(subregulations 14H(2) and (3))
NOTICE TO TRUSTEE THAT NON - MEMBER SPOUSE'S ENTITLEMENT IS SATISFIED IN RESPECT OF PARTICULAR PAYMENT SPLIT
TO the trustee of [ name of eligible superannuation plan ]:
IN RELATION TO the payment split, of which you were notified on [ date when superannuation agreement, flag lifting agreement or splitting order was served on the trustee ], in respect of the superannuation interest of [ name of member spouse ], date of birth [ date of birth of member spouse ]
Part A--Superannuation interest in a regulated superannuation fund, exempt public sector superannuation scheme, approved deposit fund, RSA or superannuation annuity
[ Complete Part A if the superannuation interest is in a regulated superannuation fund, exempt public sector superannuation scheme, approved deposit fund, RSA or superannuation annuity ]
I, [ name ], the non - member spouse in relation to the above superannuation interest, of [ postal address ], born on [ date of birth ], give notice that:
* 1. I have received from [ name of member spouse ] the amount of [ amount ] in satisfaction of my entitlement in respect of the payment split.
OR
* 1. [ Name of member spouse ] has paid the amount of [ amount ] to a regulated superannuation fund or an RSA, to be held for my benefit, in satisfaction of my entitlement in respect of the payment split.
2. I received independent legal advice from a legal practitioner explaining that the payment to me is in substitution for:
(a) any entitlement I have to receive an amount of money from a splittable payment that becomes payable in respect of the superannuation interest; or
(b) any right I have to make a request under the payment split provisions of the Superannuation Industry (Supervision) Regulations 1994 to have a new interest created in the eligible superannuation plan in which the member spouse has the superannuation interest, or to request the trustee of that plan to transfer an amount to another eligible superannuation plan to be held for my benefit.
Part B --Superannuation interest in a superannuation fund other than an interest in a regulated superannuation fund or an exempt public sector superannuation scheme
[ Complete Part B if the superannuation interest is in a superannuation fund that is not a regulated superannuation fund or exempt public sector superannuation scheme ]
I, [ name ], the non - member spouse in relation to the above superannuation interest, of [ postal address ], born on [ date of birth ], give notice that:
1. I have received from [ name of member spouse ] the amount of [ amount ] in satisfaction of my entitlement in respect of the payment split.
2. I received independent legal advice from a legal practitioner explaining that the payment to me is in substitution for any entitlement I have to receive an amount of money from a splittable payment that becomes payable in respect of the superannuation interest.
DATED:
[ signature of non - member spouse ]
* Omit if not applicable
(regulation 51)
REQUEST TO TRUSTEE BY NON - MEMBER SPOUSE FOR PAYMENT, AS LUMP SUM, OF ALL OR PART OF REMAINING ADJUSTED BASE AMOUNT
TO the trustee of [ name of eligible superannuation plan ]:
IN RELATION TO the payment split, of which you were notified on [ date when superannuation agreement, flag lifting agreement or splitting order was served on the trustee ], in respect of the superannuation interest of [ name of member spouse ], date of birth [ date of birth of member spouse ]
I, [ name ], the non - member spouse in relation to the above superannuation interest, of [ postal address ], born on [ date of birth ], being entitled to be paid, as a lump sum, an amount under paragraph 50(2)(a) of the Family Law (Superannuation) Regulations 2001 , request that I be paid, as a further lump sum, * the whole/ * a specified proportion, being [ specify the proportion that is to be paid as a lump sum ], of the remaining amount of the adjusted base amount applicable to me.
DATED:
[ signature of non - member spouse ]
* Omit if not applicable
REQUEST TO TRUSTEE BY NON - MEMBER SPOUSE FOR PAYMENT, AS LUMP SUM, OF ALL OR PART OF ADJUSTED BASE AMOUNT
TO the trustee of [ name of eligible superannuation plan ]:
IN RELATION TO the payment split, of which you were notified on [ date when superannuation agreement, flag lifting agreement or splitting order was served on the trustee ], in respect of the superannuation interest of [ name of member spouse ], date of birth [ date of birth of member spouse ]
I, [ name ], the non - member spouse in relation to the above superannuation interest, of [ postal address ], born on [ date of birth ], request that I be paid, as a lump sum, * the whole/ * a specified proportion, being [ specify the proportion that is to be paid as a lump sum ], of the amount of the adjusted base amount applicable to me.
DATED:
[ signature of non - member spouse ]
* Omit if not applicable
(regulation 58)
REQUEST TO TRUSTEE BY NON - MEMBER SPOUSE FOR PAYMENT, AS LUMP SUM, OF ALL OR PART OF REMAINING BASE AMOUNT
TO the trustee of [ name of eligible superannuation plan ]:
IN RELATION TO the payment split, of which you were notified on [ date when superannuation agreement, flag lifting agreement or splitting order was served on the trustee ], in respect of the superannuation interest of [ name of member spouse ], date of birth [ date of birth of member spouse ]
I, [ name ], the non - member spouse in relation to the above superannuation interest, of [ postal address ], born on [ date of birth ], being entitled to be paid an amount under paragraph 57(2)(a) of the Family Law (Superannuation) Regulations 2001 , request that I be paid, as a further lump sum, * the whole/ * a specified proportion, being [ specify the proportion that is to be paid as a lump sum ], of the remaining base amount allocated to me in relation to the superannuation interest.
DATED:
[ signature of non - member spouse ]
* Omit if not applicable
Form 5 -- Waiver notice in respect of payment split
(regulation 60)
Family Law Act 1975 subsection 90XZA(2) or 90YZQ(2)
WAIVER NOTICE
TO the trustee of [ name of eligible superannuation plan ]:
IN RELATION TO the payment split, of which you were notified on [ date when superannuation agreement, flag lifting agreement or splitting order was served on the trustee ], in respect of the superannuation interest of [ name of member spouse ], date of birth [ date of birth of member spouse ]
I, [ name ], of [ postal address ], born on [ date of birth ], give notice that I waive my entitlement to future payments under that payment split.
DATED:
[ signature of non - member spouse ]
(regulation 62)
Family Law Act 1975 subsection 90XZB(2) or 90YZR(2)
DECLARATION BY APPLICANT FOR INFORMATION ABOUT A SUPERANNUATION INTEREST
I, [ name ], of [ postal address ], born on [ date of birth ], make the following declaration in support of my application to the trustee of [ name of eligible superannuation plan from which information is sought ] ( the plan ) for information about:
* (a) my superannuation interest.
* (b) a superannuation interest of [ full name of member ], born on [ date of birth of member ], who is a member of the plan.
1. I am:
* (a) a member of the plan.
* (b) the spouse of [ name ], who is a member of the plan.
* (c) intending to enter into a superannuation agreement under [ Part VIIIB/Part VIIIC ] of the Family Law Act 1975 with [ name ], who is a member of the plan.
2. I require the information to:
* (a) assist me to properly negotiate a superannuation agreement.
* (b) assist me in connection with the operation of [ Part VIIIB/Part VIIIC ] of the Family Law Act 1975 .
DATED:
[ signature of person making declaration ]
* Omit if not applicable