Superannuation Withdrawal Request Please complete your personal details below – call us on 08 92488124 if you have any questions. Step 1 of 5 20% Your Contact DetailsGiven Name*Family Name*Date of Birth* Date Format: DD slash MM slash YYYY Email Address* Australian Mobile Number*Overseas Contact Number Including Country CodeMost Recent Australian Address* Street Address Address Line 2 Suburb State Postal Code Current Overseas Address Street Address Address Line 2 City Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Other InformationTax File Number*Passport Number*Passport Issuing Country*Visa NumberVisa Type*First Entry Date*Final Departure Date*Attach a copy of Visa at the end of this form. Bank Details For My RefundPlease Transfer My Refund Into My Australian Bank Account Yes Account Name*Bank Name*Account Number*BSB*Please Transfer My Refund Into My International Bank Account Yes Account Name*International Bank Account Number (IBAN)*SWIFT or BIC Code*Name of Bank* Employer DetailsCompany Name*Company Phone Number*Company Address* Street Address Address Line 2 Suburb State Postal Code Employment Start Date*Employment End Date*Name Of Super Fund*Super Fund Member Number*Add Another Employer Yes Company Name*Company Number*Company Address* Street Address Address Line 2 Suburb State Postal Code Employment Start Date*Employment End Date*Name Of Super Fund*Super Fund Member Number*Add Another Employer Yes Company Name*Company Number*Company Address* Street Address Address Line 2 Suburb State Postal Code Employment Start Date*Employment End Date*Name Of Super Fund*Super Fund Member Number*Add Another Employer Yes Company Name*Company Number*Company Address* Street Address Address Line 2 Suburb State Postal Code Employment Start Date*Employment End Date*Name Of Super Fund*Super Fund Member Number*Add Another Employer Yes Company Name*Company Number*Company Address* Street Address Address Line 2 Suburb State Postal Code Employment Start Date*Employment End Date*Name Of Super Fund*Super Fund Member Number*Add Another Employer Yes Company Name*Company Number*Company Address* Street Address Address Line 2 Suburb State Postal Code Employment Start Date*Employment End Date*Name Of Super Fund*Super Fund Member Number*Add Another Employer Yes Company Name*Company Number*Company Address* Street Address Address Line 2 Suburb State Postal Code Employment Start Date*Employment End Date*Name Of Super Fund*Super Fund Member Number*Add Another Employer Yes Company Name*Company Number*Company Address* Street Address Address Line 2 Suburb State Postal Code Employment Start Date*Employment End Date*Name Of Super Fund*Super Fund Member Number*Add Another Employer Yes Company Name*Company Number*Company Address* Street Address Address Line 2 Suburb State Postal Code Employment Start Date*Employment End Date*Name Of Super Fund*Super Fund Member Number*Add Another Employer Yes Company Name*Company Number*Company Address* Street Address Address Line 2 Suburb State Postal Code Employment Start DateEmployment End Date*Name Of Super Fund*Super Fund Member Number* AuthorisationI confirm that all of the above information is correct to the best of my knowledge.* Yes I hereby authorise Taxwise Australia to prepare and lodge my super withdrawal application on my behalf.* Yes Name*Date* Date Format: DD slash MM slash YYYY Please provide any further information you wish in the box below.Attach your supporting documents here.*EmailThis field is for validation purposes and should be left unchanged.
