MEMBER VOLUNTARY
CONTRIBUTION
Complete this form if you want to make a one-off member voluntary contribution or make
regular contributions by direct debit.
This form authorises Kinetic Super to obtain contributions from your bank account.
IMPORTANT
Member Voluntary Contributions (personal after-tax) can only be accepted if you have provided your
Tax File Number (TFN).
You may be eligible for the Government Co-Contribution, caps also apply to how much you can
contribute, please go to ato.gov.au for further information.
Please complete all relevant sections using CAPITAL LETTERS and a BLACK pen
Step 1 - Your personal details
Kinetic Super member number
Male
Surname
Female
Title
Date of birth DDMMYYYY
Given names
Residential address (compulsory)
Unit/Street number
Street name
Suburb/City/Town
State/Territory
Postcode
State/Territory
Postcode
Postal address – if different to residential
Unit/Street number/PO Box
Street name
Suburb/City/Town
Contact details
Mobile
Home
Email
If the information requested is not provided, we may not be able to complete your request.
Providing your mobile number or email address means that you consent to receive communications (including marketing communications) by
SMS or email in relation to your account, Kinetic Superannuation Fund or special offers from third parties to Fund members.
You can opt-out of this service at any time. If you would like to opt out of this service please (cross )
You may also receive marketing communications by postal mail.
If you do not wish to receive marketing communications by postal mail please (cross )
954.5 09/14 ISS4 Issued on 9 September 2014 by Kinetic Superannuation Ltd (KSL) (ABN 14 056 917 303 AFSL 222590 RSE L0000352) as Trustee
of Kinetic Superannuation Fund (KSF) (ABN 78 984 178 687 RSE R1000429), which includes Kinetic Smart Pension (KSP).
Kinetic Super | Member Voluntary Contribution
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Step 2 - Tax file number (TFN)
The Fund is authorised to seek your TFN under the Superannuation
Industry (Supervision) Act 1993.
YOU DON’T HAVE TO PROVIDE YOUR TFN, HOWEVER IF
WE DO NOT HAVE YOUR TFN, WE MAY NOT BE ABLE TO
ACCEPT A DIRECT DEBIT REQUEST OR YOUR MEMBER
VOLUNTARY CONTRIBUTIONS.
Your Tax File Number (TFN) will only be used for lawful purposes, which may change in the future as a result of legislative change. It is not an
offence not to quote your TFN. However, if you don’t provide your TFN higher tax will apply to your concessional contributions, we can’t accept
after-tax member contributions from you, the tax on super benefits paid to you may be higher and it may be more difficult to locate any lost
super benefits or consolidate your super.
For further information, please refer to the Kinetic Super Product Disclosure Statement (PDS) available at kineticsuper.com.au or on request by
calling 1300 304 000.
My TFN is
I do not wish to provide my TFN
I have already provided my TFN
Step 3 - Payment options
I would like to make a:
Please select one option below (cross ).
One-off payment of
$
(attach a cheque made payable to Kinetic Super)
.
Regular direct debit payment (complete Step 4 and 5)
BPAY® - To find out your customer reference number, please look at the back of your member card or log onto
Member Online Services at kineticsuper.com.au
Kinetic Super can only accept personal (after-tax) contributions up to the non-concessional contribution cap.
For information on non-concessional contribution caps, please go to ato.gov.au.
Step 4 - Direct debit payment details
Name of financial institution
Account name
BSB
Account number
$
.
Monthly contributions
on
or
of every month
Standing authority for online contributions
You can cancel this direct debit at any time, by completing a Direct Debit Cancellation form available at kineticsuper.com.au or on request by
calling 1300 304 000.
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Direct debit request service agreement
1. Kinetic Super may, by prior arrangement and advice, vary the
amount or frequency of debits.
2. Kinetic Super will initiate debits to your nominated bank account
in accordance with your instructions.
3. Kinetic Super agrees to provide you no less than 14 days notice
if it proposes to vary any previously agreed debit arrangements if
you have a standing order with us.
4. You may request deferment or alteration to the
agreed schedule by writing to Kinetic Super, Locked Bag 5091,
Parramatta NSW 2124, in the first instance. Kinetic Super
reserves the right to decline this request.
5. You can stop individual debits or cancel a Direct Debit (DDR) by
completing a Direct Debit Cancellation form and sending it to
Kinetic Super, Locked Bag 5091, Parramatta NSW 2124, in the
first instance.
6. In the event that you disagree with any debit under the
arrangement with Kinetic Super, you should call Kinetic Super on
1300 304 000 8am to 10pm Monday to Friday (AEST).
7. When the due date for payment falls on a day that is not a
business day, Kinetic Super will debit the customer on the
following business day.
8. In the event that your financial institution refuses to pay any
debit made under the arrangement, Kinetic Super will write to
you requesting alternative payment arrangements. You may be
charged fees by your financial institution.
9. Any information supplied by you will remain confidential and will
only be disclosed if authorised by you or where required by law.
10. Direct Debiting through Bulk Electronic Clearing System (BECS)
may not be available on the full range of customer accounts. If in
doubt please contact your financial institution before submitting
the Member Voluntary Contribution form.
11. It is your responsibility to ensure the account details provided are
correct, and if uncertain, check with your financial institution.
12. It is your responsibility to have sufficient clear funds available in
the relevant account by the due date to permit the payment of
debts.
13. Kinetic Super is dedicated to protecting all personal information
provided on behalf of its clients. In line with the Privacy
Amendment (Private Sector) Act 2000, we maintain all client
records in the strictest confidence. We only use the information
for the purpose for which it was provided. Personal information
will not be used or disclosed for any other purpose without your
consent. If you would like a copy of our Privacy Policy, please call
1300 304 000 or visit our website. The bank may require your
details to be provided in the event of a claim relating to an alleged
incorrect or wrongful debit.
Step 5 - Authorisation and declaration
ƒƒ I/We request and authorise that, until further notice in writing, you debit my account as described in Step 4 with any amounts
Kinetic Superannuation Ltd as Trustee of Kinetic Super (User ID 207256) may debit or charge me/us through the Bulk Electronic Clearing
System (BECS);
ƒƒ I/We acknowledge that this Direct Debit arrangement is governed by the terms of the above Direct Debit Request Service Agreement and is
to remain in force in accordance with the terms and conditions of that Service Agreement; and
ƒƒ I/We declare that to the best of my knowledge and belief, the information I have provided is true and correct.
Signature
Date DDMMYYYY
Signature (if joint account all signatures may be required)
Date DDMMYYYY
Checklist
Complete all steps
Send this form to
Kinetic Super
Locked Bag 5091
Sign and date authorisation and declaration
Parramatta NSW 2124
Email info@kineticsuper.com.au
Privacy
The information on this form is required or requested in order to administer and provide other services relating to your membership with the
Fund. We may not be able to manage your membership or supply these service if you do not provide the information. Kinetic Superannuation
Ltd, Trustee of Kinetic Superannuation Fund, which includes Kinetic Smart Pension is committed to the privacy principles set down by the
Federal Government (see oaic.gov.au). For a copy of the Kinetic Super Privacy Policy and Collection Statement (Policy), please visit our website
kineticsuper.com.au or call 1300 304 000.
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