Superannuation Withdrawal Request Please complete your personal details below – call us on 08 92488124 if you have any questions. "*" indicates required fields Δ Step 1 of 5 20% CompanyThis field is for validation purposes and should be left unchanged.Your Contact DetailsGiven Name*Family Name*Date of Birth* 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 IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin 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* DD slash MM slash YYYY Please provide any further information you wish in the box below.Attach your supporting documents here.*Max. file size: 16 MB.
