The Bendigo Superannuation Plan
Membership Variation Advice
Please complete this form using BLOCK LETTERS and a BLACK or BLUE pen.1. Member Details
Member Number: BIP
Title: / Surname:
Given Name(s):
Previous Title: / Previous Surname:
2. Change of Address
Postal Address:
City/Suburb: / State: / Postcode:
Phone (H): ( ) / Phone (W): ( ) / Fax No.: ( )
Mobile: / E-mail Address:
3. Regular Contribution Changes
If you are making regular contributions via a Direct Debit Request and your bank account details have changed, please complete a new Direct Debit Request form.
Please CANCEL my regular contributions
OR
Please CHANGE my existing regular contributions to:
Frequency:MonthlyQuarterlyHalf YearlyYearly
Amount:
$ / $ / $ / $
Member / Employer (Award/SG) / Employer (Voluntary) / Employer/Salary Sacrifice
Total: / $
4. Pension Payments
Please change my pension payment to:
Frequency:MonthlyQuarterlyHalf YearlyYearly
Pension Amount:MinimumMaximumOther Amount
Complete the following details only if you have chosen ‘Other Amount’ above:
Amount: $ per annum / Indexation Rate: %
Note:We require 3 business days to action your request. If we have not received your request in time to alter your next scheduled payment, please be assured your alteration will take effect from the following payment.
(continued overleaf)
5. Change of Bank Account Details
Bank Name:
Bank Address:
Suburb/Town: / State: / Postcode:
Account Name:
BSB Number: / Account Number:
6. Change of Adviser
Dealer Name:
Adviser’s Surname (or Company Name):
Adviser’s Given Name(s) if applicable:
Phone: ( ) / Fax No.: ( )
7. Change of Fees (Adviser Use Only)
<Dealer Stamp>
% / % / %
Entry Fee Commission Contributions / Entry Fee Commission Transfers In / Trail Commission
Note:These percentages should be provided excluding GST
Where any or all of these percentages are left blank, no change will be made to your current fee structure
Adviser’s Signature: / Date://
8. Additional Comments
9. Member Signature
Important Note: Information provided to the Trustee will only be used for the purpose specified. It may be accessed and updated by you through our Customer Service Centre on 1800 033 426. It will only be disclosed to other parties where required by law (eg. ATO) or to implement your request (eg. Fund Administrator). If you do not provide all of the requested information we may not be able to action your request.
I consent to the collection and use of the above information by the Trustee for the purposes specified. I authorise the above changes to be made to my membership details. I authorise provision of information regarding my membership, and the payment of ongoing service brokerage to the above adviser (where new adviser has been nominated).
I consent to the alteration of my current fee structure, where applicable, as noted in Section 6 of this form.
Client Signature: / Date://
Previous Signature (where name has changed):
Note:If you wish to renew or change your binding nomination of beneficiaries, insurance or your investment strategy, please complete a separate form available from your adviser or our Customer Service Centre
The Bendigo Superannuation Plan (RSE No. R1000139)GPO Box 529, HOBART TAS 7001
Customer Service Centre – 1800 033 426 Facsimile (03) 6215 5800
Sandhurst Trustees Limited ABN 16 004 030 737 AFSL No. 237906 RSE Licence No. L0000154OA214 (02/11)