Australia

SUPERANNUATION
taxback.com, Suite 3, Level 13, 222 Pitt Street, Sydney, NSW 2000 1
CHECKLIST
1. Witnessed** Power of Attorney Form (page 3)
2. Beneft Claim Forms (pages 4-7)
3. Attach certifed* copies of the required passport pages
4. Attach certifed* copy of your 2
nd
Identifcation document(s)
5. Additional superannuation applications
If you are applying for more than one fund, you must complete every set of documents
separately for each fund.
Before submitting your documents, please ensure you have completed all elements of the checklist below.
*CERTIFICATION/WITNESSING GUIDELINES
How to certify documents?
To certify your documents please present them to an approved certifer to be certifed. The approved certifer must write
on the copies, on the same side as the photocopied image:
I certify that this is a true and correct copy of the original document which I have sighted
This must be followed by their signature, full name, contact address & phone number, occupation and place of employment,
identifying number (if applicable) and date of certifcation. The document must be stamped by the certifer where applicable.
The certifcation must be in English or accompanied by an accredited translation.
How to Witness the Power of Attorney form?
The person, who witnesses the Power of Attorney form, confrms that it was signed by you before him. The person should
sign and stamp the document. The authorized people who can witness the Power of Attorney form are listed below.
Who can certify/witness my documents?
Certifers must be employed in one of the following occupations: Member of the Police Force / Justice of the Peace /
Notary public officer / Bank manager / Judge of a court / Magistrate / Registar or deputy registar of a court / Australian
consular officer or an Australian diplomatic officer.

How much does certifcation cost?
Certifcation services can be free or a charge may apply.
To fnd your nearest taxback.com offce please visit: www.taxback.com/contactus.asp
Attach to your pack the signed and Witnessed** Power of Attorney form on page 3
Then post all documents to your nearest taxback.com offce.
Please just sign the Beneft Claim Forms (pages 4-7) . All signatures must match your passport signature.
1
Attach to your pack a certifed* copy of your passport. This copy must show your Australian visa, entry and exit stamps,
your signature and photo page.
2
Attach another certifed* copy of Identification (Eg: Driving licence, National Identification Card or Student card).
OR
Attach a certifed* copy of two of the following (from different banks): ATM Card, Visa, MasterCard, Diners Club
or American Express Card. If you have only one bank card, please attach a certifed copy of a bank
statement from the same bank.
3
4
5
INSTRUCTION FORM
Australia
SUPERANNUATION
taxback.com, Suite 3, Level 13, 222 Pitt Street, Sydney, NSW 2000 2
The person who is authorised to certify documents must sight the original and the copy to make
sure both documents are identical, and then make sure all pages have been certifed as shown
above. Each page that contains a copy of your documents must be certifed separately. The
approved certifer must write on the copies, on the same side as the photocopied image.
SAMPlE OF CERTIFIED IDENTIFICATION
S
A
M
P
L
E
Copy of the Identifcation card
of the individual.
Certifcation & signature of
authorised person.
Authorised persons stamp and
registration number (if applicable).
Name of authorised person.
Qualifcation of the
authorised person.
Contact details of the
authorised person.
Phone number of authorised
person.
Date of authorisation.
14 St. Stephen's Green
Dublin 2
Ireland
+353 1 887 1999
+353 1 887 1999
+353 1 670 6963
superclaims@taxback.com
0
6
1
3
5



6
0
6
7

1
1
/
0
9

Change of member details
Completing this section in full will help us identify your account.
Member number: Date of birth:
Title: Ms Mrs Miss Mr Dr
Other
Given name/s:
Family name:

Postal address:

Completing this section in full will help us administer your
account. Suitable certied proof must be supplied with
this form.
Member number: Date of birth:
Title: Ms Mrs Miss Mr Dr
Other
Given name/s:

Family name:

If your name has changed, provide your previous signature here:
Residential address:

Postal address (if different from residential):


Telephone number (home):

Telephone number (work):

Telephone number (mobile):

Email:
I nominate the below person(s) as my preferred beneciary(ies)
for the payment of my death benet in HESTA. I understand
my nomination will be used by the Trustee as a guide and the
Trustee is not bound by my nomination when exercising its
absolute discretion to pay my benet through HESTA.
Given name/s:
Family name:

Relationship of this person to me (e.g. spouse, child, etc.):

% of my super I would like HESTA
to consider paying this person: %
Given name/s:
Family name:

Relationship of this person to me (e.g. spouse, child, etc.):

% of my super I would like HESTA
to consider paying this person: %
Given name/s:
Family name:

Relationship of this person to me (e.g. spouse, child, etc.):

% of my super I would like HESTA
to consider paying this person: %
Total (must be a whole number and add up to 100%):
%
I declare that I have read all the information supplied and that
the above details are correct.
I understand that my personal information will be used in
accordance with HESTAs privacy policy.
Members signature:
Date:
1 Your previous member details with HESTA
This form enables existing HESTA members to update their account details. See page overleaf for instructions on how to complete it.
Complete all parts of this form in capital letters, using a black pen, and mail to HESTA, PO BOX 600, Carlton South Vic 3053.
Check that you have signed and dated the declaration and that all certied documentation is attached if applicable.
2 Your new details (see overleaf for more information)
3 Preferred beneciary(ies) (see over for details)
4 Declaration
Contact HESTA Free call 1800 813 327 www.hesta.com.au
Issued by H.E.S.T. Australia Limited ABN 66 006 818 695 AFSL No. 235249 Trustee of HESTA Super Fund ABN 64 971 749 321 SPIN HST0100AU
X X X X X
X X X X X
Street no. Street name
Suburb
State Postcode
D D M M Y Y Y Y
D D M M Y Y Y Y
Street no. Street name
Suburb
State Postcode
Street no. Street name
Suburb
State Postcode
An Industry
SuperFund
D D M M Y Y Y Y
XX
5
0
3
5


0
5
/
1
1
I am aware that as a member I have access to
nancial advice on my existing HESTA account
through HESTA Superannuation Advisers at no extra
cost
I understand if I transfer the full account balance of
my HESTA super to another super fund, any HESTA
insurance entitlements will cease
I understand I can apply for additional insurance
through HESTA that covers me 24 hours a day, seven
days a week
I am aware the HESTA Super Income Stream is
available for me to access income in retirement or
transition to retirement
I am aware I have access to transition-to-retirement
advice through HESTA Superannuation Advisers at
a xed dollar fee of $495, with no ongoing asset-
based or account-based advice fees
I understand this authority will apply until cancelled,
in writing, by me
Member signature:
Date:
D D M M Y Y Y Y
Return your completed form to:
HESTA Super Fund
PO Box 600
Carlton South VIC 3053
or
hesta@hesta.com.au
or
Fax: 1300 368 636
3 Declaration
Contact HESTA Free call 1800 813 327 hesta.com.au
Issued by H.E.S.T. Australia Limited ABN 66 006 818 695 AFSL No. 235249 Trustee of HESTA Super Fund ABN 64 971 749 321 SPIN HST0100AU
An Industry
SuperFund
Given name/s:
Family name:
Business name (if authorised person is a nancial adviser):
Business address:
Street no. Street name
Suburb
State/Territory Postcode
Authorised persons phone number:
Authorised persons signature:
Given name/s:
Family name:
Business name (if authorised person is a nancial adviser):
Business address:
Street no. Street name
Suburb
State/Territory Postcode
Authorised persons phone number:
Authorised persons signature:
4
5
XX