Instructions and form for retirees and estate trustees
Application for direct
payment of government
super contributions
WHO COMPLETES THIS APPLICATION
You should complete this application if you want to request a
direct payment of superannuation co-contribution and/or low
income superannuation contribution.
You can only apply for a direct payment if one of the
following applies:
nyou have retired and don’t have an active, eligible account
nyou have retired due to permanent incapacity or invalidity
nyou are the legal personal representative authorised to
apply on behalf of a person who is eligible for the reason
listed above
nyou are the legal personal representative authorised to
apply on behalf of a deceased person.
An eligible account is an account in a complying
superannuation fund or a retirement savings account that
can accept government super contributions. ‘Risk only’
accounts that just provide a death benefit, defined benefit
interests and accounts from which you receive a super
income stream are all examples of accounts for which your
super fund cannot accept government super contributions.
If you do not meet the eligibility criteria, we can’t make a direct
payment – we can only pay your government superannuation
contribution to your super fund or retirement savings account.
NAT 10759-04.2013
To transfer your government super contributions to a
complying superannuation fund, you need to provide us
with the fund and account details. You can do this by:
nvisiting ato.gov.au/superseeker
ncompleting a Superannuation fund nomination form
(NAT 8676) and sending it to the address shown on
the form – this form is available from our website at
ato.gov.au, or you can phone 1300 720 092 to order
a copy.
Manage your super online
You can view and actively manage your super accounts online
at ato.gov.au/superseeker.
This service will provide you with details of the accounts
held by super funds, including account number and contact
details of the fund holding your account in addition to any
accounts held by the Australian Taxation Office (ATO) on your
behalf. This service will also enable you to:
ncomplete and submit a fund nomination form enabling the
transfer of any ATO held money to your super fund
nconsolidate your super fund-held accounts.
OUR COMMITMENT TO YOU
We are committed to providing you with accurate, consistent
and clear information to help you understand your rights and
entitlements and meet your obligations.
If you follow our information in this publication and it turns out
to be incorrect, or it is misleading and you make a mistake as
a result, we must still apply the law correctly. If that means you
owe us money, we must ask you to pay it but we will not charge
you a penalty. Also, if you acted reasonably and in good faith we
will not charge you interest.
If you make an honest mistake in trying to follow our information
in this publication and you owe us money as a result, we will
not charge you a penalty. However, we will ask you to pay
the money, and we may also charge you interest. If correcting
the mistake means we owe you money, we will pay it to you.
We will also pay you any interest you are entitled to.
If you feel that this publication does not fully cover your
circumstances, or you are unsure how it applies to you,
you can seek further assistance from us.
We regularly revise our publications to take account of any
changes to the law, so make sure that you have the latest
information. If you are unsure, you can check for more recent
information on our website at ato.gov.au or contact us.
This publication was current at April 2013.
© AUSTRALIAN TAXATION OFFICE FOR THE
COMMONWEALTH OF AUSTRALIA, 2013
You are free to copy, adapt, modify, transmit and distribute this material as
you wish (but not in any way that suggests the ATO or the Commonwealth
endorses you or any of your services or products).
MORE INFORMATION
For more information about government superannuation
contributions:
nvisit ato.gov.au
nphone us on 13 10 20 between 8.00am and 6.00pm
Monday to Friday
nwrite to us at
Australian Taxation Office
PO Box 3578
ALBURY NSW 2640
If you do not speak English well and need help from the
ATO, phone the Translating and Interpreting Service on
13 14 50.
If you are deaf, or have a hearing or speech impairment,
phone the ATO through the National Relay Service (NRS)
on the numbers listed below:
nTTY users, phone 13 36 77 and ask for the ATO number
you need
nSpeak and Listen (speech-to-speech relay) users, phone
1300 555 727 and ask for the ATO number you need
ninternet relay users, connect to the NRS on
relayservice.com.au and ask for the ATO number
you need.
PUBLISHED BY
Australian Taxation Office
Canberra
April 2013
JS 27357
HOW TO COMPLETE
THIS APPLICATION
SECTION A: REASON FOR APPLICATION
Question 1
Why are you applying for direct payment?
Place an ‘X’ in the applicable box.
Before we can pay the super co-contribution for a
deceased person, a final tax return must be lodged on their
behalf. We pay the super co-contribution directly to the
deceased person’s legal representative.
Your low income superannuation contribution payment will
still be assessed if you do not lodge an income tax return.
Question 4
Name
Provide your full name.
Have you changed your name?
If you have changed your name, you need to provide proof
of this change – for example, a marriage certificate, deed poll
or change of name certificate from the births, deaths and
marriages registration office of an Australian state or territory,
or equivalent in your country.
Question 5
Residential address
Provide your residential address.
Question 2
Indicate which government superannuation contribution you are
requesting a direct claim for.
Place an ‘X’ in the applicable box. Both low income
superannuation contribution and co-contribution boxes can
be marked.
SECTION B: RETIRED OR DECEASED
PERSON’S DETAILS
The retired or deceased person is the individual the
government superannuation contribution relates to. Provide
your details as they appear on your account, statement or
correspondence from us.
For more information about making this application on behalf
of a retired or deceased person, see section D on page 3 of
these instructions.
Question 3
Tax file number (TFN)
Question 6
Postal address
Provide your postal address.
If this is the same as your residential address, write
‘AS ABOVE’.
Question 7
Daytime phone number
Provide your daytime phone number, including the area code.
Question 8
Date of birth
Provide your date of birth.
Question 9
Correspondence reference number
Provide your correspondence reference number, if possible.
You will find the reference number on your request for super
fund nomination letter.
Your reference number is in the top right-hand corner.
Provide your TFN.
You don’t have to provide your TFN to us – however, if you do,
it will help us process your claim.
Application for direct payment of government super contributions
3
SECTION C: RETIRED OR DECEASED PERSON’S
SUPPORTING DOCUMENTATION
Place an ‘X’ in the applicable boxes.
You must provide certified copies of the relevant documents
to support your application.
Do not send original documents, and do not use pins
or staples.
All copied pages of original documents must be certified as true
and correct copies by one of the following:
nbarrister
ndoctor
njudge
nJustice of the Peace
nminister of religion who is authorised to celebrate marriages
npolice officer
nbank, building society or credit union officer with at least
five years service
nsheriff’s officer
nsolicitor.
They must sight the original document and the copy and
certify that each page is a true copy by writing or stamping
‘CERTIFIED TRUE COPY’, followed by:
ntheir signature
ntheir printed name
ntheir qualification (for example, Justice of the Peace) and
relevant reference number
nthe date.
If the person certifying the documents also acts as a
Commissioner for Declarations, they should also write their
qualification according to the approved list above, and not
in their role as a Commissioner for Declarations – otherwise,
we won’t be able to accept your application.
If you are outside Australia, you can take the original
documents to an Australian Embassy, High Commission or
Consulate. The staff can certify copies of these documents.
If you are unable to reach an Australian Embassy, High
Commission or Consulate, your documents can be certified
by a notary public, Justice of the Peace, judge of the court,
or registrar or deputy registrar of the court.
If neither of the above options is available to you, you
can send us copies bearing an apostille (certificate of
authenticity) if the issuing country is a signatory to the
Hague Apostille Convention. For more information on
copies bearing an apostille, visit our website at ato.gov.au
and search for ‘apostille’.
SECTION D: AUTHORISED PERSON’S DETAILS
If you are applying because you have retired, you don’t
need to complete this section.
Only complete this section if you are authorised to act as
a legal personal representative on behalf of a retired or
deceased person.
Question 10
Authorisation
Provide details of your authority to make this application on
behalf of the retired or deceased person – for example, if you
have a power of attorney, a probate, a notice of public trustee
or you are an estate trustee.
Question 11
Name
Provide your full name.
Question 12
Residential address
Provide your residential address.
Question 13
Postal address
Provide your postal address.
If this is the same as your residential address, write
‘AS ABOVE’.
Question 14
Daytime phone number
Provide your daytime phone number, including the area code.
4
Application for direct payment of government super contributions
SECTION E: AUTHORISED PERSON’S
SUPPORTING DOCUMENTATION
If you are applying because you have retired, you don’t
need to complete this section.
Place an ‘X’ in the applicable boxes.
If you are authorised to act on behalf of the retired or deceased
person, you must provide certified copies of the documents you
have marked on the list on page 3 of the application.
Do not send original documents, and do not use pins
or staples.
Have you changed your name since taking on this role?
If you have changed your name, you need to provide proof
of this change – for example, a marriage certificate, deed poll
or change of name certificate from the births, deaths and
marriages registration office of an Australian state or territory,
or equivalent in your country.
For more information about certifying copies of documents,
see section C on page 3 of these instructions.
SECTION F: ELECTRONIC FUNDS TRANSFER (EFT)
Direct refund
It’s faster and simpler to have your refund paid directly to your
Australian financial institution account. Complete your account
details on the form, even if you have provided them to us
previously. If you have changed your registered tax agent or
have a new account, check that you have completed the item
with the new details.
for an executor should only be provided if the correct paperwork
has been provided to support the claim.
Complete the following:
nprint the bank state branch (BSB) number. This six-digit
number identifies the financial institution. Do not include
spaces, dashes or hyphens in the number
nprint the account number. You cannot use an account number
with more than nine characters. Do not include spaces in the
account number
nprint the account name, as shown on the account records.
Do not print the account type – for example, savings,
cheque or mortgage offset. Joint accounts are acceptable.
The account name must not exceed 32 characters. If your
account name exceeds 32 characters, provide the first
32 characters of your account name in the spaces provided
– this figure includes spaces between each word and
between the initials in the account name.
SECTION G: DECLARATION
You need to complete one declaration – if you are applying
because you have retired, complete the retired person
declaration; if you are applying because you are authorised
to act on behalf of a retired or deceased person, complete
the authorised person declaration.
How to lodge your application
Keep a copy of this application for your records and send the
original, together with copies of your supporting documents,
to us at:
Australian Taxation Office
PO Box 3578
ALBURY NSW 2640
If you do not complete this item or do not have an
Australian financial institution account, a cheque will be
mailed to you.
When completing the EFT details, please ensure that you are
the claimant or eligible to receive the payment. If the claim is for
a deceased person, the EFT details must match the deceased
person, or their estate, or that of the executors. The EFT details
Application for direct payment of government super contributions
5
Application for direct payment of
government superannuation contributions
WHEN COMPLETING THIS APPLICATION
n Print
clearly in BLOCK LETTERS using a black pen.
n Place
n If
X in all applicable boxes.
a question does not apply, leave it blank.
not use whiteout or correction tape.
n Do
Section A: Reason for application
1
Why are you applying for direct payment?
You have retired, and don’t have an active, eligible account.
You have retired due to permanent incapacity or invalidity.
You are the legal personal representative authorised to apply on behalf of a person who is eligible for the reason listed above.
You are authorised to apply on behalf of a deceased person.
2
For which government super contribution are you requesting a direct payment?
Both low income superannuation contribution and co-contribution boxes can be marked.
low income superannuation contribution
co-contribution.
Section B: Retired or deceased person’s details
3
Tax file number (TFN)
We are authorised under the Taxation Administration Act 1953 to request your tax file number (TFN).
You are not obliged to provide your TFN – however, not doing so may cause delays in processing your application.
4Name
Title:
Mr
Mrs
Miss
Ms
Other
Family name
First given name
Other given name/s
If you have changed your name, you need to provide proof of this change.
5
Residential address
Suburb/town/locality
State/territory
(Australia only)
Country if other than Australia
NAT 10759-04.2013
Sensitive (when completed)
Postcode
(Australia only)
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6
Postal address
Suburb/town/locality
State/territory
(Australia only)
Country if other than Australia
7
Daytime phone number (including area code)
8
Date of birth
Day
9
Month
Postcode
(Australia only)
Year
Quote your correspondence reference number, if possible
Section C: Retired or deceased person’s supporting documentation
You must provide certified copies of the documents listed below to support your application.
See page 3 of the instructions.
Retired due to permanent incapacity or invalidity
a certificate from a legally qualified medical practitioner certifying that the disability is
likely to result in your inability to continue in your current vocation
AND
one of the following documents:
a letter from your superannuation fund certifying that they accept that you have met their
conditions for having your money withdrawn due to a disability
a statutory declaration stating that your superannuation fund has accepted that you have
met their conditions for having your money withdrawn due to a disability.
Retired having reached preservation age
You must provide either:
one of the following documents
Australian drivers licence issued under state or territory law
passport
OR
one of the following documents
birth certificate
citizenship certificate issued by the Australian Government
AND
one of the following documents
an Australian bank, credit union or building society account statement less than one year old that contains
your name and current home address that match the details on this application
a notice issued by Australian, state or territory government or local council within the past 12 months that contains
your name and residential address – for example, an ATO notice of assessment or a council rates notice.
Death
Provide the following documents:
a certified copy of the death certificate
a letter signed by the deceased estate trustee that advises of the person’s death.
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Sensitive (when completed)
Section D: Authorised person’s details
10Authorisation
In what capacity are you authorised to make this application on behalf of the retired or deceased person?
11Name
Title:
Mr
Mrs
Miss
Ms
Other
Family name
First given name
Other given name/s
12 Residential address
Suburb/town/locality
State/territory
(Australia only)
Country if other than Australia
Postcode
(Australia only)
13 Postal address
Suburb/town/locality
State/territory
(Australia only)
Country if other than Australia
Postcode
(Australia only)
14 Daytime phone number (including area code)
Section E: Authorised person’s supporting documentation
You must provide certified copies of documents as listed below to prove your authority to act on
behalf of the retired or deceased person.
One of the following documents:
Australian drivers licence issued under state or territory law
passport
birth certificate
citizenship certificate issued by the Australian Government
AND
one of the following documents (to prove your relationship with the retired or deceased person):
power of attorney
probate
notice of public trustee signed on behalf of the retired or deceased person
If you have changed your name since taking on this role, you need to provide proof of this change.
Sensitive (when completed)
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Section F: Electronic funds transfer (EFT)
Direct refund
Provide your financial institution details to have your refund paid directly to you.
It’s faster and simpler to have your refund paid in this way.
Write the BSB number, account number and account name below. See the instructions.
BSB code (must have six digits)
Account number (maximum of 9 digits)
Full account name – for example, JQ Citizen. Do not show the account type, such as cheque, savings, mortgage offset
Ensure that you are the claimant or eligible to receive the payment. If the claim is for a deceased person, the EFT details
must match the deceased person, or their estate, or that of the executors. The EFT details for an executor should only be
provided if the correct paperwork has been provided to support the claim.
Section G: Declaration
Complete and sign one of the following statements that applies to you.
RETIRED PERSON’S DECLARATION
I declare that the information given on this application is complete and correct.
Name (Print in BLOCK LETTERS)
Signature
Date
Day
Month
Year
OR
AUTHORISED PERSON’S DECLARATION
I declare that:
n this application has been prepared in accordance with the information supplied to me by the individual or entity identified
in this application
n I have received a declaration from the individual or entity identified in this application stating that the information provided
is true and correct
n I am authorised by the individual or entity identified in this application to submit this request to the Commissioner of Taxation.
Name (Print in BLOCK LETTERS)
Signature
Date
Day
Penalties may be imposed for giving false or
misleading information.
Month
Year
Send your completed application to us at:
Australian Taxation Office
PO Box 3578
ALBURY NSW 2640
Privacy information
We are authorised under the Superannuation (Government Co-contribution for Low Income Earners) Act 2003 to ask for
the information in this application. We need this information to help us administer the taxation and superannuation laws.
Where authorised by law to do so, we may give this information to other government agencies. These agencies could
include the Department of Human Services, law enforcement agencies and the Australian Bureau of Statistics.
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Sensitive (when completed)