Nomination Of Beneficiary And Payment Allocation Form
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1
2Nomination of Beneficiary and
Payment Allocation Form
Issued by Colonial Mutual Superannuation Pty Ltd ABN 56 006 831 983 AFSL 235025 (Trustee) the trustee of the Colonial Super
Retirement Fund ABN 40 328 908 469 (the Fund).
The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809 AFSL 235035 (CMLA) is responsible for the administration of
the Fund and provides insurance benefits to the Fund as insurer.
A – Member’s details
Given name(s)
Surname
Address
State
Postcode
Home phone number
Business phone number
Mobile phone number
Date of birth
(
)
(
)
(
)
/
/
Email address
Policy number
B – Non-binding nomination
A non-binding nomination allows you to inform the Trustee how you would like any benefit to be paid in the event of your death.
This nomination is not binding on the Trustee who has complete discretion as to which of your dependants and/or legal personal
representative will receive any benefit payable on your death and the form of payment. To assist the Trustee is making this decision, you
may nominate anyone who is a dependant as defined in the Trust Deed.
A dependant for this purpose includes:
•
a spouse, including a person (whether of the same sex or a different sex) with whom you are living on a genuine domestic basis in a
relationship as a couple and a person with whom you are in a relationship registered under State or Territory law
•
a child of any age (including an adopted child, step child or an ex-nuptial child, a child of your spouse and your child within the meaning
of the Family Law Act 1975)
•
a person with whom you have an interdependency relationship
•
any person financially dependant on you.
You may also nominate that your benefit be paid to your legal personal representative (i.e. the executor or administrator of your estate).
C – Beneficiary nominations
Member’s Instructions – Please tick the relevant box
I wish to cancel all current beneficiary nominations for this policy
I wish to nominate the following beneficiaries (If there is insufficient space to show all the beneficiaries you wish to nominate please list
the additional nominees on a separate piece of paper and sign and date the paper and attach it to this form):
Nominee 1
Given name(s)
Surname
Address
State
Postcode
Form of Payment
Date of birth
Sex
Lump sum
/
/
%
Male
Female
Relationship to you
Pension
%
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CommInsure is a registered business name of The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809 AFSL 235035 (CMLA)
001-773 210212 (CI194)
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