Super/Pension account Payment request

1 Asgard Super/Pension Payment request | 1 of 6 Super/Pension accountPayment requestComplete this form in BLOCK LETTERS by typing directly into the form or using black pen, print and sign the completed form to us via one of the following methods: ask your adviser to lodge it on your behalf on AdviserNET submit a copy via our secure Document Upload facility on Investor Online or AdviserNET (accessed from Forms > Document Upload menu) post to Asgard, PO Box 7490, Cloisters Square WA 6850 email a copy to fax to (08) 9481 4834 If you submit this form online, you don t need to post us the original. However, if you re faxing or emailing and supporting documents are required, you ll also need to post us the original signed copy of this form along with original supporting documents. We can then finalise your Call our Customer Relations team on 1800 998 185 Monday to Friday, between and , Sydney time ( during daylight savings time) or email Privacy laws protect your privacy.

2 Read our Privacy Policy for more information. A copy can be obtained from our website at Generally your request will be finalised and Payment made within approximately 10 working days for partial Payment and 20 working days for full Payment once all our requirements are Have you signed and dated this form? Have you indicated an amount if you are making a partial withdrawal? Have you attached all your supporting documents if required? Power of Attorney original certified copy is required Guardianship original certified copy is required Identification Form including certified ID original certified copy is required Change of Name Marriage Certificate/Birth Certificate original certified copy is required Contribution Remittance advice original is required Additional Deposit advice original is required Notice of intent to claim or vary a deduction for super contributions form Court Orders original certified copy is required Separation Certificate/Employer letter on letterhead confirming cessation of employment original certified is required Permanent Incapacity Claim form original is required Terminal Medical Condition Claim form original is required ATO approval letter for accessing preserved benefitsImportant Information Before

3 Withdrawing monies, recontributing or closing your Superannuation or Pension account , please contact your adviser to discuss any changes to your account and refer to the current disclosure document to consider all implications and options available. If you are applying to access your benefits under Permanent Incapacity or Terminal Medical Condition please complete the additional relevant form and attach it to this request . Do not complete this form if you are applying for a release of funds under Severe Financial Hardship or as a Temporary Resident and have departed Australia. For Severe Financial Hardship, please complete the Financial Hardship application available from your financial adviser or our Customer Relations team. If you are a Temporary Resident and have departed Australia, please complete the Application for a departing Australia superannuation Payment form available from If you are making a cash withdrawal and didn t provide the necessary identification documents when opening your account (eg if your employer opened an account on your behalf): you will have a verification status of deferred until exit ; and to comply with Anti-Money Laundering and Counter-Terrorism Financing (AML/CTF) laws, you will need to complete and supply us with an Identification Form for Deferred Individuals (along with certified copies of identification documents).

4 For more information on our requirements, please refer to our Identification Form for Deferred Individuals available from our website at or call our Customer Relations team. If you are rolling over to a self managed super fund ( smsf ) you are required to provide certified copy of identification for each request to the smsf . If you are transferring some or all or your account balance to another existing Asgard super account in your name, please complete and attach an original Contribution Remittance/Rollover advice for the destination account . If you are transferring to an Investment account , please complete and attach an original Investment Additional Deposit advice . As this is not a superannuation account this transfer will be treated as a cash withdrawal and you must be able to have full access to your superannuation benefits or have unpreserved superannuation benefits.

5 If you have not supplied us with your tax file number, please complete the tax file number details in section 1. If you have an eWRAP or Infinity eWRAP account , please contact your financial adviser who will arrange your Payment Super/Pension Payment request | 2 of 61. account details mandatory sectionAccount number Date of birth | | Title Surname Given names Postal address State Postcode Phone (Business) Phone (Home) Phone (Mobile) Facsimile Email This is my new address and contact details, can you please update my account details for all future tax file number (TFN) is Under the Superannuation Industry (Supervision) Act 1993, we are authorised to collect your TFN, which will be used for legal purposes only.

6 This includes finding or identifying your super benefits in Asgard super , calculating tax on super payments and providing information to the ATO. These purposes may change in the future. We may disclose your TFN to another superannuation provider, when your benefits are being transferred, unless you ask us in writing not to disclose your TFN to any other superannuation provider. It is not an offence not to quote your TFN. However giving your TFN to your superannuation fund will have the following advantages (which may not otherwise apply): your superannuation fund will be able to accept all types of contributions to your account /s the tax on contributions to your superannuation account /s will not increase as a result of no TFN contributions tax other than the tax that may ordinarily apply, no additional tax will be deducted when you start drawing down your superannuation benefits, and it will make it much easier to trace different superannuation accounts in your name so that you receive all your superannuation benefits when you retire.

7 These advantages may change in the Payment amount mandatory sectionIf you intend to claim (or vary) a tax deduction for personal contributions made in the current or previous financial year, you must complete section 7 or vary a deduction for super contributions (Notice). If your Notice covers personal contributions included in your Payment , you will be unable to vary the notice to reduce the amount claimed as a deduction after the Payment has been made. If you are electing to rollover your benefits and no amount is indicated, we will close and roll all of your benefits. Pay my entire benefit and close my account Proceed to section 4 When we close your account we will cancel your insurance linked to your super account , unless you tell us to continue it at the time of final Payment . If you hold a suspended/frozen asset you have the option to cancel your insurance before the final Payment by completing an account amendment, rather than waiting until the final Payment is made for this to occur.

8 See section 6. (A continuation option is not available for Salary Continuance Insurance). If you are closing your account and hold a suspended/frozen asset we will automatically include you in any future redemption Pay my maximum benefit and leave $1000 in my account as I would like to keep my account open Fees may still Super/Pension Payment request | 3 of 62. Payment amount mandatory section (continued)OR Partial withdrawal (not an option for Term Allocated Pension) For super or Pre-retirement Pension accounts with a cash partial withdrawal please indicate the amount below, otherwise we will only pay out all of your unrestricted non preserved benefits. For partial rollovers, the order of cashing will be taken firstly from preserved, then restricted non-preserved and then unrestricted non-preserved benefits. If you are requesting a variation to this please advise us in writing at the time of this withdrawal.

9 If the amount indicated below will leave insufficient balance in your account to cover for any fees and costs payable, we will only pay the maximum balance available in your account . Pay the following amount: Gross/before tax (in words) $ , , . X X OR Net/after tax (in words) $ , , . X XOR Please pay my unrestricted non preserved benefits only For Pension accounts by indicating an amount in the partial withdrawal section you are electing to receive a lump sum for tax Payment source (this option is not available for Elements, SMA fund , Rollover Service or Corp super Service)Do you require funds to be taken from your share trading account ? Yes OR NoORIs this partial withdrawal to be funded from a specific managed investment(s)?

10 Yes, complete the section below. No Proceed to section 4 Product codeManaged Investment nameGross amount $Total Dollar based withdrawals should only be requested when you are withdrawing part of the nominated asset. Dollar based payments WILL NOT change the accounts portfolio profile percentage allocation. If your withdrawal is more than 95% of the value of the nominated managed investment, this investment will be fully redeemed and the balance remaining will be placed in your cash balance to be invested according to your current investment profile. 4. Payment optionsPlease complete at least one of the following options. Option 1: Transfer to another Asgard account If you don t currently have an open account , your financial adviser can open an account online for you, or you can complete and attach an application from a current Product Disclosure Statement.