Family member application form
Information sheet
When to use this form
Your initial contribution
Use this form to apply to become a family member of
Woolworths Super.
–– To become a family member, your initial contribution
must be a minimum of $1,000.
–– If you wish to transfer money from another
superannuation fund into your Woolworths Super
account, please complete a separate Request to
transfer superannuation benefits from an external
fund to Woolworths Super form for each amount you
wish to transfer. This form can be downloaded from our
website at woolworthssuper.amp.com.au.
Note: You must meet the eligibility requirements for
family membership.
When completing this form
–– Print clearly in BLOCK letters.
–– Refer to this Information sheet where you see this
symbol: 
If you are aged 65 to 74
If you will be using Woolworths Super to consolidate your
superannuation benefits to start an AMP retirement
income stream, or if you are aged 75 and over, please
contact AMP to determine your eligibility to apply.
Documents you need to return
to AMP
your completed Family member application form
a cheque and/or an instruction to transfer
superannuation benefits you currently have in
another fund into Woolworths Super (to accompany
the above form).
a Request to transfer superannuation benefits
from an external fund to Woolworths Super form*
for each transfer from another fund (if applicable).
an Investment option selection form* to advise us
of your investment option selection.
a Beneficiary nomination form* (if applicable).
*These forms can be downloaded from our website at
woolworthssuper.amp.com.au. Alternatively, you can contact us
for a copy.
Return the above documents to:
Making your investment option
selection
–– Please complete an Investment options selection form
to select your investment option(s).
–– This form should be completed and returned with this
application form.
–– This form can be downloaded from our website at
woolworthssuper.amp.com.au.
–– Refer to your Investment Guide Fact Sheet for details
on the investment options available.
–– You are able to change your investment options at any
time, to suit your financial needs.
Important: If you do not select investment option(s) by
returning the Investment options selection form with this
application, you will be invested in the default investment
option until you choose to change. The default investment
option is shown in your Product Disclosure Statement.
Nominating your beneficiary
–– Please complete a Beneficiary nomination form to
nominate a beneficiary (or beneficiaries) to receive your
death benefit in the event of your death.
–– This form should be completed and returned with this
application form.
–– This form can be downloaded from our website at
woolworthssuper.amp.com.au.
Woolworths Super
Locked Bag 5043
PARRAMATTA NSW 2124
Issued by AMP Superannuation Limited (ASL) ABN 31 008 414 104, AFSL No. 233060,
the trustee of the AMP Superannuation Savings Trust ABN 76 514 770 399.
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Providing your Tax File Number
(TFN)
We are required to tell you the following details before you
provide your Tax File Number (TFN) for your
superannuation products. Under the Superannuation
Industry (Supervision) Act 1993, the trustee is authorised
to collect your TFN, which will only be used for lawful
purposes.
These purposes may change in the future as a result of
legislative change. The trustee may disclose your TFN to
another superannuation provider when your benefits are
being transferred, unless you request the trustee in
writing that your TFN not be disclosed to any other
superannuation provider.
It is not an offence if you do not quote your TFN. However,
giving your TFN to the fund will have the following
advantages (which may not otherwise apply):
–– We will be able to accept all types of contributions to
your account.
–– The tax on contributions to your account will not
increase.
–– Other than the tax that may ordinarily apply, no
additional tax will be deducted when you start drawing
down your superannuation benefits.
–– It will make it much easier to trace different
superannuation accounts in your name so that you
receive all your superannuation benefits when you
retire.
Please retain this information sheet for your records—
do not return it with your completed form(s).
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80021.0 06/12
More information about the use of tax file numbers for
superannuation changes can be obtained from the
Australian Taxation Office Superannuation Hotline on
13 10 20.
Family member application form
Use this form to apply to become a family member in a Woolworths Super plan (if you meet eligibility requirements).
Before completing this form, you should have received and read the Product Disclosure Statement and relevant Fact Sheets to
understand how the product works.
Please print in CAPITAL LETTERS and place a cross ✗ in any applicable boxes.
1. Member details
2. Family member applicant’s details (continued)
Please enter the details of the member (ie the person who is
currently the member of the plan in which the family
applicant is applying for membership).
Member number
Product type
Email
Occupation (or specify if retired/student)
Industry (if applicable)
Plan name
WOOLWORTHS GROUP SUPERANNUATION PLAN
Title
Date of birth
Country of residence
Australia
Country of citizenship
Surname
Australia
May we phone or email you to clarify any details in this
application?
Given name(s)
No
Date joined plan
Yes—enter your preferred contact day and time below
Sex
Male Address for communications (family member)
Female
Please cross ✗ if same as residential address.
2. Family member applicant’s details
Please enter details of the family member (ie the person
applying for family membership in the plan).
Title
Address
Date of birth
Suburb
State
Surname
Postcode
Type of family member
Given name(s)
Please indicate your relationship to the member (please
cross ✗ one box only):
Sex
Male Spouse (includes a
de facto spouse)
Female
Residential address (must not be a PO Box)
Parent
Sibling
Suburb
State
Contact phone number
Postcode
Mobile number
Grandparent
Grandchild
Son/daughter-in-law
Brother/sister-in-law
Father/mother-in-law
Child (includes adopted
child, a stepchild and an
ex-nuptial child)
A person in an
interdependency
relationship with the
employee member
AMP Superannuation Limited (ASL) ABN 31 008 414 104, AFSL No. 233060,
the trustee of the AMP Superannuation Savings Trust ABN 76 514 770 399.
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2. Family member applicant’s details (continued)
3. Initial contribution details
 Please refer to the attached information sheet for
Parent or legal guardian’s details
Note: Please only complete this section if the family member
applicant is under age 18.
Title
details of documents you need to return with this
form.
Total initial contribution
Date of birth
$
(Minimum of $1,000)
Payment method
Surname
Please indicate which payment method(s) you will use to
make your initial contribution:
Given name(s)
Cheque
Sex
Male Female
Residential address (must not be a PO Box)
Suburb
State
Contact phone number
Postcode
Mobile number
BSB number
–
Bank account number
Cheque number
Cheque amount
$
Transferring money from another fund
Email
Fund name 1
Occupation (or specify if retired/student)
Cheque amount
Industry (if applicable)
Fund name 2
Country of residence
Cheque amount
Australia
Country of citizenship
Australia
May we phone or email you to clarify any details in this
application?
No
Yes—enter your preferred contact day and time below
Address for communications (Parent or legal guardian)
$
$
Fund name 3
Cheque amount
$
Fund name 4
Cheque amount
$
Please cross ✗ if same as residential address.
Address
Suburb
State
Postcode
Relationship to family member applicant
Please indicate your relationship to the person applying to
become a family member of the plan (please cross ✗ one
box only):
Parent Guardian
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4. Employment status (if you are aged 65 to 74)
–– When you are 65 or over, there are currently restrictions on
the types of contributions that AMP can accept and when
we are required to cash superannuation benefits. To make
sure we meet these requirements, we need to ask
applicants that are aged 65 and over the following
questions.
Have you worked for at least 40 hours within a 30-day
consecutive period in the current financial year?
Yes
No—we are only able to accept certain contributions.
Please refer to the Making Contributions section of the
Member Guide Fact Sheet for further details.
5. Tax file number (TFN) notification
 I have read and understood the information provided
on the attached information sheet about providing
my Tax File Number (TFN).
If you wish to provide your TFN, please enter the details
below:
Tax File Number (TFN)
Under the Superannuation Industry (Supervision) Act 1993,
you are not obliged to disclose your Tax File Number (TFN)—
however, there may be tax consequences.
6. Acknowledgement and declaration
I acknowledge that:
–– I should ensure that I understand the consequences of
applying to become a family member in a Woolworths
Super plan (which are part of the AMP Superannuation
Savings Trust) by reading the applicable Product
Disclosure Statement, relevant Fact Sheets and seeking
professional advice.
–– If I am under age 18:
I should consult the parent or guardian detailed in this
form before lodging this form with the trustee, and
understand that I waive any claims against the trustee in
relation to my Woolworths Super account arising out of, or
in connection with, my being a minor.
Family member declaration:
–– I have received, read and understood the accompanying
Woolworths Super Product Disclosure Statement and
relevant Fact Sheets.
–– At the date of this application, I am in an eligible family
relationship with the member.
–– I apply to become a family member of Woolworths Super,
which is part of the AMP Superannuation Savings Trust
(SST).
–– To the best of my knowledge, information and belief, the
information provided in my application is true and correct.
–– I understand that if my application is accepted I will
become a family member in a Woolworths Super plan due
to my relationship with a member of that plan.
6. Acknowledgement and declaration (continued)
–– I will notify the trustee in writing immediately if I no
longer have a family relationship with the member or I am
no longer eligible to contribute or remain a member of
Woolworths Super.
–– I understand that as a family member, I need to make an
initial contribution of at least $1,000 and can then
contribute as often as I like subject to maintaining a
minimum balance of $1,000—either via personal
contributions or via contributions from my employer.
–– Where I am applying to become a member of the SST with
the assistance of a financial planner, I authorise my
financial planner to derive this form on my behalf and to
use the information provided by me in this application and
any other form relevant to the SST to complete and submit
an electronic application on my behalf.
–– Any document or information to be used for the purposes
of this application (whether or not provided on or with
this application):
a)if it is about another person, is provided with the
authority of that person (if required), and
b)may be used for any other products, services or
benefits offered or provided to me/us by or through
the trustee or any other company in the AMP group.
Note: If you wish to check any information before signing,
you may request a copy of this information from your
financial planner or the trustee.
–– If an agent is signing this application on my behalf, the last
2 declarations above are also given by and bind the agent
in the agent’s personal capacity.
–– If I am under age 18, I will not commence any action
against the trustee in relation to my superannuation
benefits in my Woolworths Super account arising out of or
in connection with my being under age 18.
Parent or Legal Guardian (if applicable):
I agree and declare that:
–– I am the parent or legal guardian of the family member
applicant.
–– The family member has the capacity to understand the
consequences of making this application.
–– I understand and the family member applicant
understands the consequences of investing in Woolworths
Super, including through reading the applicable Product
Disclosure Statement, relevant Fact Sheets and by
obtaining professional advice.
Family member applicant’s signature
✗
Date
Parent or legal guardian signature (for applicants under 18)
✗
Date
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7. Checklist
Have you completed the member’s details?
Have you completed the family member’s details?
Have you completed the parent/guardian details (where
applicable)?
Have you provided the payment method for your initial
payment?
Have you considered the request to provide your TFN
(in section 5)?
Have you read and understood the Acknowledgement
and declaration in section 6?
Have you signed and dated the form where indicated?
Has the parent/guardian signed and dated the form
where indicated (if applicable)?
Have you completed, signed and attached all the required
documents (please refer to the attached information
sheet for a list of documents required)?
Where to send this form:
Mail this completed form (and any other required
documents) to:
SignatureSuper
Any questions?
1300 361 267
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80021.0 06/12
Woolworths Super
Locked Bag 5043
PARRAMATTA NSW 2124