research.

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Section B – Confirm your eligibility

Please select all schemes that apply.

I am a CSS member and my AGS number is:

I am a PSS member and my AGS number is:

I am a PSSap (including Ancillary) member and my membership number is:

AND

Select which option applies to you. I am a contributing member (which means superannuation contributions

are currently being paid into my account)

OR

I am not a contributing member (I am a preserved member).

Please be aware that if you are not a contributing member, you are only eligible to consolidate monies for the purpose of setting up a CSCri account. All monies paid into the scheme, as indicated in Section C, will be used for the purpose of establishing your CSCri account.

AND

Select one income stream type only.

I wish to apply for a standard retirement income stream

I am age 65 or over

OR

I have reached my preservation age and have permanently retired from the workforce (ie I intend never again to become gainfully employed for 10 or more hours per week)

OR

I am age 60 or over and have ceased employment since turning 60

OR

I have met another condition of release (ie permanent incapacity)

OR

I wish to apply for a transition to retirement income stream

I am a current CSS, PSS or PSSap (including Ancillary) member and I have reached my preservation age but have not yet turned 65 and wish to receive my superannuation benefit in the form of a transition to retirement income stream

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Section C – Indicate your source of funds and starting balance

If you are starting your CSCri account with multiple sources of funds or from personal contributions only they will be consolidated in PSSap first and invested in the Cash Option during the consolidation process. If you are not already a PSSap member, you will be set up with a temporary PSSap Ancillary membership for the purpose of accepting these amounts. You should also note that administration fees may apply to this account whilst open. More information is available in the PSSap PDS at pssap.gov.au

Approximate opening balance to establish my CSCri account:

$

(this will be the sum of the amounts provided below)

Please use the following sources to establish my CSCri account:You may choose more than one source.

Note: You are required to contact PSS or CSS to initiate the transfer to CSCri.

Full balance of my PSS or CSS account, which is approximately:

$

Note: This can be an approximate amount as you may not know your exact benefit amount yet.

The following amount from my PSS or CSS account:

$

AND/OR

Full balance of PSSap (including Ancillary) account, which is approximately:

$

Note: By selecting this option your full PSSap account balance as at the day of processing will be transferred. Your account will be closed. If another employer contribution is received we will open a new PSSap account. Ancillary members are required to complete a new application for future salary sacrifice contributions.

Part of the balance of my PSSap (including Ancillary) account:

The following amount from my PSSap (including Ancillary) account:

$

I want to leave the minimum balance in my PSSap (including Ancillary) account and have the remaining balance used to establish my CSCri account which is approximately:

$

Note: If you are an existing PSSap member and wish to retain your account, you must keep the minimum amounts in your PSSap account:

> $1,000 for contributors including Ancillary members > $5,000 for non-contributing members.

Section C continued on next page

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AND/OR

Personal contribution

If over age 65, yes, I have met the work test.*

*You must work 40 hours over 30 consecutive days during the current financial year for us to accept your voluntary contribution. Once aged 75, we’re unable to accept a voluntary contribution from you

I have enclosed a cheque for:

$

Note: Enclose a cheque payable to ‘Public Sector Superannuation accumulation plan’ for [insert your name here] which is crossed ‘Not negotiable’.

Please ensure you understand the super contribution caps that apply to personal contributions. You can confirm the contribution caps at ato.gov.au. If you are claiming a tax deduction for personal contributions you will need to lodge a claim form with your super fund prior to commencing your CSCri pension. If you are unsure about this or would like a copy of the claim form, please call us on 1300 736 096.

AND/OR

Rollover an amount from another super fund.

Number of superannuation funds that CSCri will receive monies from:

Approximate total value of funds to be received by CSCri:

$

Section C continued on next page

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Transfer detailsProvide details of the fund you wish to transfer from (if transferring from more than one fund, please copy this page and provide for each fund you wish to transfer from). You will not need to complete this section if transferring from PSSap (including Ancillary), PSS or CSS. If you are using funds from PSS or CSS, do not complete this form, contact the scheme to initiate the Transfer.

FROM

Name of the fund you want to transfer your super from

Please provide the name exactly as per your last statement or contact the fund for the correct details.

Your Member/Client Identifier at the fund

ABN of fund

ABN = Australian Business Number

USI of fund

USI = Unique Superannuation IdentifierImportant: this transfer cannot be processed without the USI number

Phone number of fund

TO Public Sector Superannuation Accumulation Plan (PSSap)

USI: 65127917725001

ABN: 65 127 917 725

Ph: 1300 725 171

OR Commonwealth Superannuation Corporation retirement income (CSCri)

USI: 65127917725002

ABN: 65 127 917 725

Ph: 1300 736 096

Transfer values Whole amount (balance of my account)

A gross dollar amount of

$

Authorisation for transfer requests:By signing this request form I am making the following statements:

> I request and consent to the transfer of superannuation as described in this form

> the information I have provided on this form is true and correct

> I am aware that I may ask my superannuation provider for information about any fees or charges that may apply, or any other information about the effect this transfer may have on my benefits, including insurance cover, and have obtained or do not require such information

> I have read the CSCri PDS, and this application is made subject to the terms and conditions of that information

> I authorise PSSap to contact the fund named on this form in order to obtain information relating to this transfer request.

> I consent to my Tax File Number being disclosed for authorised purposes

> I am aware and agree that any amounts received during the consolidation process will be invested in the Cash option.

> once my benefits have been transferred from the fund named on this form, the Trustee of that fund is discharged from any further liability for the amount transferred.

SIGNATUREDate signed

D D M M Y Y Y Y

/ /

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Section D – Choose your investment option or mix of options

You can choose one or a mix of four investment options to invest your CSCri account balance. If you do not make a choice, you will be automatically invested in the default option, which is Income Focused.

Please invest my account balance in the following option or mix of options:

Cash %

Income Focused (default option)

%

Balanced %

Aggressive %

Total 100%

Ensure your total percentage equals 100% and your selection is in whole percentages only.

Note: You can change your investment options at any time using your secure CSCri Member Services Online account area or by sending us your completed Change your account details form available at cscri.gov.au. A fee may apply. For more information, please refer to your CSCri PDS which is also available to view and download at cscri.gov.au

Section E – Select your income stream payment order (if investing in two or more investment options)

Only complete this section if you wish to invest in two or more investment options. If you do not complete this section, your income stream payments will draw down using method (1) below. Select one method only.

Please pay my income stream using my selected income stream payment method:

(1) Pro-rata method (default) You elect your income stream payments to be withdrawn from each investment option you selected in Section D in proportion to the balance in each investment option at the time of the withdrawal.

OR

(2) Proportional method You specify (below) the proportion to be withdrawn from each of the investment options you selected in Section D.

Cash %

Income Focused (default option)

%

Balanced %

Aggressive %

Total 100%

OR

(3) Priority method You specify (below) the order of investment options from which your income stream payments are to be withdrawn from the investment options you selected in Section D.

Please number options below, 1-4.

Cash

Income Focused (default option)

Balanced

Aggressive

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Section F – Provide your income stream payment details

Deposit my income stream payments into the following bank account:

Name(s) in which your account is held

Bank/financial institution

BSB –

Account number

Note: Your income stream payments can only be deposited into an account held in your name or jointly in your name. Any Australian financial institution with a BSB number will be accepted. CSCri will not be liable for any errors that occur based on the account details you provide.

Pay my first income stream payment in the following month:

Note: If you do not make a selection, we will commence your income stream payment the next available pay run. Fortnightly payments are generally paid to your bank account every second Thursday (subject to how long your bank takes to process the payment).

If you elect a monthly, quarterly, half yearly or annual payment frequency – payments are paid regularly to your bank account, generally on the 21st day of the month in which the payment is due. If the 21st day of the month falls on a weekend or public holiday, your income stream payment will generally be made on the last business day that precedes the 21st day of the month.

I wish to be paid my income stream:(please select one only)

Note: If you do not make a selection, we will establish your income stream with monthly payments.

Fortnightly

Monthly

Quarterly

Half yearly

Annually

I wish to receive the gross income stream amount per payment of:(please select one only)

Note: If you do not make a selection, we will establish your income stream with your minimum payment amount.

Minimum allowed under legislation

Maximum allowed under legislation (for a transition to retirement income stream only; the maximum amount is not pro-rated in your first year)

Other (please nominate an amount to the nearest dollar)

$

Note: The amount you list above must be within the minimum and maximum (if applicable) amounts permitted under law. For more information refer to your CSCri PDS, which is available to view and download at cscri.gov.au

Section G – Nominate your reversionary beneficiary

Select how you wish to nominate your beneficiaries. Select one option only.Note: Section 7 of the CSCri PDS provides detailed information on the different types of beneficiary nominations – non-binding, binding or reversionary.

Reversionary beneficiary (please provide their details below)Nominating a reversionary beneficiary means that if you die, your income stream will continue to be paid to your nominated dependant until the benefit is reduced to nil or commuted.

Title Mr Mrs Ms Miss Other

Surname

Given name(s)

Date of birthD D M M Y Y Y Y

/ /

Gender Male FemaleSection G continued on next page

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Relationship to you

OR

Binding nominationUse the Nominate your beneficiaries form available at cscri.gov.au

OR

Non-binding nominationUse the Nominate your beneficiaries form available at cscri.gov.au. Alternatively you can make a non-binding nomination using CSCri Member Services Online. To register, visit cscri.gov.au once we confirm your CSCri account is established.

Section H – Provide your Tax File Number

Tax File Number

Note: We are authorised to collect your Tax File Number (TFN) under the Superannuation Industry (Supervision) Act 1993. You are not obliged to disclose your TFN, but if you do not we may not be able to consolidate your superannuation and your income stream payments may be subject to a higher tax rate.

Section I – Complete your Tax File Number declaration

If you are under age 60, you will need to complete an ATO Tax File Number Declaration form to reduce the PAYG tax withheld from your income stream payments by the tax offset and/or tax-free threshold. If you do not submit this form, PAYG tax will be deducted from your taxable income stream payments at the highest marginal tax rate plus the Medicare levy as required by current tax rules. You can download this form at cscri.gov.au or contact us on 1300 736 096.

If you wish to reduce the PAYG tax withheld, you must lodge the claim form before you start your CSCri or lodge it with this application.

Are you under age 60? No (please go to Section J)

Yes

AND my completed ATO Tax File Number Declaration form is attached

OR my completed ATO Tax File Number Declaration form was sent to CSCri on

D D M M Y Y Y Y

/ /

Section J – Nominate a third party authority

Use this section if you wish to authorise a financial planner (such as an Industry Fund Services financial planner) or other third party to enquire on your behalf in respect of your CSCri.

I nominate the following financial planner/third party representative(s):Company name (if applicable)

Name of representative

Date of birthD D M M Y Y Y Y

/ /

Email

@

Phone BUSINESS HOURS MOBILE NUMBER

Postal address

SUBURB STATE POSTCODE

If you wish to nominate more than one third party authority, please provide their details on a separate sheet and enclose it with your completed application form.

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Section K – Provide proof of identity

Note: To protect your account against fraud, money laundering and terrorism financing, under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006, you must complete a ‘100 point check’ and attach the following certified documents:

Primary documents (70 points)Provide ONE of the following certified documents:

> birth certificate > birth card issued by the NSW Registry of Births, Deaths and Marriages > Australian Citizenship certificate > a current passport > an expired passport which has not been cancelled and was current within the preceding two years > another document of identity having the same characteristics as a passport (eg this may include some

diplomatic documents and some documents issued to refugees).

Note: You do not accumulate additional points for more than one document from this category.

Secondary documents (40 points)Provide ONE of the following certified documents containing your photograph and/or signature:

> An Australian driver’s license or another licence or permit issued under a law of the Commonwealth, a State or Territory

> An identification card issued to a public employee > An identification card issued by the Commonwealth, a State or Territory as evidence of your entitlement

to a financial benefit > A student ID issued by a tertiary education institution.

Note: Additional documents from this category can be awarded 25 points.

Tertiary documents (if required) (25 points)Provide a certified identification document, eg marriage certificate (for maiden name only), credit card, council rates notice, telephone account, foreign driver’s licence, Medicare card, etc.

Note: More than one document may be counted, but points from a particular source may be counted only once (eg if a MasterCard and Visa card are issued from the same financial institution, only one may be counted).

Certifying your documentsThe following people can certify your documents:

> a legal practitioner enrolled on the roll of a supreme court or the high court of Australia > a judge or magistrate of a court > a chief executive officer of a Commonwealth court > a registrar or deputy registrar of a court > a Justice of the Peace (JP) > a notary public > a police officer > an Australian consular officer or an Australian diplomatic officer > an agent or a permanent employee of the Australian Postal Corporation with two or more years of

continuous service in an office supplying postal services to the public > a finance company officer with five or more years of continuous service with one or more finance companies > a person employed by, or an authorised representative of, the holder of an Australian financial services

licence with five or more continuous years of service > a member of the Institute of Chartered Accountants of Australia (ICA), Certified Practicing Accountants

(CPA Australia) or the National Institute of Chartered Accountants (NIA).

For a full list of certifying authorities, visit the Legislation website at legislation.gov.au

The certifying authority must confirm in writing that you are the valid holder of the identification that you are presenting and that any copies are true copies of the original. The certification must include the name, address, occupation, telephone number and registration number (if applicable) of the certifying authority.

emailmembers@cscri.com.au

webcscri.gov.au

phone1300 736 096

overseas callers+61 2 4298 6052

financial advice1300 277 777

fax1300 304 241

postCSCri Locked Bag 8840 Wollongong NSW 2500

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Section L – Declaration

Note: Before you sign this form, you must read the CSCri FSG and CSCri PDS which contains important information about the features, costs, benefits and risks of investing in this product. They will help you to decide if it is appropriate for your own objectives, financial situation and needs.

I declare that: > the information shown on this application is true and correct > I will provide Commonwealth Superannuation Corporation, the trustee of Public Sector Superannuation

accumulation plan (PSSap) through which CSCri is offered, within a reasonable period with any information it may request relating to my membership of an Australian Government public sector scheme and update information provided in this application

> I have read the CSCri PDS and CSCri FSG, and this application is made subject to the terms and conditions of that information

> I understand and acknowledge that if I am not already a PSSap member (including Ancillary) and I am commencing my CSCri account using multiple sources or using only personal contributions, I will require a PSSap Ancillary account to be opened to accept these monies (in the Cash option) and will be subject to fees and costs associated with this.

> I have read the PSSap PDS and PSSap FSG, and this application is made subject to the terms and conditions of that information

> I understand and accept that no party associated with CSCri guarantees the performance of the investment options in CSCri

> I understand that there are super contribution caps that apply to personal contributions and that CSCri is not liable for payment of any remedies caused by the member exceeding their contribution cap

> I understand that the investment option or mix of options I have selected in this application will remain in place until I make a subsequent investment choice and it is processed

> I authorise the third party listed in Section H (if completed) to make enquires about my CSCri > I am aware and agree that Commonwealth Superannuation Corporation will have records of my personal

information and consent to the use of my information to: > confirm my identity > administer my superannuation > manage my superannuation investments > meet regulatory requirements

and > conduct market research and product development.

> I acknowledge Commonwealth Superannuation Corporation has recommended that I obtain financial advice > I am applying to become a member of CSCri and if accepted as a member, I agree to be bound by the Trust

Deed that governs the Fund.

> I am aware that personal information I or a third party provide, such as my employer, is collected, held, used and disclosed as required or authorised by law in accordance with the privacy policies and notice, available via cscri.gov.au or by contacting us on 1300 736 096, for the purpose of managing my super. This includes the management of superannuation investments, providing me with superannuation products and information, the administration of my account, conducting market research and product development. The privacy policies and notice contain important information about how personal information is handled, including rights to access and update that information and how a complaint about a breach of privacy can be made.

SIGNATUREDate signed

D D M M Y Y Y Y

/ /

Please review the checklist at the start to ensure your application is complete.

Please send this form, with your certified proof of identity documentation and ATO Tax File Number declaration form (if applicable) to:

CSCri Locked Bag 8840 Wollongong NSW 2500