*SA007.

905EJ1*
Title Mr Mrs Ms Miss Other Date of birth / /
Given names

Surname

Residential address (must be provided)

Suburb State Postcode

Postal address (if different from above)

Suburb State Postcode

Daytime Telephone Mobile
- -
E-mail

Membership number

Pension Type (select an option

)
Account based pension
Transition to Retirement Pension
Step 1 Complete your personal details
Please pay the commutation as follows:
Option 1: PAY AS CASH (select an option

)
Full withdrawal (if available under the rules of the Scheme)
or
A partial withdrawal of $ , gross
Note that for Transition to Retirement Pensions, payment can only be made from your unrestricted non-preserved
component.
Please note that:
Paymenls will be paid eilher by cheque (in lhe name ol lhe accounl holder only) and sent to the address shown in
Step 1, or by EFT to the account where your regular pension payments are forwarded.
(select an option

)
I wish to have my withdrawal paid by:
Cheque
EFT
Tax may be payable on cash paymenls.
Step 2 Provide payment instructions
If you need help
For assistance call NGS Super Customer Service Team on 1300 133 177.
Please print in black or blue pen,
in uppercase, one character per box.
A
NGS Super Pension Division
Request for withdrawal
Issued by Non-Government Schools Superannuation Fund Pty Ltd ABN 46 003 491 487 AFSL No 233154 as Trustee of Non-Government Schools Superannuation Fund
ABN 73 549 180 515.
*SA007.905EJ2*
Option 2: ROLLOVER TO ANOTHER FUND (select an option

)
Full withdrawal (if available under the rules of the Scheme)
or
A partial withdrawal of $ ,
Name of fund


Fund address

Suburb

State Postcode

Cheque in lavour ol


Fund contact name

Fund contact number Fund type (select an option

)
- Lump Sum Annuity
Fund ABN*
- - -
SPIN*
-
Membership or Policy number*

* A transfer to another fund cannot occur without the ABN and SPIN or member/policy number of the Fund you are transferring to.
ll your rollover lund does nol have an A8N you will need lo conlacl lhe lund direclly lo requesl evidence ol lheir complying slalus,
such as their notice of compliance.
Option 3: ROLL-BACK TOTAL BENEFIT TO SUPER FUND ACCOUNT
Roll-back my total benet to NGS Super account number
*
.
Roll-back$ , to NGS Super account number
*
.
*
Note: If you do not have an active super account please complete and attach a Membership Application form.
Step 2 Provide payment instructions (continued)
Preserved portion of pensions cannot be withdrawn until the following conditions have been met:
You are al leasl 65 years ol age,
You are al leasl 60 years ol age and have ceased employmenl since allaining age 60,
OR
You are belween 55 and 60 years old, have ceased employmenl and have permanenlly relired lrom lhe worklorce.
Permanently retired is dened as never being gainfully employed again for more than 10 hours per week. Gainful employment
means employed or self-employed for gain or reward in any business, trade, profession, calling, occupation or employment.
If you are eligible, please complete one of the following declarations and attach proof of age to allow your benet payment
to be processed (e.g. certied photocopy of your drivers licence, passport or birth certicate).
(select an option

)
Yes, l am al leasl 55 years ol age, have ceased employmenl and inlend lo permanenlly relire lrom lhe worklorce.
Yes, l am al leasl 60 years ol age and l have ceased employmenl since allaining age 60.
Yes, l am al leasl 65 years ol age.
Step 3 Complete preservation declaration (to be completed
by Transition to Retirement Pensioners only)
*SA007.905EJ3*
By signing this form:
l have read and underslood lhis lorm
l undersland lhal lhe inlormalion conlained in lhis lorm will be handled by lhe lund lo process my pension wilhdrawal
l undersland lhal in processing my wilhdrawal, my personal inlormalion may be disclosed lo or accessed by lhe Truslee's
adminislralor, governmenl bodies and olher parlies as required, including lhe lruslees ol any olher lund l may lransler lo
and I consent to this handling of my personal information in this manner
l approve lhe deduclion ol any appropriale exil lees lrom lhe amounl paid subjecl lo legal reslriclions
l undersland lhal under Tax Ollce regulalions, l musl keep a copy ol lhis lorm lor lve (5) years lrom lhe dale compleled.
Signature Date

/ /
Please return your completed form to:
NGS Super,
GPO Box 4303,
Melbourne, VIC 3001.
For identication purposes, you MUST attach a certied copy of either your Drivers Licence or Passport (or acceptable
alternatives). See the Completing proof of identity section for details of certication and acceptable alternative documents.
Failure to provide appropriate proof of identication will result in delays in the processing of your payment(s).
Step 4 Attach proof of identity
Step 5 Sign the form
What you need to provide before your payment can be processed
Primary Photographic Identication
You will need lo provide a certied copy of one of the following primary identication documents:
Current Australian or foreign drivers licence containing a photo, address and signature
Auslralian passporl conlaining a pholo and signalure lhal is currenl or expired wilhin lhe lasl lwo years
Current foreign passport, or similar document issued for the purpose of international travel, containing a photo and signature
Current card issued under a State or Territory for the purpose of proving a persons age, including a photo
Current national identity card issued by a foreign government for the purpose of identication, containing a photo and signature
Secondary Identication
If you are unable to provide any primary identication, you will need to provide a certied document from each of the following lists:
Provide ONE of the following primary
non-photographic identication
documents:
birlh cerlilcale or birlh exlracl
citizenship certicate issued by the
Commonwealth
pension card issued by Centrelink that
entitles the person to nancial benets
AND ONE of the following secondary identication documents
containing your name and residential address:
letter from Centrelink (or other Government body) within the past
twelve months regarding a Government assistance payment
Tax Ollce Nolice ol Assessmenl issued wilhin lhe pasl lwelve monlhs
rates notice from local council issued within the past three months
electricity, gas or water bill issued within the past three months
What is a certied copy?
If you have chosen to have any amount paid as cash, the copy of the identication document provided MUST be certied as a true
and correct copy by a person authorised to do so. Please see below for information on how to, and who can, certify documents.
How to certify documents
After sighting the original and the copy and making sure both documents are identical, the certier must include on EACH page:
Written or stamped certied true copy
Signature and printed name
Date (the date of certication must be within twelve months prior to the date the form is received by us)
Qualication (such as Justice of the Peace, Australia Post employee, etc).
Who can certify documents in Australia
Any one of the following authorised persons can certify documents as being true and correct copies:
1. A person who is currently licensed or registered under a law to practice in one of the following occupations:
Chiropractor Dentist Legal practitioner Medical practitioner
Nurse Optometrist Patent attorney Pharmacist
Physiotherapist Psychologist Trade marks attorney Veterinary surgeon
2. A person enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a
legal practitioner
3. A person on the following list:
Australia Post Permanent Employee or Agent (who is currently employed with the post ofce & has at least two continuous
years of service or is in charge of supplying postal services to the public)
Australian Consular Ofcer or Australian Diplomatic Ofcer (within the meaning of the Consular Fees Act 1955)
Bailiff
Bank Ofcer, Building Society Ofcer or Credit Union Ofcer (with two or more continuous years of service)
Commissioner for Afdavits or Declarations
Fellow of the National Tax Accountants Association
Finance Company Ofcer (with two or more continuous years of service with one or more nance companies)
Justice of the Peace
Marriage celebrant (registered under Subdivision C of Division 1 of Part IV of the Marriage Act 1961)
continued over
Completing proof of identity
*SA007.905EJ3*
Member of Chartered Secretaries Australia
Member of Engineers Australia (other than at the grade of student)
Member of the Association of Taxation and Management Accountants
Member of the Australasian Institute of Mining and Metallurgy
Member of the Australian Defence Force (who is an ollcer, or a non-commissioned ollcer wilhin lhe meaning ol lhe
Defence Force Discipline Act 1982 with two or more years of continuous service or a warrant ofcer within the meaning of
that Act)
Member of the Institute of Chartered Accountants in Australia, the Australian Society of Certied Practising
Accountants or the National Institute of Accountants
Member of Commonwealth Parliament, State Parliament, Territory Legislature or a Local Government Authority
(State or Territory)
Minister of Religion (under Subdivision A of Division 1 of Part IV of the Marriage Act 1961)
Notary Public
Australia Post Permanent Employee (who is currently employed with the post ofce and has at least two continuous
years of service)
Permanent employee of the Commonwealth (or Commonwealth Authority) or a State or Territory (or State or Territory
Authority) or a Local Government Authority with two or more years of continuous service
Person before whom a statutory declaration may be made under the law of the State or Territory in which the
declaration is made
Police Ofcer or Sheriff
Teacher employed on a full-time basis at a school or tertiary education institution
Senior Executive Service Employee of the Commonwealth (or Commonwealth Authority) or a State or Territory (or State
or Territory Authority)
Court Ofcer:
- Registrar or Deputy Registrar of a Court
- Judge
- Clerk
- Magistrate
- Master of a Court
- Chiel Lxeculive Ollcer ol a Commonweallh Courl
4. Ofcer with, or Authorised Representative of an Australian Financial Services Licensee (who has had at least two years of
continuous service with one or more licensees)
Who can certify documents outside of Australia
an authorised staff member of an Australian Embassy, High Commission or Consulate
an authorised employee of the Australian Trade Commission who is in a country or place outside Australia
an authorised employee of the Commonwealth of Australia who is in a country or place outside Australia
a Member of the Australian Defence Force who is an ofcer or a non-commissioned ofcer with 5 or more years of
continuous service
a nolary public, subjecl lo approval by lhe lund AML/CTl Ollcer on a case by case basis. Please conlacl lhe lund lor advice
prior to obtaining a notary public certication.
Change of name or signing on behalf of another person
If you have changed your name or are signing on behalf of the applicant, you will need to provide a suitable certied supporting
document:
Purpose Suitable supporting document
Change of name Certied copy of marriage certicate, deed poll or change
of name certicate from the Births, Deaths and Marriages
Registration Ofce
Signed on behalf of the applicant Certied copy of guardianship papers or Power of Attorney
Completing proof of identity
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