ASGARD Transfer Authority - Asgard Wealth …

1 2. Your detailsTitleSurnameGiven NamesDate of Birth||Postal AddressStatePostcodePhone HomeBusinessMobileFacsimileEmailComplete this form in BLOCK LETTERS and:eIf this form relates to an employee Superannuation Account, post it to ASGARD employee Superannuation, PO Box 7461,Cloisters Square, Perth WA 6850If this form relates to any other Superannuation Account, post it to ASGARD , PO Box 7490, Cloisters Square, Perth WA 6850 Use a separate form for each fund being transferred We will accept photocopies with an original signatureNote:Privacy laws protect your privacy. Please read our Privacy Brochure for more information. A copy can be obtained from ASGARD Investor ASGARD Investor Services on 1800 998 185 or email AuthorityFund NamePolicy/Account NumberName of Administration Company/TrusteeAdministration Company s/Trustee s AddressStatePostcodePlease transferTotal Account ValueORPartial Account Value of$.

2 Amounts paid into the policy after 30 June 1983 that I have claimed as a tax $,,.If you are leaving an Employer, complete the details below:Name of Previous EmployerDate left Previous Employer||1. Details of fund to be transferredOFFICE USE ONLYA ccount Code-BA-011 of 2 I understand that: once benefits have been transferred, the Trustee of my previous fund is discharged from any further liability in respect of any amount in certain cases, ASGARD may be required by law to deduct tax from the untaxed portion, if any, of the Eligible Termination Payment I approved the deduction of Transfer fees, if any, from the benefits transferred (subject to legislative restrictions) transfers between funds are done at least every three ||x4.

3 SignatureAFGTRA120505 Please Transfer the amount shown above to ASGARD Capital Management Ltd as Trustee for the Account Type noted in section ASGARD Rollover Service is a complying approved deposit other Service and each of the Accounts is, or forms partof,a complying superannuation fund. ASGARD is acting on my behalf for this Transfer , and I authorise you to provide all relevantinformation to cheques payable to ASGARD (Account Type).3. Instructions to the Trustee of the transferor fundASGARD Capital Management Ltd ABN 92 009 279 592 Australian Financial Services Licence Number 240695 Investor Services 1800 998 185PO Box 7490, Cloisters Square, Perth WA 6850892 of 22. Your details (continued)Account Number Account type (tick one):Separately ManagedAccounts FundsSuper employee SuperAllocated PensionTerm Allocated PensionManaged ProfilesSuperEmployee SuperAllocated PensionTerm Allocated PensioneWRAPS uperAllocated PensionTerm Allocated PensionElementsSuperAllocated PensionTerm Allocated PensionOther ASGARD Accounts(tick one): ASGARD Rollover ServiceASGARD Corporate Superannuation Service TO WHOM IT MAY CONCERNCERTIFICATE OF COMPLIANCEWe certify that:1.

4 The ASGARD Superannuation Account, ASGARD employee Superannuation Account, ASGARD AllocatedPension Account, ASGARD Term Allocated Pension Account, ASGARD eWRAP Superannuation Account, ASGARD eWRAP Allocated Pension Account and ASGARD eWRAP Term Allocated Pension Account (each an Account ) together comprise a complying superannuation fund under Section 45 of the SuperannuationIndustry (Supervision) Act 1993 ( SIS ) Superannuation Fund Number 262 047 The ASGARD Superannuation Account (including the ASGARD Elements Superannuation Account)Superannuation Product Identification Number ( SPIN ) is ASG0002AU. The ASGARD Allocated PensionAccount (including the ASGARD Elements Allocated Pension Account) and ASGARD Term Allocated PensionAccount (including the ASGARD Elements Term Allocated Pension Account) SPIN is ASG0003AU.

5 TheASGARD employee Superannuation Account SPIN is ASG0007AU. The ASGARD eWRAP SuperannuationAccount SPIN is ASG0020AU. The ASGARD eWRAP Allocated Pension Account and ASGARDeWRAP TermAllocated Pension Account SPIN is ASGARD Corporate Superannuation Service ( ACSS ) is a complying superannuation fund under Section45 of SIS Superannuation Fund Number 135 386 940. The SPIN is The ASGARD Rollover Service ( ARS ) is a complying approved deposit fund under Section 47 of SIS the Superannuation Fund Number 161 663 940. The SPIN is The Trustee of the Accounts, ACSS and ARS is ASGARD Capital Management of the Accounts or ACSS have been directed by the Australian Prudential Regulation Authority to ceaseaccepting contributions under Section 63 of and on behalf of the TrusteeASGARD Capital Management LtdASGARDASGARD Capital Management LtdABN 92 009 279 592 Australian Financial Services Licence Number 240695A SEALCORP CompanySydneyLevel 12400 George StreetSydney NSW 2000 MelbourneLevel 41, ANZ Tower55 Collins StreetMelbourne VIC 3000 PerthLevel 38, Central Park152 St George s TerracePerth WA 6000 BrisbaneLevel 21, Central Plaza One345 Queen StreetBrisbane QLD 4000 AdelaideLevel 25, Santos House91 King William StreetAdelaide SA 50001800 998 18589