PLUS Pension Plan change of personal details form

HOSTPLUS Pension Plan
change of personal details form
Complete this form if your contact details have changed or if you would like to change your nominated beneficiaries.
This form must be completed in full. Please use BLOCK letters and dark ink.
Step 1 Provide your old HOSTPLUS member details
*Mandatory fields
Please fill in all details to help us identify your account
Pension Plan membership number
Date of birth*
/
Title
Phone number
/
Given name(s)*
Surname*
Address*
Suburb
State
Postcode
Email
If you’d like to change your personal details, proceed to Step 2. Or to change your preferred beneficiary(ies), proceed to Step 4.
Don’t forget to sign the form over the page.
Step 2 Provide your new details (if required)
Change my contact details to:
Address
Suburb
State
Postcode
Change my email address to:
Change my phone number to:
Phone number (home)
Phone number (work)
Mobile number
Change my name to:
Title
Given name(s)
Surname
Important: For your change of name to be registered on our records you must provide documents listed in Step 3.
Step 3 Attach certified documentation (if applicable)
Changing your name or date
of birth?
How to certify a copy of a document
If you are changing your name or date of birth
please attach a certified copy of one of the
following as applicable:
Step 2Take the copy and the original document to
a person who is legally allowed to certify
documents.These people include:
• marriage certificate
• deed poll
• certificate to change name, or
• divorce certificate.
In addition to supplying one of the above,
please also attach certified copies of any two
of the following:
•current bill (eg. power bill)
showing your present address
• birth certificate
• bank statement
• marriage certificate (if not used already)
• driver’s licence
• passport.
If you’re changing your name, all documents need
to state the name you’re now using.
Step 1 Make a copy of the original document.
•chiropractor
•dentist
• nurse
• registered medical practitioner
• pharmacist
•psychologist
• veterinary surgeon
•legal practitioner, who is enrolled on the roll of
the Supreme Court of a State or Territory or the
High Court of Australia
•Australian Consular Officer or Australian
Diplomatic Officer (within the meaning of the
Consular Fees Act 1955)
•bank officer with two or more years of
continuous service
• judge of a court
• Justice of Peace
• magistrate
• minister of religion
•member of the Institute of Chartered
Accountants in Australia, the Australian Society
of Certified Practicing Accountants or the
National Institute of Accountants
• notary public
• officer with, or authorised representative of, a
holder of an Australian financial services licence,
having two or more years of continuous service
with one or more licensees
• permanent employee of the Australian Postal
Corporation with two or more years of
continuous service who is employed in an office
supplying postal services to the public
• police officer
• registrar, or deputy registrar, of a court
• teacher employed on a full-time basis at a school
or tertiary education institution.
Step 3Ask the person who’s certifying the
document to do the following:
• write in English on the copy ‘this is a certified
copy of the original’
• sign and print his or her name, address,
occupation, business telephone number and
registration number (if applicable)
• provide contact details.
Step 4 Change of nominated beneficiary(ies)
You can nominate more than four beneficiaries by attaching extra names to this form. You are able to nominate dependents (ie. spouse, child, financial dependent,
interdependent) or your legal personal representative as the person(s) you would prefer to receive your superannuation benefits in the event of your death.
Under the HOSTPLUS trust deed the trustee decides who receives your death benefit. However, the trustee will consider your nomination and other information
on dependents obtained when any claim is lodged.
Change my preferred nominated beneficiary(ies) to:
1. Given name
Middle initial(s)
Surname
Nature of relationship eg. spouse, child, etc.
2. Given name
Share %
Middle initial(s)
Surname
Nature of relationship eg. spouse, child, etc.
3. Given name
Share %
Middle initial(s)
Surname
Nature of relationship eg. spouse, child, etc.
4. Given name
Share %
Middle initial(s)
Surname
Nature of relationship eg. spouse, child, etc.
Share %
1
0
0
Make your decision binding
As a member of HOSTPLUS you also have the option to make a free death benefit nomination which generally legally binds HOSTPLUS to pay your death benefit
to the beneficiaries you have nominated – provided your nominees are eligible and the nomination is current. Please make sure you read our pension guide to find
more about who can be a beneficiary for the purposes of superannuation.
For your nomination to be effective, it is important that you keep it up to date, particularly if your family or marital circumstances change.
If you would like to make a binding death nomination you can download the brochure and nomination form at hostpluspension.com.au or call us on 1300 348 546.
Step 5 Sign the declaration
Nominated death beneficiaries
Declarations
It is your responsibility to inform your beneficiaries that you have provided
HOSTPLUS with their personal information. You should refer them to the
HOSTPLUS privacy policy at: www.hostplus.com.au/privacy
I, whose signature appears below, declare that:
Your Privacy
HOSTPLUS is seeking to collect personal information from you today so that
it may change your name, date of birth or beneficiaries on your HOSTPLUS
account. The personal information we are seeking to collect from you is your
name, address, date of birth, contact details, your beneficiaries and your
relationship with them. We need to collect the requested personal information
to update your details on your HOSTPLUS account. If you do not provide this
information, we will be unable to update your details. The HOSTPLUS privacy
policy is available on the HOSTPLUS website at hostplus.com.au/privacy and
includes information about overseas disclosure of personal information, how
you may access and seek correction of your personal information as well as
how you can make a complaint about a breach of your privacy.
HOSTPLUS usually discloses your personal information to our administrator
Superpartners, mail houses and the ATO. Superpartners may disclose your
personal information to overseas recipients.
General – relating to your HOSTPLUS account
• I declare that all details given in this application form are accurate and
complete and that I have the power to invest in HOSTPLUS.
• I undertake to provide the trustee with any further information it may request
relating to my HOSTPLUS membership and I will update the trustee if any of
the information provided changes.
Privacy declarations
• I have read and understood the HOSTPLUS privacy policy.
• I understand that it is my responsibility to inform my beneficiaries that I have
provided HOSTPLUS with their personal details and I should refer them to
the HOSTPLUS privacy policy.
• I consent to receiving information on new products, special offers and
promotions from HOSTPLUS, HOSTPLUS industry parties and associations
(direct marketing) unless advised otherwise by me.
Please see the Superpartners Privacy Policy at www.superpartners.com.au for
further information.
Signature*
Date*
/
/
Each application must have your original signature on it. Faxed, scanned or photocopied signatures cannot be processed.
When you have completed this form please send it to:
HOSTPLUS Pension Plan
Locked Bag 200
Carlton South VIC 3053
Issued by Host-Plus Pty Limited ABN 79 008 634 704, AFSL No. 244392, RSEL No. L0000093, RSE No. R1000054, MySuper No. 68657495890198
INH_0497 03/14