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