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Fund:UniSuper ABN 91 385 943 850Trustee:UniSuper Limited ABN 54 006 027 121 Level 35, 385 Bourke Street, Melbourne VIC 3000Administrator:UniSuper Management Pty Ltd ABN 91 006 961 799 AFSL 235907ÊIRREGÀNAR7ŠLump sum voluntary member contribution by cheque formUNISF00082 0314March 2014Please complete this form if you want to make a lump sum voluntary member contribution by cheque.Important information UniSuper cannot accept any non-concessional (after-tax) contributions from any members who have not quoted their Tax File Number (TFN). To find out if UniSuper has your TFN please refer to your most recent Benefit Statement or call the UniSuper Helpline on 1800 331 685 between 8.30am and 7.00pm Monday to Thursdays and 8.30am to 6.30pm (Melbourne time) Fridays.Voluntary member contributions can be made if you are less than 65 regardless of your employment status. If you are aged 65 or older but under 75, voluntary member contributions can only be made if you have been gainfully employed for at least 40 hours in a period of 30 consecutive days in the financial year in which the contribution is made (known as the Work Test). UniSuper cannot accept voluntary member contributions if you are aged 75 and older.If you would like to make a personal contribution by cheque, please note that cheques must be either: personal—from an account in your name (either own or joint), a bank cheque, or otherwise made at your direction from after-tax money that you are personally entitled to.Contributions will be invested in your future contributions strategy. If you have not chosen a future contributions strategy, the contribution will be invested in the Balanced option, which is the Fund’s default investment option. You can change your future contributions strategy at any time by logging into MemberOnline or by completing an Investment choice form, available from our website or by calling the UniSuper Helpline. No fee applies if you change your future contributions strategy.Under preservation requirements, any contributions you make into super must generally remain in the superannuation system until you permanently retire from the workforce on or after reaching your preservation age. The government has imposed caps on the total amount of contributions that can be made into super each financial year. If you exceed the caps you may pay a much higher tax rate on any contributions that exceed the caps, or we may be required to refuse contributions in some circumstances. It is your responsibility to monitor the amount of contributions you make to ensure the cap is not exceeded.Please note this form is not for members who intend to claim a tax deduction for personal contributions. If you wish to claim a tax deduction please complete a Notice of intent to claim a tax deduction for personal super contributions form, available on our website, or by calling the UniSuper Helpline on 1800 331 685.SECTION 1 — Member details Please use BLACK or BLUE BALL POINT PEN and print in CAPITAL LETTERS. Cross where required UniSuper member number■■■■■■■■■■■Title Mr ■ Mrs ■ Ms ■ Dr ■ Professor ■Other■■■■■■■■■■■■■■■Surname■■■■■■■■■■■■■■■■■Given name■■■■■■■■■■■■■■■■■Date of birth (DDMMYYYY)■■■■■■■■Contact number (during business hours)*(■■)■■■■■■■■■■Email address*■■■■■■■■■■■■■■■■■@■■■■■■■■■■■■■■■■Further informationFor further information on preservation, contribution caps, the Work Test or help to complete this form: call the UniSuper Helpline on 1800 331 685 email enquiry@unisuper.com.au visit the UniSuper website at www.unisuper.com.auPrivacy informationUniSuper recognises the importance of protecting your personal information and is committed to complying with its privacy law obligations. For more information on how we collect and manage your information please refer to the Privacy statement at the end of this form. * Mandatory.SECTION 2 — Voluntary member contribution declarationI declare that: (Please select one box only)■I am aged less than 65 ■I am aged 65 or older but under 75 and have been gainfully employed for at least 40 hours in a period of not more than 30 consecutive days in the current financial year
Page 2 of 2SECTION 4 — Member declaration and signature Read this declaration before you sign and date your form.• I declare the information I have given on this form is true and correct.• I acknowledge that the lump sum voluntary member contribution will be invested according to my chosen investment options, or the default option if I haven’t made an investment selection, and will be preserved in the superannuation system until a condition of release is met.• I declare that the cheque provided with this form is either a personal cheque (from an account in my name or jointly in my name), a bank cheque, or is otherwise paid in at my direction from after-tax money that I was otherwise personally entitled to.• I acknowledge that processing of the contribution may be delayed if this form has not been properly completed or there are any outstanding issues with the cheque or information provided with this form and that the Trustee may at its discretion choose not to accept this contribution and return it to me.• I consent to my personal information being used in accordance with UniSuper’s Privacy Policy.Signature7Date (DDMMYYYYYY)■■■■■■■■RETuRN yOuR COMPlETEd FORM TOgEThERwITh yOuR ChEquE MadE PayablE TOuNISuPER lIMITEd TO:UniSuper Level 35, 385 Bourke Street Melbourne VIC 3000Please see ‘Important information’ overleaf for accepted cheque types.SECTION 3 — Voluntary member contribution cheque detailsI wish to make a lump sum voluntary member contribution by cheque in the amount of :$ ■■■,■■■.■■Name of drawer■■■■■■■■■■■■■■■■■ Bank/branch■■■■■■■■■■■■■■■■■I confirm that the cheque is:(a) a personal cheque in my name (or jointly in my name)( b) a bank cheque(c) a third-party cheque (i.e. the drawer of the cheque does not contain my name). Where the cheque is a third-party cheque you must complete the third party declaration below for UniSuper to be able to accept the cheque as a personal contribution.I declare that the cheque provided with this form is paid in at my direction from after-tax money that I was otherwise personally entitled to.SignatureDate (DDMMYYYY)■■■■■■■■Privacy statementUniSuper recognises the importance of protecting your personal information and we’re committed to complying with our privacy law obligations. We collect your personal information to administer your account, improve our products and services and to provide you with, and promote, UniSuper membership benefits, services and products. You consent to our collecting sensitive information about you, where collecting that information is reasonably necessary for us to perform one or more of our functions or activities. We usually collect personal and sensitive information directly from you, however, it may also be collected from third parties, such as your employer.We may also collect this information from you because we are required or authorised by or under an Australian law or a court/tribunal order to collect that information.If you do not provide this information, we may not be able to administer your account, or provide you with a product or service.We may disclose your information to any service provider we engage (for example mail-houses, auditors, insurers, actuaries, lawyers) to carry out or assist us to provide your membership benefits, services and products. This includes overseas entities. Where information is transferred overseas, we will seek to ensure the recipient of the data has security systems to prevent misuse, loss or unauthorised disclosure in line with Australian laws and standards.Our Privacy Policy contains information about how you may access any personal information held by us, how to correct your information and how to make a complaint about a breach of the Privacy Act. Our Privacy Policy is available from our website at www.unisuper.com.au or by calling us on 1800 331 685 between 8.30am and 7.00pm Monday to Thursday and 8.30am and 6.30pm Friday (Melbourne time).