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BT Protection Plans Ongoing Partial Rollover Request

Perforate PerforatePage 1 of 2 BTF33169 0420vxGPO Box 5467, Sydney NSW 2001, Australia Telephone 1300 553 764 Facsimile (02) 9274 5239 Email Funds Management Limited ABN 63 002 916 458 AFSL 233724 Retirement WrapABN 39 827 542 991, RSE R1001327By completing this form, you consent to the Rollover or transfer of part of the superannuation benefits from your nominated superannuation account to Retirement Wrap to occur each year on or after the policy renewal date for the annual premium amount on your Term Life as Superannuation and/or Income Protection as Superannuation insurance policy(ies).

Page 1 of 2 BTF33169_1218vx BT Protection Plans Ongoing Partial Rollover Request Westpac Securities Administration Limited ABN 77 000 049 472 AFSL 233731

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  Protection, Plan, Request, Partial, Ongoing, Rollovers, Protection plans ongoing partial rollover request

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