MAP Superannuation Plan Product Disclosure Statement Issued 01 March 2014 For more information:

FINANCIAL ADVICE FOR PROFESSIONALS
MAP Superannuation Plan
Product Disclosure Statement
Issued 01 March 2014
For more information:
Phone: 1800 640 055
Write: GPO Box 1130
Brisbane QLD 4001
Visit:
www.mapfunds.com.au
MAP Superannuation Plan Product Disclosure Statement 01 March 2014.
Issued by MAP Funds Management Ltd (AFSL No 240753; ABN 85 011 061 831; APRA RSE Licence No L0000703).
Trustee of MAP Superannuation Plan (ABN 71 603 157 863; RSE R1001587).
Important Information
This Product Disclosure Statement (PDS) provides
a summary of significant information and contains
a number of references to important additional
information marked with a “!” (each of which forms
part of this PDS). You should consider this PDS and
the important additional information before making a
decision about this product.
Contents
About MAP Super
2
How Super Works
2
Benefits Of Investing With MAP Super
2
Risks of Super
3
The information in this PDS is general information
only and does not take into account your personal
financial situation or needs. You should consult a
licensed financial adviser to obtain financial advice
that is tailored to suit your personal circumstances.
How We Invest Your Money
3
Fees and Costs
4
How Super is Taxed
5
This PDS has been prepared in accordance with
Subdivision 4.2B of Division 4 of Part 7.9 Corporations
Regulations 2001.
Insurance in Your Super
6
How To Open An Account
7
About MAP Super
The MAP Superannuation Plan (MAP Super or the Fund) is
offered by MAP Funds Management Ltd (MAP, we, us or our),
established in 1957 by doctors disenchanted with the retirement
funding and investment products offered at the time. MAP
has evolved to provide a range of comprehensive, specialist
and individually tailored financial, investment and retirement
planning services to professionals, their staff and families.
Our commitment is to continue being a trusted provider
of super and related services to discerning investors across
Australia. Our team of specialists will be there to provide
personalised service to each and every member, so you can
choose what is right for you… after all it is your journey, you
should do it your way.
How Super Works
About super
Super is a way to save for your retirement which is, in part,
compulsory. It is a long-term investment. You usually can’t
access your super until you are aged between 55 and 60, but
there are some special circumstances where you can withdraw
it earlier than this. Tax concessions and other government
benefits generally make it one of the best long-term investment
vehicles.
Contributions
There are different types of contributions available to you (e.g.
employer contributions, voluntary contributions, government
co-contributions). Generally, if you are employed and earn
more than $450 a month, your employer is required to make
contributions into a super fund for you. If you are self-employed,
the onus is on you to contribute to super and take advantage of
the tax concessions and other government benefits.
Benefits Of Investing With MAP Super
Have your Our staff answer your call. Speak to a person
voice heard immediately, no waiting.
Grow your
super
MAP Super accepts all super contributions,
including UK Pension Transfers.
Portability
MAP can move with you throughout your
employment journey. Changing jobs, no
problem.
Super
Service
Opportunity for MAP to search for any lost
super you may have.
Investment Eight investment options to choose from. Mix
and match your options to suit you.
Flexibility
MAP Super offers affordable Death, Death and
Insurance
to suit your Total Permanent Disablement (TPD), Income
Protection insurance so you can plan for your
needs
retirement and know that you are covered for
those unexpected events and ‘what ifs’.
Access
to expert
advice
MAP financial planners focus on strategic
advice on a broad range of financial products,
in MAP Super, and can assist you to tailor a
financial strategy to suit your individual needs
now, and in retirement.
MAP financial planners are licensed through
MAP Financial Planning Pty Ltd ABN 91 090
411 537 (AFSL No 239 117), a wholly owned
subsidiary of MAP Funds Management Ltd.
Most people have the right to choose which super fund they’d
like their employer to direct their superannuation guarantee
contributions to. If you don’t have a choice about your super
fund or don’t tell your employer where to pay your super
contributions they will be put into a super fund your employer
has chosen.
Partners
discount
Regardless of whether you have chosen your super fund
or it is decided for you, you can make your own additional
contributions. You can do this by:
Retirement MAP have been servicing the retirement needs
Experience of members since 1957.
1. Asking your employer to deduct extra money from your pay
before tax is taken out and to pay this into your MAP Super
account (called salary sacrifice);
2. Putting any money you have saved into your MAP Super
account and in doing so you may be eligible for the
government co-contribution if your income is within a
certain range; and
3. Transferring super you have in another super fund into your
MAP Super account.
Member
Online
MAP will add up all MAP Super, MAP Pension
and MAP PST accounts held by you and your
spouse or partner. With all your account
balances added together, you may be eligible
for a lower fee rate.
Track your super, switch between investment
options, update your details and much more at
your convenience.
To create incentives for individuals to boost their retirement
savings, the Commonwealth Government has legislated tax
concessions on superannuation contributions and investment
earnings. Tax savings on super contributions and benefits
are provided by the Government. There are limitations on
contributions to, and withdrawals from, super.
For further information about how super works, including about
how making additional contributions and withdrawals see www.
moneysmart.gov.au.
2 | Page
Risks of Super
All investments have some level of risk. Different investment
strategies may carry different levels of risk, depending on the
assets which make up the strategy – for example, cash, bonds,
property and equities all have different levels of risk. MAP Super
offers a variety of investment options. The likely investment
return, and the level of risk, is different for each investment
option depending on the underlying mix of assets. Those assets
with the highest return over the longer term may also have the
highest level of short-term risk.
When considering your investment in super, it is
important to understand that:
•
The value of the investment will go up and down;
•
The level of returns will vary, and future returns may differ
from past returns;
•
Returns are not guaranteed and you may lose some of your
money;
•
The amount of your future superannuation savings
(including contributions and returns) may not be enough to
provide adequately for your retirement;
•
Laws affecting your super may change in the future; and
•
The level of risk for you will vary depending on a range of
factors including your age, your investment time frame,
where other parts of your wealth are invested and your
risk tolerance.
How We Invest Your Money
MAP Super offers eight (8) investment options:
Inflation risk •
Market risk •
Settlement risk •
Interest rate risk
•
Currency risk
•
Derivatives risk
•
Fund risk
•
Legislative risk •
Liquidity risk
•
Credit risk
•
Investment management risk
! You should read the important information in the MAP
Superannuation Plan Additional Information Guide about the
risks of super before making a decision. Visit
www.mapfunds.com.au. The material relating to the risks of
super may change between the time when you read this Product
Disclosure Statement and the day when you acquire the MAP
Superannuation Plan.
Multi Asset Class Options
Cash
Capital Stable
Australian Equities
Balanced Moderate
International Equities
Balanced
Diversified Property
Growth
Each option has different risk and return attributes.
You can choose one option or a combination of different
options. If you don’t make a choice, the Trustee will contact you
in regards to making a choice. If the Trustee is unable to contact
you and your account receives a contribution, your funds may
be returned.
WARNING: You must consider the likely investment return, the risk
and your investment time frame when choosing which option to
invest in.
Summary of the balanced investment option
Some other key risks associated with investing in super
include:
•
Single Asset Class Options
Designed for:
Members who seek high returns over
the medium to long term in a diversified
investment option, and who are
comfortable accepting fluctuations in
their account balance over the medium
to long term.
Return Objective:
CPI + 4.00%
Minimum
Suggested
Investment Time:
5 - 7 years.
Standard Risk
Measure
Medium to High
Asset Allocation
Range
Cash
Australian Equities
International Equities
Diversified Fixed
Interest
Diversified Property
Alternative Assets
Defensive vs Growth Defensive
Asset Allocation
Growth
Range
0 - 20%
15 - 50%
15 - 50%
5 - 40%
0 - 20%
0 - 25%
25 - 40%
60 - 75%
Refer to the “Standard Risk Measure Guidance” in the MAP Super
Additional Information Guide.
1
You can switch between investment options at any time or
ask that future contributions be paid into a different option
by advising us in writing or online.
3 | Page
MAP Super invests in Australian and overseas assets through
a combination of internal and external Investment Managers.
Our in-house investment team selects the external Investment
Managers on the basis of their investment style, people and
processes to meet the risk and return attributes of MAP Super’s
investment options. MAP may add, remove, or alter an existing
investment option at any point in time. We will notify you
in writing of any significant changes at least 30 days before
implementing such changes.
How fees and costs are charged to your account
Labour standards or environmental, social or ethical
considerations are not taken into account by MAP in the
selection, retention or realisation of investments relating to MAP
Super. However, any external Investment Managers MAP Super
invests with may choose, at their discretion, whether to take
into account environmental, social or ethical issues or labour
standards when making their investment decisions.
This section provides summary information about the main
fees and costs for our Balanced investment option effective
01 April 2014. All fees disclosed in this PDS and the MAP
Super Additional Information Guide are GST inclusive. Similar
information is included in other fund PDSs so you can compare
MAP Super’s fees and costs with those of other funds.
! You should read the important information in the MAP
Superannuation Plan Additional Information Guide about how we
invest your money before making a decision. Visit
www.mapfunds.com.au. The material relating to how we invest
your money may change between the time when you read this
Product Disclosure Statement and the day when you acquire the
MAP Superannuation Plan.
Any fees and costs related to the administration of your account
or those you incur for withdrawals or switches are paid directly
from your account and will be shown on your annual account
statement. All other fees and costs are deducted from your
investment earnings before the earnings are applied to your
account.
Main fees and costs for the balanced investment option
These fees and costs are maximum amounts – you may pay less
in some cases.
Type of fee or cost
FEES WHEN YOUR MONEY MOVES IN OR OUT OF THE FUND
Fees and Costs
Establishment fee
Nil
Contribution fee
Nil
Withdrawal fee
$50 for partial withdrawals (Nil for
Retirement, Death, TPD, Financial Hardship,
Compassionate, balances less than $1,000
or Family Law splitting).
Termination fee
$50 (Nil for Retirement, Death, TPD,
Financial Hardship, Compassionate,
balances less than $1,000 or Family Law
splitting).
CONSUMER ADVISORY WARNING
DID YOU KNOW?
Small differences in both investment performance and fees
and costs can have a substantial impact on your long term
returns. For example, total annual fees and costs of 2% of your
fund balance rather than 1% could reduce your final return by
up to 20% over a 30 year period (for example, reduce it from
$100,000 to $80,000). You should consider whether features such
as superior investment performance or the provision of better
member services justify higher fees and costs. You may be able to
negotiate to pay lower contribution fees and management costs
where applicable. Ask the fund or your financial adviser.
TO FIND OUT MORE
If you would like to find out more, or see the impact of the fees
based on your own circumstances, the Australian Securities and
Investments Commission (ASIC) website (www.moneysmart.
gov.au) has a superannuation calculator to help you check out
different fee options.
Group fee discount
Amount
MANAGEMENT COSTS
The fees and costs
for managing your
account:
Account Balance
Amount 1
$0-$9,999
$150 + up to 0.50%
Balances $10,000 or
more:
For that portion of
your account:
$0-$249,999
up to 1.90%
$250,000 to $499,999
up to 1.90%
$500,000 to $999,999
up to 1.80%
$1m to $1,499,999
up to 0.70%
Over $1.5m
up to 0.50%
Additional Fees may apply. For further information about fees and
costs refer to the MAP Super Additional Information Guide.
1
MAP will add up all MAP Super, MAP Pension and MAP PST
accounts held by you and your spouse or partner. With all your
account balances added together, you may be eligible for a
lower fee rate.
Changes to fees and costs
MAP may introduce new fees or change existing fees at any
time. We will notify you at least 30 days before we introduce new
fees or increase existing fees.
4 | Page
Example of annual fees and costs for the balanced
investment option
This table gives an example of how the fees and costs in MAP
Super’s Balanced Investment Option can affect your superannuation
investment over a one year period. You should use this table to
compare this product with other superannuation products.
EXAMPLE - the Balanced
Investment Option
BALANCE OF $50,000 WITH TOTAL
CONTRIBUTIONS OF $5,000
DURING YEAR 1
Contribution
Fees 2
Nil
For every $5,000 you put in, you will
be charged $0.
PLUS
Management
Costs 3
Up to
1.90%
And, for every $50,000 you have in
the fund you will be charged up to
$950 each year.
Up to
1.90%
If you put in $5,000 during a year
and your balance was $50,000, then
for that year you will be charged:
Up to $950.5
What it costs you will depend on the
investment option you choose.
EQUALS Cost of
fund 4
It is a requirement of the Corporations Regulations that the above
example assumes a balance of $50,000.
2
Under the Corporations Regulations this example is required,
notwithstanding that MAP Super does not charge a contribution fee.
3
This example applies the highest possible management costs
(includes maximum Administration Fee of 1.60% and maximum
Investment Option Fee for for the Balanced Investment Option of
(0.50%) and assumes an investor’s account balances to be between
$10,000 and $250,000. In practice your investment and balance will
vary weekly and management costs will be calculated based upon
your actual investment balance each week. MAP Super may rebate
unused fees to members at the end of each financial year. Refer to the
MAP Superannuation Plan Additional Information Guide for further
information about rebates.
4
This example, only relates to contribution fees and management
costs. It does not include all fees which may apply to an investment in
MAP Super.
5
Additional Fees may apply. For withdrawals other than
withdrawals associated with Retirement, Death, Financial Hardship,
Compassionate, TPD, balances less than $1,000 or Family Law
Splitting, you will also be charged a withdrawal fee of $50 for every
amount you withdraw.
1
WARNING: If you consult a MAP Financial Planner you may agree
to a Member Advice Fee. The amount of the fee will be set out in
the Statement of Advice, and with your written consent will be
deducted from your MAP Super account.
! You should read the important information in the MAP
Superannuation Plan Additional Information Guide about fees
and costs for all of MAP Superannuation Plan’s investment
options before making a decision. Visit www.mapfunds.com.au.
The material relating to fees and costs may change between the
time you read this Product Disclosure Statement and the day
when you acquire the MAP Superannuation Plan.
How Super is Taxed
There are a number of ways that super is taxed. MAP Super will
pay the tax applying to your account directly to the Australian
Taxation Office. Tax may be deducted from your contributions,
account balance or the Fund’s earnings.
Tax on Contributions
Type of
Contribution
Before-tax
(concessional)
Eg. Super
Guarantee (SG)
contributions,
Self-Employed
Contributions,
Salary Sacrifice
Contributions,
Other Employer
/ Award
Contributions.
Tax 1
Individuals who earn less than $300,000,
contributions will be taxed at 15% up to the
applicable concessional contribution cap.
Individuals who earn more than $300,000,
contributions will be taxed at 30% up to the
applicable concessional contribution cap.
The concessional contribution caps for the
2013/14 financial year are as follows; 1
General concessional cap is $25,000 (indexed
each financial year by reference to CPI)
Individuals over 59 years, $35,000 (From 1
July 2014, this contribution cap of $35,000 will
apply to individuals over 49 years.)
If you exceed the above concessional
contribution caps you will be liable to pay an
excess concessional contributions charge.
After-tax (nonconcessional)
Eg. Personal
Contributions,
Spouse
Contributions,
Government
CoContributions.
0% on contributions up to the $150,000 cap
per annum.
If you are under 65 you may be able to bring
forward the next two years’ worth of nonconcessional contributions, contributing up
to $450,000 in the first year of any three years.
However any contributions received within
the following two years will be taxed as excess
non-concessional contribution tax. If you exceed
the above concessional contribution caps you
will be required to pay an excess concessional
contribution tax at a rate of 30% plus Medicare
Levy.
1
If you have more than one superannuation fund, all concessional
contributions made to all your funds are added together and
count towards the concessional contribution cap. Superannuation
taxation and contribution caps may change. For further details refer
to www.ato.gov.au.
WARNING: If you exceed the contribution caps applicable to
superannuation you will pay extra tax.
5 | Page
Tax on investment earnings
Earnings on your superannuation investment will be taxed at a
maximum of 15%.
WARNING: You should provide us with your tax file number
when you join MAP Super. It is not compulsory to provide your
tax file number, however if you don’t tell us your tax file number,
you may pay extra tax on your contributions or when you later
access your benefit, or you may not be able to make some
types of contributions. It will also be more difficult to find your
superannuation benefits if you change address without notifying
us or to trace different super amounts in your name so that you
receive all your super benefits when you retire.
Tax on withdrawals
Component
Tax Rate
Tax-Free
No tax paid on withdrawals.
Taxable
If you are under 55, you will be charged 20%
plus Medicare Levy on your withdrawal. If you
are between 55 and 59, you can withdraw
up to $175,000 tax free, and above this, your
withdrawal will be taxed at 15% plus Medicare
Levy. If you are 60 or over, no tax is payable on
withdrawals.
For information about how tax applies to super contributions,
investment earnings and withdrawals, see
www.moneysmart.gov.au.
Insurance in Your Super
Insurance doesn’t have to cost a fortune. MAP Super offers
affordable insurance options so you can plan for your retirement
and know that you are covered for those unexpected events and
‘what ifs’.
Choose from a range of optional insurance covers including Income
Protection, Death, TPD:
•
Death insurance provides a lump sum benefit in the event of death.
•
TPD Insurance provides a lump sum benefit if you suffer a Total
and Permanent Disablement, or are diagnosed with a Terminal
Illness.
•
Income Protection pays a set percentage of your monthly income for a pre-defined length of time in the event that you suffer Total Disability as a result of illness or injury.
You can choose to take up all or any combination of the above
insurance cover options.
There are costs associated with insurance cover. These costs which
are deducted from your account are calculated on the amount of
cover you request, your age, gender, occupation and assessment by
the Insurer.
Types of group life insurance
MAP Super offers two types of insurance cover – personal
and employee. The type of insurance cover available to you is
determined by your employment status.
! You should read the important information in the MAP
Superannuation Plan Additional Information Guide about how
super is taxed before making a decision. Visit
www.mapfunds.com.au. The material relating to how super is
taxed may change between the time when you read this Product
Disclosure Statement and the day when you acquire the MAP
Superannuation Plan.
Your employment status:
You are eligible to apply for:
You are self-employed
Personal Cover
You are an employee of
your own company or of a
Participating Employer 1
Either Personal Cover or Employee
Cover
You are neither of the above
Personal Cover
Participating Employer means an employer who makes or agrees
to make contribution payments to MAP Super.
1
6 | Page
Cover when you join
Provided you meet eligibility conditions, when you sign up to MAP Super you can elect to receive default death and total and permanent
disablement cover without any medical underwriting. The level of default cover you receive is determined by the type of group life insurance your are
eligible to receive (refer to previous page).
Amount of Default Cover you receive
Age next birthday
Personal Default Cover 2
Value of Employee Cover
16 – 35 years
$535,500
$535,500
36 – 40 years
$318,000
$318,000
41 – 45 years
$189,000
$189,000
46 – 50 years
$109,500
$109,500
51 – 55 years
$61 ,500
$61 ,500
56 - 60 years
$37,500
$37,500
61 years
$28,500
$28,500
62 years
Death $25,500 TPD $22,950
$25,500
63 years
Death $22,500 TPD $18,000
$22,500
64 years
Death $21,000 TPD $14,700
$21,000
65 years
Death $19,500 TPD $11,700
$19,500
66 years
Death $19,500 TPD $9,750
$19,500
67 years
Death $19,500 TPD $7,800
$19,500
68 years
Death $16,500 TPD$4,950
$16,500
69 years
Death $15,000 TPD $3,000
$15,000
70 years
Death $15,000 TPD $1,500
$15,000
Males $2.80 to $5.25 per week
Females $1.44 to $3.47 per week
$3 per week.
Premiums are annualised and deducted from
your account monthly in arrears.
Premiums are annualised and deducted from
your account monthly in arrears.
Cost for Default Cover and when is it paid?
Does the value of default cover remains the
same as I age?
Death remains the same.
TPD reduces after you turn 60 as follows (based
on age next birthday)
61
100%
66
50%
62
90%
67
40%
63
80%
68
30%
64
70%
69
20%
65
60%
70
10%
If you apply for default cover above age 60, the
amount of cover you receive will incorporate the
TPD reduction applicable.
Does the cost for cover remain the same as
I age?
When does cover commence
Death & TPD cover will vary with your age.
TPD Cover beyond age 65 is on an Activities of
Daily Living (ADL) basis only.
TPD Cover beyond age 65 is on an Activities
of Daily Living (ADL) basis only.
Cost will vary with age.
Cost remains the same.
Cover commences once a contribution is
received into your account.
Cover commences once a contribution is
received into your account.
2
Default Personal Cover is Limited for the first thirty-six (36) months of your membership. Any pre-existing illness or injuries are not covered during this time. Refer to ‘Insurance Terms and Conditions’ in the MAP Superannuation Plan Additional Information Guide for
further information on Limited Cover.
WARNING: Unless you decline the default cover or cancel it, the cost of the cover will be deducted from your account. You have 28 days from
application to opt out from the default cover before you will incur an insurance premium. If you opt-out of default cover and later wish to
obtain any level of cover, the normal underwriting process will apply. You can decline the cover or change or cancel your cover at any time.
You can choose to decline your default cover on you MAP Superannuation Plan Application Form, or subsequently by writing to the address
on the first page of this PDS.
7 | Page
Changing Group Insurance Cover
Applying for
You can apply for additional group life cover by
additional cover completing a MAP Super Insurance Application
Form and a personal health statement which
accompanies this PDS (also available at www.
mapfunds.com.au).
All additional cover is subject to underwriting
and policy maximums as follows: Death – No
Maximum; TPD - $3 million; Terminal Illness - $3
million; and Income Protection - 75% of predisability Monthly Income up to a maximum
$25,000 per month*.
*You can also apply for additional cover equal
to the amount your Employer contributes to
your superannuation subject to a maximum
of 10%. This amount is included in the $25,000
per month maximum.
Refer to the MAP Superannuation Plan
Additional Information Guide, available at
www.mapfunds.com.au for further details.
Transferring
cover
Reducing /
Cancelling
Cover
You may be able to transfer your current
Death, TPD and Income Protection Cover from
another insurer to MAP Super. Refer to the MAP
Superannuation Plan Additional Information
Guide for further details.
You can reduce or cancel your group life cover
at any time by writing to the address on the
front page.
How To Open An Account
To open a MAP Super account:
1. Read this PDS and other important information referred to
in the PDS;
2. Complete the MAP Super Application Form included with
this PDS or available from www.mapfunds.com.au;
3. Submit your completed form to MAP;
4. You or your employer can then start to make regular or ad
hoc payments into your account.
If you change your mind about investing in MAP Super, a 14 day
cooling-off period applies. Cancellations must be submitted
to MAP within 14 days from the date your MAP Super account
is confirmed. If you cancel during this time, you will not pay
any fees or charges. We will refund an amount to you (if you
are entitled to access your super) or transfer an amount to a
complying fund you nominate in writing. The refund may be
decreased or increased to allow for market movements during
that time. We may also deduct any tax or duty incurred.
If you have a complaint about MAP Super, including insurance,
please contact our Complaints Officer:
Telephone: 07 3838 1234 or 1800 640 055
Write to:
The Complaints Officer
MAP Funds Management Ltd
GPO Box 1130
Brisbane QLD 4001
Making a claim
You can find out more about MAP’s Complaints Charter on our
website www.mapfunds.com.au
If you make an insurance claim, the Trustee will determine whether
you are entitled to be paid based on the terms of the policy, the
Fund’s rules and the law.
Hannover Life Re Australasia Ltd and MAP Financial Planning Pty
Ltd have consented and have not withdrawn their consent to being
named in this PDS in the form and context in which it appears.
Warning information about:
•
eligibility for, or the cancellation of, the insurance cover;
•
details of any definitions, conditions and exclusions applicable
to the insurance cover;
•
the level and type of optional insurance cover available;
•
the actual cost of the optional insurance cover in dollars, or the
range of costs that would be payable depending on a person’s
circumstances; and
The information in this PDS is subject to change from time to time.
Information that is not materially adverse can be updated by us.
Updated information can be obtained at www.mapfunds.com.au. A
paper copy of updated information can be obtained free of charge
by contacting MAP on 1800 640 055.
any other significant matter in relation to insurance cover, may
affect your entitlement to insurance cover and the important
additional information in the MAP Superannuation Plan Additional
Information Guide should be read before deciding whether the
insurance is appropriate.
! You should read the important information about MAP
Super’s full range of insurance cover (including default cover
and additional cover, optional cover, premiums and how they
are calculated, eligibility for cover, as well as changing or
cancelling insurance cover, conditions and exclusions) in the
MAP Superannuation Plan Additional Information Guide before
making a decision. Visit www.mapfunds.com.au. The material
relating to insurance may change between the time when you
read this Product Disclosure Statement and the day when you
acquire MAP Super.
MAP Superannuation Plan
ABN: 71 603 157 863
SPIN: MAP0005AU
8 | Page
FINANCIAL ADVICE FOR PROFESSIONALS
MAP Superannuation Plan Application Form
01 March 2014
MAP Superannuation Plan ABN 71 603 157 863, SFN 2967 359 49, SPIN MAP0005AU, APRA Registrable Superannuation Entity No R1001587 is issued by
MAP Funds Management Ltd ABN 85 011 061 831 AFSL No 240753 RSE Licence No L0000703.
IMPORTANT INFORMATION. Before completing this form you must read the MAP Superannuation Plan Product Disclosure Statement (PDS) dated 01
March 2014.
Please complete this form in BLOCK LETTERS. Questions? Call us on 1800 640 055 or email [email protected]
Are you an existing / previous MAP Member?
No
Yes
Please enter your existing / previous member number
Personal Details
TitleSurname Given Name(s)
Date of Birth
Gender
Male
Female
Indeterminate/Unspecified /Intersex
Tax File Number (It is not compulsory to quote your TFN)
My Tax File Number is:
I understand that this information will be used strictly for the purpose of compliance with Australian Federal taxation laws and will, if appropriate, be forwarded to the Australian Taxation Office (ATO).
I do not wish to provide my Tax File Number. I understand the consequences of not providing my TFN.
Address Details
Residential Address
State
Postcode
Postal Address (if same as Residential Address write “as above”)
State
Postcode
Contact Details
Phone (home)
Phone (work)
Phone (fax)
Phone (mobile)Email
9 | Page
Employment Details
Employment Status
Full-Time
Part-Time
Permanent Part-Time
Not Employed (go to Your Investment Choice)
Casual
Employee Of Your Own Company
Self-Employed /Substantially Self-Employed
Occupation
Business / Company Name
Employer Postal Address
State
Employer Phone
Employer Fax
Date You Joined Your Employer
D
Are You Currently In Active Employment*?
Yes
Postcode
D
/
/
M M
Y
Y
Y
*Active Employment means you are gainfully employed (including being on Employer
approved leave except leave caused by illness or injury) and attending work and
performing your normal duties and hours without restriction due to illness or injury.
No
Your Investment Choice
MAP Super offers eight (8) investment options. Please nominate the investment option/s you wish to invest in. You can select one option, or a
combination of options, however your total nomination must equal to 100%.
Australian
Equities
International
Equities
%
Diversified
Property
%
Cash
%
Capital Stable
%
%
Balanced
Moderate
Balanced
%
Growth
%
Total
%
100%
Death Benefit Nomination
In the event of my death, I request the Trustee of the MAP Superannuation Plan to distribute my benefit as set out below.
Please select one of the below options:
Y
Non-Binding Nomination: I understand that my nomination is not binding on the Trustee of the MAP Superannuation Plan
Beneficiary Name
Relationship
Proportion
1
%
2
%
3
%
4
%
Total Proportion 100%
Binding Nomination: Please complete a Binding Death Benefit Nomination Form (available at www.mapfunds.com.au)
I do not wish to make a Death Benefit Nomination
10 | Page
Insurance Cover
MAP Super offers two types of insurance cover – personal and employee. The type of insurance cover available to you is determined by your
employment status;
Your employment status:
You are eligible to apply for:
You are self-employed
Personal Cover
You are an employee of your own company or of a Participating Employer
You are neither of the above
1
1
Either Personal Cover or Employee Cover
Personal Cover
Participating Employer means an employer who makes or agrees to make contribution payments to the MAP Superannuation Plan.
Please indicate which insurance cover type you are eligible to apply for:
Personal Cover
Employee Cover
Provided you meet eligibility conditions, when you sign up to MAP Super you receive Default Death and TPD Cover. The level and cost of insurance
cover will depend on whether you are eligible for Personal or Employee Cover.
NOTE: You do not need to complete any additional paperwork to receive Default Cover.
Other Insurance Options
I wish to apply for Death Only or Death and TPD insurance in excess of, the Default Cover. (Please complete the Insurance Application Form on pages 21 to 33 of this document.)
I wish to apply for Income Protection Insurance. (Please complete the Insurance Application Form on pages 21 to 33 of this document.)
I wish to decrease my Default Cover or downgrade my Default Cover to Death Only Cover (Please submit this request in writing to us.)
I wish to opt-out of Default Cover. (You do not need to complete any additional paperwork.)
Privacy
We are committed to protecting the privacy of information you have provided to us in relation to your investments. The information provided is only
used to administer your investment, to communicate with you about your investment and to ensure that you receive the benefits relating to your
investment.
We do not normally disclose member information to outside parties, except those contracted to provide services to the MAP Superannuation Plan.
These include the Fund’s Auditors, Lawyers, Custodian and Insurer. If you, or anyone else on your behalf, makes a claim for a benefit, the Insurer may
give or receive information about you to or from medical practitioners, legal practitioners, health service providers, past or present employers, other
consultants, experts and companies in order to assess and process the claim.
With your written consent, we will disclose information about your MAP Superannuation Plan investment to your accountant, financial consultant
or others you have nominated. Personal information may also be disclosed to the Australian Taxation Office or other government authorities
or agencies as required by law.
Promotional Mail
Please tick here if you do not wish to receive promotional material.
11 | Page
Declaration
•
I have received and read the Product Disclosure Statement dated 01 March 2014 and any supplementary information to this document,
•
I apply to become a participant in the MAP Superannuation Plan,
•
I declare that all of the details on the application are correct,
•
I understand the conditions I must meet to be eligible for Default Personal Cover or Default Employee Cover ( see pages 6 and 7 of the PDS),
•
I understand that insurance cover requiring underwriting as outlined on pages 6 to 8 of this PDS requires me to complete the Insurance
Application Form at the back of this document,
•
I consent to the collection and disclosure of information about me for the purposes outlined above,
•
I give MAP Funds Management Ltd permission to contact my employer if required to confirm my employment, and
•
Upon acceptance of my application, I agree to be bound by the provisions of the Trust Deed dated 28 Jul 1994 as amended from time to time
which relates to the MAP Superannuation Plan.
Signature
Date
D
D
/
M M
/
Y
Y
Y
Y
Privacy Policy - The information you are providing in this form is subject to the Privacy Amendment (Private Sector) Act 2000. The Act sets out principles
for dealing with personal information which includes standards for collection, storage, accuracy and use of information and for disclosure required by
the Australian Taxation Office as well as your right to access your personal information which we hold. MAP has developed policies for complying with
this legislation which you may view on request.
MAP Funds Management Ltd (ABN 85 011 061 831, AFSL 240753) (‘MAP’) is the trustee and issuer of the MAP Superannuation Plan and the MAP Pension
Plan (ABN 71 603 157 863); and the MAP Pooled Superannuation Trust (ABN 92 209 339 241). The Product Disclosure Statements (‘PDS’) are available
at www.mapfunds.com.au or by calling 1800 640 055. This document may contain advice which is general in nature and not specific to your particular
circumstances. Before making an investment decision or acting on general advice you should consider your own financial situation, the PDS and
whether the particular financial product is right for you. Financial planning advice can be obtained from MAP Financial Planning Pty Ltd (ABN 91 090
411 537, AFSL 239117), a wholly owned subsidiary of MAP. (REF - MAPFM 0613)
12 | Page
FINANCIAL ADVICE FOR PROFESSIONALS
MAP SUPERANNUATION PLAN
ROLL IN FORM
Please complete this form in BLOCK LETTERS. Questions? Call us on 1800 640 055 or email [email protected]
When forwarding this form
To complete your rollover MAP requires the following documents to be forwarded with this form:
Certified proof of identity - either a certified photocopy of your current drivers licence or a certified photocopy of your current
passport. See the back of this form for details of who can certify your ID. If you do not have these documents, see our ‘Identification
Requirements Factsheet’ or contact us on 1800 640 055.
Important information
This form can be used to transfer either the WHOLE or PART
of the balance of your superannuation benefits. This form will
NOT change the fund to which your employer pays your
contributions. Use the Choice of Fund Form to change the
fund to which your employer pays your contributions.
Things you need to consider
Before transferring your other superannuation accounts to
The MAP Superannuation Plan, you should consider:
•
•
•
•
•
1
E xit fees;
B
enefits you may be losing, such as insurance;
C
osts;
I nvestment performance and
W
hether you should seek professional advice.
What happens if I do not quote my Tax File Number (TFN)?
You are not obliged to provide your TFN to your superannuation
fund. However, if you do not provide your TFN, your fund may be
taxed at the highest marginal tax rate plus the Medicare Levy on
contributions made to your account in the year, compared to the
concessional tax rate of 15%. If the Trustee does not have your
TFN, you will not be able to make personal contributions to your
superannuation account. Choosing to quote your TFN will also
make it easier to keep track of your superannuation in the future.
Under the Superannuation Industry (Supervision) Act 1993, the
Trustee is authorised to collect your TFN, which will only be used
for lawful purposes. These purposes may change in the future
as a result of legislative change. The TFN may be disclosed to
another superannuation provider, when your benefits are being
transferred, unless you request in writing that your TFN is not to
be disclosed to any other trustee.
Member details
MAP Account Number
Date of Birth
Tax File Number (You are not obliged to provide your TFN. See above for details of what happens if you do not quote your TFN.)
Title
Given Name(s)
Surname
Postal Address
Residential Address (if same as Postal Address write “as above”)
Phone (home)
Phone (work)
Phone (mobile)
Email
I authorise MAP to update my address and contact details if the details provided above differ to the details currently held.
13 | Page
2
Fund details
FROM FUND (If you have multiple accounts with this fund or accounts with another fund, complete a separate form for each account)
Fund Name Your member/account number
Australian Business Number (ABN)
Superannuation Product ID Number (SPIN)
Phone
TO FUND
Fund Name
Your member/account number
MAP Superannuation Plan
3
Australian Business Number (ABN)
Superannuation Product ID Number (SPIN)
Phone
71603157863
MAP0005AU
07 3838 1234
Transfer amount
I wish to transfer:
The WHOLE balance of my superannuation benefits
OR
PART of the balance of my superannuation benefits as shown: $
4
Declaration and signature
By signing this request form I am making the following statements:
•
I declare I have fully read this form and the information provided is true and correct;
•
I am aware I may ask my superannuation provider for information about any fees or charges that may apply, or any other
information about the effect this transfer may have on my benefits, and do not require any further information;
•
I discharge the superannuation provider of the fund I am transferring from of all further liability in respect of the benefits paid and
transferred to MAP Superannuation Plan; and
•
I request and consent to the transfer of superannuation as described above and authorise the superannuation provider of each fund to
give effect to this transfer.
I authorise MAP Funds Management to obtain account information from the transferring fund named in section 2 above.
I have attached my certified identification as requested.
I have attached the certificate of compliance which appears at the back of this form.
Signature
Date
Privacy Policy - The information you are providing in this form is subject to the Privacy Amendment (Private Sector) Act 2000. The Act sets out principles for dealing with personal
information which includes standards for collection, storage, accuracy and use of information and for disclosure required by the Australian Tax Office as well as
your right to access your personal information which we hold. MAP has developed polices for complying with this legislation which you may view on request.
Please send the completed form to: MAP Funds Management, Reply Paid 1130, Brisbane Qld 4001
Contact Us
GPO Box 1130, Brisbane QLD 4001
[email protected]
www.mapfunds.com.au
Telephone:
Toll Free:
Facsimile:
07 3838 1234
1800 640 055
07 3838 1235
MAP Funds Management Ltd (ABN 85 011 061 831, AFSL 240753) (‘MAP’) is the trustee and issuer of the MAP Superannuation Plan and the MAP Pension Plan (ABN 71 603 157
863); and the MAP Pooled Superannuation Trust (ABN 92 209 339 241). The Product Disclosure Statements (‘PDS’) are available at www.mapfunds.com.au or by calling 1800 640
055. This document may contain advice which is general in nature and not specific to your particular circumstances. Before making an investment decision or acting on general advice
you should consider your own financial situation, the PDS and whether the particular financial product is right for you. Financial planning advice can be obtained from MAP Financial
Planning Pty Ltd (ABN 91 090 411 537, AFSL 239117), a wholly owned subsidiary of MAP. (REF - MAPFM 0613)
14 | Page
FINANCIAL ADVICE FOR PROFESSIONALS
MAP FUNDS MANAGEMENT LTD
Level 5, 135 Wickham Tce, Brisbane
GPO Box 1130 Brisbane, Qld, 4001
Phone 07 3838 1234
Facsimile 07 3838 1235
Toll Free 1800 640 055
www.mapfunds.com.au
[email protected]
Certificate of compliance
MAP Superannuation Plan
SFN 2967 359 49
ABN 71 603 157 863
The MAP Superannuation Plan is a superannuation fund established in accordance with the Superannuation Industry (Supervision) Act
1993 (SIS). The Trustee of this fund is MAP Funds Management Ltd ABN 85 011 061 831.
We certify that:
a)The Trustee has lodged an irrevocable election for the fund to be a regulated superannuation fund within the meaning
of Section 19 of SIS.
b)The Fund will be administered as a complying superannuation entity for the purposes of SIS. The Trustee has not received
a notice of non-compliance from the Australian Prudential Regulation Authority.
c)The Australian Prudential Regulation Authority has not directed the Fund not to accept contributions or rollovers under
Section 63 of SIS.
Yours faithfully,
G.J. Hoyes
Company Secretary
MAP Funds Management Ltd
How to certify personal documents
All copied pages of ORIGINAL proof of identification documents (including any linking documents) need to be certified as true copies by
any individual approved to do so (see below).
The person who is authorised to certify documents must sight the original and the copy and make sure both documents are identical,
then make sure all pages have been certified as true copies by writing or stamping ‘certified true copy’ followed by their signature,
printed name, qualification (eg Justice of the Peace, Australia Post employee, etc) and date.
The following can certify copies of the originals as true and
correct copies:
•
A
permanent employee of Australia Post with five
or more years of continuous service
A
finance company officer with 5 or more years of
continuous service
A
n officer with, or authorised representative of, a
holder of an Australian Financial Services Licence
(AFSL), having five or more years continuous service
with one or more licensees
A
notary public officer
•
•
•
•
•
•
•
•
•
•
•
A police officer
A
registrar or deputy registrar of a court
A
Justice of the Peace
A
person enrolled on the roll of a State or Territory Supreme
Court or the High Court of Australia,
as a legal practitioner
A
n Australian consular officer or an Australian
diplomatic officer
A
judge of a court
A
magistrate, or
A
Chief Executive Officer of a Commonwealth court.
15 | Page
This page has been left blank intentionally.
16 | Page
FINANCIAL ADVICE FOR PROFESSIONALS
MAP Superannuation Plan Choice of Fund Form
Personal Details
Title
Given Name(s)
Surname
Chosen Fund Details
Fund Name
M A
P
S
U
P
E
R
A
N
Australian Business Number (ABN)
7
1
6
0
3
1
5
7
8
6
N
U
A
T
I
O N
P
N
A
L
Superannuation Product ID Number (SPIN)
3
M A
P
0
0
0
5
A
Your member/account number
U
Phone
0
7
-
3
8
3
8
1
2
3
4
Declaration and Signature
•
I request that all future employer contributions be made to the fund specified above.
Signature
Date
D
D
/
M M
/
Y
Y
Y
Y
Privacy Policy - The information you are providing in this form is subject to the Privacy Amendment (Private Sector) Act 2000. The Act sets
out principles for dealing with personal information which includes standards for collection, storage, accuracy and use of information and for
disclosure required by the Australian Tax Office as well as your right to access your personal information which we hold. MAP has developed
polices for complying with this legislation which you may view on request.
Please give your completed form to your employer.
MAP Funds Management Ltd (ABN 85 011 061 831, AFSL 240753) (‘MAP’) is the trustee and issuer of the MAP Superannuation Plan and the
MAP Pension Plan (ABN 71 603 157 863); and the MAP Pooled Superannuation Trust (ABN 92 209 339 241). The Product Disclosure Statements
(‘PDS’) are available at www.mapfunds.com.au or by calling 1800 640 055. This document may contain advice which is general in nature and
not specific to your particular circumstances. Before making an investment decision or acting on general advice you should consider your own
financial situation, the PDS and whether the particular financial product is right for you. Financial planning advice can be obtained from MAP
Financial Planning Pty Ltd (ABN 91 090 411 537, AFSL 239117), a wholly owned subsidiary of MAP. (REF - MAPFM 0613)
17 | Page
Certificate of compliance
MAP Superannuation Plan
SFN 2967 359 49
ABN 71 603 157 863
FINANCIAL ADVICE FOR PROFESSIONALS
MAP FUNDS MANAGEMENT LTD
Level 5, 135 Wickham Tce, Brisbane
GPO Box 1130 Brisbane, Qld, 4001
Phone 07 3838 1234
Facsimile 07 3838 1235
Toll Free 1800 640 055
www.mapfunds.com.au
[email protected]
The MAP Superannuation Plan is a superannuation fund established in accordance with the Superannuation Industry (Supervision) Act 1993 (SIS).
The Trustee of this fund is MAP Funds Management Ltd ABN 85 011 061 831.
We certify that:
a)
The Trustee has lodged an irrevocable election for the fund to be a regulated superannuation fund within the meaning
of Section 19 of SIS.
b)
The Fund will be administered as a complying superannuation entity for the purposes of SIS. The Trustee has not received
a notice of non-compliance from the Australian Prudential Regulation Authority.
c)
The Australian Prudential Regulation Authority has not directed the Fund not to accept contributions or rollovers under
Section 63 of SIS.
Yours faithfully,
G.J. Hoyes
Company Secretary
MAP Funds Management Ltd
18 | Page
FINANCIAL ADVICE FOR PROFESSIONALS
MAP Superannuation Plan
Binding Death Benefit Nomination Form
Member details
MAP Account Number
Title
Date of Birth
Given Name(s)
Surname
Postal Address
Residential Address (if same as Postal Address write “as above”)
Phone (home)
Phone (work)
Phone (mobile)
Email
I authorise MAP to update my address and contact details if the details provided above differ to the details currently held.
Beneficiary Information
In the event of my death, I request the Trustee of the MAP Superannuation Plan to distribute my benefit as set out below. This nomination is
to be binding on the Trustee of the MAP Superannuation Plan.
The person (s) I have nominated below are beneficiaries as defined in the Superannuation Industry (Supervision) Act and Regulations.
Beneficiary Name
Relationship
Proportion
1
%
2
%
3
%
4
%
Total Proportion 100%
19 | Page
Member signature
NOTE: You are required to sign this section in the presence of your witnesses
Signature
Date
D
D
/
M M
/
Y
Y
Y
Y
Witness declarations and signatures
Two witnesses are required. Each witness must be over 18 years of age and must not be a beneficiary.
We declare that the above statement was signed and dated in our presence by:
Member name
Witness Information
Witness Name
Address
Signature
Date
1
2
Please send the completed form to: MAP Funds Management, Reply Paid 1130, Brisbane Qld 4001
Contact Us
GPO Box 1130, Brisbane QLD 4001
[email protected]
www.mapfunds.com.au
Telephone:
Toll Free:
Facsimile:
07 3838 1234
1800 640 055
07 3838 1235
MAP Funds Management Ltd (ABN 85 011 061 831, AFSL 240753) (‘MAP’) is the trustee and issuer of the MAP Superannuation Plan and the MAP Pension Plan (ABN 71 603 157 863);
and the MAP Pooled Superannuation Trust (ABN 92 209 339 241). The Product Disclosure Statements (‘PDS’) are available at www.mapfunds.com.au or by calling 1800 640 055. This
document may contain advice which is general in nature and not specific to your particular circumstances. Before making an investment decision or acting on general advice you should
consider your own financial situation, the PDS and whether the particular financial product is right for you. Financial planning advice can be obtained from MAP Financial Planning Pty Ltd
(ABN 91 090 411 537, AFSL 239117), a wholly owned subsidiary of MAP. (REF - MAPFM 0613)
20 | Page
MAP Superannuation Plan
Insurance Application Form
FINANCIAL ADVICE FOR PROFESSIONALS
01 March 2014
MAP Superannuation Plan ABN 71 603 157 863, SFN 2967 359 49, SPIN MAP0005AU, APRA Registrable Superannuation Entity No R1001587 is
issued by MAP Funds Management Ltd ABN 85 011 061 831 AFSL No 240753 RSE Licence No L0000703.
COMPLETE THIS FORM ONLY IF YOU WANT COVER IN EXCESS OF OR INSTEAD OF DEFAULT COVER OR IF
YOU WANT INCOME PROTECTION COVER.
IMPORTANT INFORMATION. Before completing this form you must read the MAP Superannuation Product Disclosure Statement (PDS) dated 01
March 2014.
1 Member details
MAP Account Number
Title
Date of Birth
Given Name(s)
Surname
Postal Address
Residential Address (if same as Postal Address write “as above”)
Phone (home)
Phone (work)
Phone (mobile)
Email
2 Employment Details
Employment Status
Full-Time
Part-Time
Permanent Part-Time
Not Employed (go to Death Only and Death and TPD Insurance)
Casual
Employee Of Your Own Company
Self-Employed /Substantially Self-Employed
Occupation
Business / Company Name
Employer Postal Address
Employer Phone
Employer Fax
21 | Page
If you are self-employed or an employee of your own company: How long have you been self employed?
years
months
% of business you own
No. of employees (excluding yourself )
3 Death only and Death and Total and Permanent Disablement (TPD) Insurance
Do you wish to apply for Death Only or Death & TPD Insurance in excess of or instead of Default Cover?
No (Go to Income Protection Insurance ) OR
Yes (complete this section for EITHER personal cover or employee cover)
PERSONAL COVER ONLY
I already have MAP Group Life cover (including Default Cover) which I would like to increase as shown (do not complete if you wish to
increase cover due to a Lifetime Event – see below):
Death Only ($)
Death & TPD ($)
Amount of MAP cover I currently have (including default cover)
ADD: I would like to increase my current cover by the amount shown:
EQUALS: Total cover required:
Death Only ($)
Death & TPD ($)
I don’t currently have MAP Group Life cover. I would like to apply for:
No Maximum
Due to a Lifetime Event* I wish to increase my cover by
Maximum $3m total cover, all sources
Must be the lesser of 25% of agreed benefit, $200,000 or amount
of / increase in mortgage
* Includes the purchase of a home, marriage, birth or adoption of a child. See the MAP Superannuation Plan Additional Information Guide for
details.
I wish to upgrade my Personal Default Cover to Full cover (equal to Default Cover amount with 36 Limited Cover condition removed).
ADDITIONAL INFORMATION YOU NEED TO PROVIDE TO APPLY FOR DEATH ONLY OR DEATH & TPD COVER
•
•
•
•
For cover less than $1 million total cover, complete a Short Form Personal Statement (Section 5).
For cover greater than $1 million total cover, complete a Personal Statement & Declaration of Health (Section 6).
For Increase in cover due to a Lifetime Event attach a certified copy of your marriage certificate, your child’s birth certificate or loan
agreement and go straight to Privacy, Duty of Disclosure and Declaration (Section 7).
To decrease your default cover or to change your default cover to Death Only, request this in writing to MAP Funds Management Ltd.
EMPLOYEE COVER ONLY
I already have MAP Group Life cover (including Default Cover) which I would like to increase as shown (do not complete if you wish
to increase cover due to a Lifetime Event – see below):
Death Only (units)
Death & TPD (units)
Amount of MAP cover I currently have (including default cover)
ADD: I would like to increase my current cover by the amount shown:
EQUALS: Total cover required:
Death Only (units)
Death & TPD (units)
I don’t currently have MAP Group Life cover. I would like to apply for:
No Maximum
Maximum $3m total cover, all sources
Due to a Lifetime Event* I wish to increase my cover by one (1) unit.
* Includes the purchase of a home, marriage, birth or adoption of a child. See the MAP Superannuation Plan Additional Information Guide for
details.
ADDITIONAL INFORMATION YOU NEED TO PROVIDE TO APPLY FOR DEATH ONLY OR DEATH & TPD COVER
•
•
•
•
For cover less than $1 million total cover, complete a Short Form Personal Statement (Section 5).
For cover greater than $1 million total cover, complete a Personal Statement & Declaration of Health (Section 6).
For Increase in cover due to a Lifetime Event attach a certified copy of your marriage certificate, your child’s birth certificate or loan
agreement and go straight to Privacy, Duty of Disclosure and Declaration. (Section 7)
To decrease your default cover or to change your default cover to Death Only, request this in writing to MAP Funds Management Ltd.
22 | Page
4
Income Protection Insurance
Do you wish to apply for Income Protection Insurance?
No (go to section 5)
Yes
If yes, are you applying for:
Benefit Period
Waiting Period
2 years
30 days
OR
An increase in existing insurance?
Benefit Amount
What is your Annual Salary* (excluding superannuation)?
The benefit you require (as a % of your annual salary):
OR
To age 65
New insurance? OR
$
%
Max. 75% but not greater than $25,000/month
90 days
Do you require optional Employer Superannuation Contribution Cover? (not available for
self-employed)
Yes
%
OR
No
Max 10% but not greater than actual contribution amount
(this is included in your max $25,000 per month benefit)
ADDITIONAL INFORMATION YOU NEED TO PROVIDE TO APPLY FOR INCOME PROTECTION COVER
•
Complete a Personal Statement & Declaration of Health (Section 6).
* Definition of Salary: Where the member does not directly or indirectly own part of their employer, salary is pre-tax salary from the employer
but not including any director’s fees, commissions, overtime payments, bonuses, penalty or shift allowances, investment income, income
received from deferred compensation plans, disability income policies or retirement plans, income not derived from vocational activities, unless
the Insurer has expressly agreed otherwise. Where the person directly or indirectly owns part or all of a business or practice which is their
employer, salary is the annual share of the income of that business or practice generated by their personal exertion in the previous 12 months
after the deduction of their share of expenses in generating that income, or any other income the Insurer has expressly approved.
23 | Page
5
Short form personal statement
IF YOU ARE REQUIRED TO COMPLETE A PERSONAL STATEMENT AND DECLARATION OF HEALTH, DO NOT COMPLETE A SHORT FORM
PERSONAL STATEMENT, GO STRAIGHT TO PERSONAL STATEMENT AND DECLARATION OF HEALTH (Section 6).
Personal Details
Occupation
HeightWeight
cm
kg
Health Questionnaire
(Before you begin, please read the Duty of Disclosure warning at the back of this form). Tick either “No” or “Yes” for each question:
(1)
Have you had any medical advice, investigation or treatment for any of the following:
(a)
Chest pain, indigestion or ulcer?
No
Yes
(b)
High blood pressure, rheumatic fever, or any heart disorder or complaint?
No
Yes
(c)
Cancer or tumour of any type?
No
Yes
(d)
Mental illness, depression, nervous conditions, stress or fatigue?
No
Yes
(e)
Diabetes, any ailment or condition relating to the thyroid, bowel, liver, gall bladder, kidney or bladder
(including thyroidism, renal colic, nephritis, pyelitis, cystitis or irritable bowel syndrome)?
No
Yes
(f )
Any disease or injury to the head, neck or spine including back strain, disc disorder, lumbago, fibrositis,
sciatica or neuritis?
No
Yes
(g)
Tendonitis, tenosynovitis, RSI or Regional Pain Syndrome, arthritis, gout or any other injury, deformity or
disease involving any joint or limb?
No
Yes
(h)
Fainting attacks, fits of any kind, epilepsy, paralysis or stroke?
No
Yes
(i)
Anaemia, Leukaemia, Haemophillia or any other blood disorder?
No
Yes
(j)
Any sexually transmitted disease?
No
Yes
(k)
Coughing of blood or passage of blood from the bowel or in the urine?
No
Yes
(l)
Any skin disorders or conditions; any congenial abnormality?
No
Yes
Any impairment of sight, hearing or speech?
No
Yes
(2)
(3)
Have you required surgical treatment, medical examinations, investigations, X-rays or blood tests?
No
Yes
(4)
During the last 5 years, have you taken, or been prescribed any medication or drug, such as stimulants,
sedatives or tranquillisers? If yes, list name of drug and dosage below:
No
Yes
(5)
Has any insurance company ever refused, set special conditions, or charged a higher than normal premium
for life or disability insurance cover on your life?
No
Yes
(6)
Have you ever made a claim for or received benefits under disablement insurance, Workers compensation,
Motor Vehicle Accident Insurance, Social Security sickness or invalid benefits or Veterans Affairs sickness or
invalid benefits?
No
Yes
(7)
Have any of your Parents, Brothers or Sisters suffered from heart disease, diabetes, kidney disease, mental
illness, cancer or other hereditary disorder? If yes, provide details below:
No
Yes
(8)
Do you engage in any hazardous pastimes or pursuits including motor sports, private flying, scuba diving,
abseiling, parachuting, competitive football, etc? If yes, please provide details below:
No
Yes
If you answered “yes” to any question above, please provide full details below, or alternatively attach more information or paper where required.
24 | Page
5
DOCTOR DETAILS
My regular doctor’s name and address:
Name
Address
Date of last consultation
D
D
/
M M
/
Y
Y
Y
State
Postcode
How long has this doctor known you?
Y
Reason for and result of last consultation
Aids Statement
Please tick No or Yes to each of the following:
Have you EVER been infected by the virus which causes AIDS (the Human Immunodeficiency Virus)?
No
Yes
Have you EVER sought or are expecting to receive treatment for AIDS or an AIDS related condition or have you ever had a positive test for HIV?
No
Yes
Have you EVER injected yourself with any drug not prescribed by a medical practitioner, engaged
in male to male anal sexual activity or worked as or engaged in sexual activity with a prostitute or
someone you know or suspect to be HIV positive?
No
Yes
If you answered “Yes” to any question above, please provide full details below, or alternatively attach more information or paper where required:
25 | Page
6 Personal Statement and Declaration of Health
COMPLETE THIS SECTION IF YOU ARE APPLYING FOR DEATH ONLY OR DEATH & TPD COVER GREATER THAN $1 MILLION TOTAL
COVER OR IF YOU ARE APPLYING FOR INCOME PROTECTION COVER.
Insurance History
Has Life, Disability, Accident and Sickness or Superannuation cover on your life ever been declined, deferred or
withdrawn from any Insurance Company or accepted with a loading, exclusion or other than as applied?
No
Yes
No
Yes
If you answered “yes”, please provide full details (including dates, name of company and reason):
Have you ever made a claim for disability benefits under an Insurance, Superannuation or Worker’s
Compensation policy, Veterans Affairs or under Social Security or Centrelink (including CTP and public
liability)?
Please provide full details (including dates, cause of claim, type of benefit and amount paid, claim number and insurance company):
Other than this application, do you have or are you applying for Life, TPD, Trauma, Disability Income or
Income Protection with any other company?
If yes, please provide full details:
Company
Type of Policy
Benefit Amount
Owner
To be replaced
No
Yes
No
Yes
Habits, Activities and Residence
Please tick No or Yes to each of the following questions:
Do you drink alcohol?
No
Yes
Please state type and weekly quantity:
Have you smoked in the last 12 months?
No
Yes
Please state form and daily quantity:
Do you currently, or do you intend to engage in any hazardous pastime and/or sporting activity such as aviation (other than as a fare paying
passenger on a recognised airline), motor racing of any kind, diving, football, parachuting, hang gliding, etc?
No
Yes
Please provide full details:
Are you an Australian or New Zealand citizen or do you have an Australian Permanent Resident’s visa?
No
Yes
Please provide full details
Do you intend travelling overseas in the immediate future (i.e. next 2 years)?
No
Yes
Please give full details (where, when, duration and reason):
26 | Page
Occupation Details
Occupation
How long have you been in your current occupation?
How many hours do you work per week?
months
Years
What are your principal duties and where do you perform these duties?
Duties (eg sales, office work)
% of time
Do you hold any professional / trade qualifications?
No
Qualification obtained
Location (eg office, driving (local, interstate))
Yes (please provide details)
Name of institution where obtained
Has your main occupation, employer or employment status changed in the last three (3) years?
Previous Occupation
% of time
Employer
No
Employment Status*
Yes (please provide details)
Date from
Date to
*Employment Status (eg unemployed, employed, employed by own company, self employed, partnership)
Do you have any other occupation?
No
Yes (please provide details)
Occupation
Name of Employer
How long have you been in this other occupation?
years
How many hours do you work per week in this other occupation?
months
What is your monthly income from this other occupation?
$
Financial Details
COMPLETE THE FINANCIAL DETAILS SECTION ONLY IF YOU ARE APPLYING FOR INCOME PROTECTION INSURANCE, OTHERWISE
GO TO MEDICAL STATEMENT. PLEASE NOTE THAT BASED ON THE FINANCIAL INFORMATION BELOW, ADDITIONAL FINANCIAL
INFORMATION MAY BE REQUIRED.
If disabled, would all or part of your income continue?
(eg sick leave, other disability income policies, pension, investment, rental, company profit share, etc)
No
Yes (please provide details)
27 | Page
Financial Details continued..
Employees only (i.e., no ownership in employer’s business)
In respect of your principal occupation, what has been the total value of remuneration paid by your employer over the last two years? This
should be determined by calculating the amount you could be expected to receive if your total remuneration was received as a salary or wage
(before income tax is deducted).
Y
Last tax year
Y
Y
Y
$
Remuneration
Y
Previous tax year
Y
Y
How much of this was commission / bonus / overtime?
$
Y
$
Remuneration
How much of this was commission / bonus / overtime?
$
Self-Employed only (i.e. sole trader, employed by / director of own company or trust, partnership)
Last tax year
Business $
Y
Y
Y
Y
Your share $
Y
Previous tax year
Business $
Y
Y
Y
Your Share $
Gross Income
LESS Business Expenses
Net Income (Loss)
PLUS the following paid to you
Wages / salary / drawings / Director’s fees
Superannuation costs
Total
Please note: any amounts received as wages / salary / drawings / director’s fees must not be paid from past profits, capital or loans.
Medical Statement
Name and address of your Doctor:
Name
Address
State
Postcode
Details of last medical consultation, including doctors, physiotherapists, chiropractors and ANY other health professional.
Date
Health Professional
Your height
cm
Address
Reason
Outcome / Result
Your weight
kg
28 | Page
Please tick No or Yes to each of the following questions:
Within the LAST THREE YEARS have you, other than advised above:
(a)
Consulted, been examined or treated by, or received advice from any doctor, psychologist,
psychiatrist, counsellor, chiropractor, physiotherapist or other health care professional
(naturopath, etc) or been in a hospital or been advised to have an operation?
No
Yes
(b)
Either occasionally or regularly taken any drugs, stimulants, sedatives, tranquillisers,
medications by mouth, by inhalation or by injection?
No
Yes
Have you EVER had an ECG, x-ray, transfusion, mammogram, surgery or any other investigation?
No
Yes
Have you EVER had any blood tests which revealed an abnormality, eg raised blood sugar, liver
function or renal function results, or anaemia, etc?
No
Yes
Do you contemplate seeking any medical examination, advice, treatment or surgery in the future?
No
Yes
Please provide full details for all YES answers to the questions above. If more space is required, please go to Additional Information.
Date
Health Professional
Address
Reason
Outcome / Result
Have you EVER received any advice or treatment for:
(a)
High blood pressure, raised cholesterol, stroke or circulatory disorder?
No
Yes
(b)
Chest pain, shortness of breath, palpitations, any heart complaint or rheumatic fever?
No
Yes
(c)
Asthma, bronchitis or other lung complaint?
No
Yes
(d)Diabetes?
No
Yes
(e)
Indigestion, hernia, gastric or duodenal ulcer, colitis or any other intestinal disorder?
No
Yes
(f )
Hepatitis or other liver or gall bladder disease?
No
Yes
(g)
Back, neck or knee complaint or any disorder of the joints, bones or muscles (e.g. gout, arthritis)?
No
Yes
(h)
Kidney or bladder disease, renal colic, stones or blood in the urine?
No
Yes
(i)
Depression, anxiety, stress, mental or nervous condition, or chronic fatigue?
No
Yes
(j)
Cancer, tumour, melanoma, sunspots or growth of any kind?
No
Yes
(k)
Eczema, dermatitis, psoriasis or any other skin condition?
No
Yes
(l)
Tinnitus, hearing loss or any defect in hearing, sight or speech?
No
Yes
(m)
Anaemia, leukaemia, haemophilia or other blood disorder?
No
Yes
(n)
Thyroid or prostate disorder, any disorder of the reproductive organs, or sexually transmitted disease?
No
Yes
(o)
Persistent diarrhoea, unexplained weight loss, enlarged lymph glands, recurrent fever or night sweats?
No
Yes
(p)
Multiple sclerosis, epilepsy, fits of any kind, recurrent headaches, dizzy spells or fainting attacks?
No
Yes
(q)
Any other physical impairment, congenital abnormality, deformity or symptoms of ill health, illness or
injury?
No
Yes
Females only
(r)
Have you ever had any gynaecological conditions (eg endometriosis, abnormal pap smear, etc)?
No
Yes
(s)
Have you ever had any complications of pregnancy or childbirth?
No
Yes
(t)
Are you currently pregnant?
If yes, what is the expected date of delivery?
(u)
Have you ever had a breast lump (even if you have not seen a doctor about it)?
No
Yes
D D / M M / Y Y Y Y
No
Yes
Please provide full details for all YES answers to the above questions on the following page.
29 | Page
Please provide full details for all YES answers to the questions on the previous page. If more space is required, please attach a
separate sheet addressing the questions below.
Specific Condition
Question no.___________
Question no. ____________
Date symptoms first started and description of
symptoms?
What was the condition and which part of the
body was affected?
What was the medical diagnosis including
results of x-rays and investigations?
What was the frequency (daily, weekly, etc) of
attacks or symptoms?
What was the severity (mild/moderate/ severe)
and duration of attacks or symptoms?
How long were you unable to work or perform
your normal duties/activities?
If a hospital visit was required, please provide
date and duration of your stay.
What advice/treatment did you receive?
Are you still receiving treatment? If so, please
advise nature and frequency of treatment.
When did you last suffer from any symptoms?
Degree of recovery (%)?
Please supply name and address of all doctors
or hospitals or other consultants.
Family History
Please tick No or Yes:
Have any of your parents, brothers or sisters suffered from heart disease, diabetes, kidney disease, mental illness, cancer, Huntington’s Disease or
any other hereditary disease?
No
Yes (please provide full details Including age at diagnosis and age at death, if applicable)
Questions in Relation to AIDS
Please tick No or Yes to each of the following:
Have you EVER been infected by the virus which causes AIDS (the Human Immunodeficiency Virus)?
No
Yes
Have you EVER sought or are expecting to receive treatment for AIDS or an AIDS related condition
or have you ever had a positive test for HIV?
No
Yes
Have you EVER injected yourself with any drug not prescribed by a medical practitioner, engaged in
male to male anal sexual activity or worked as or engaged in sexual activity with a prostitute or
someone you know or suspect to be HIV positive?
No
Yes
If you answered “yes” to any question above, please provide full details below, or alternatively attach more information or paper where required:
30 | Page
Additional Information (to assist with clarification of any issue)
Please use this section to assist with clarification of any issue.
Please attach additional pages if there is insufficient room. Are you attaching additional pages?
No
Yes
31 | Page
7
Privacy, and Duty of Disclosure
PRIVACY
We are committed to protecting the privacy of information you have provided to us in relation to your investments. The information provided is
only used to administer your investment, to communicate with you about your investment and to ensure that you receive the benefits relating
to your investment. We do not normally disclose member information to outside parties, except those contracted to provide services to the MAP
Superannuation Plan. These include the Fund’s Auditors, Lawyers, Custodian and Insurer. If you, or anyone else on your behalf, makes a claim for
a benefit, the Insurer may give or receive information about you to or from medical practitioners, legal practitioners, health service providers,
past or present employers, other consultants, experts and companies in order to assess and process the claim. With your written consent, we will
disclose information about your MAP Superannuation Plan investment to your accountant, financial consultant or others you have nominated.
Personal information may also be disclosed to the Australian Taxation Office or other government authorities or agencies as required by law.
IMPORTANT INFORMATION FROM THE INSURANCE PROVIDER REGARDING PRIVACY
Note: References to ‘we’, ‘us’, or ‘our in the following two paragraphs refer to the Insurance Provider, Hannover Life Re of Australasia Ltd (HLRA),
Level 7, 70 Phillip Street, Sydney NSW 2000, Tel: 02 9251 6911, Fax: 02 9251 6862.
Privacy Act 1988 - Our Obligations under the Act
The Privacy Act 1988 (the Act) sets out a number of principles that we must comply with in the collection, security, storage, use and disclosure of
personal information. These principles are known as the National Privacy Principles. The following information is provided to you in accordance
with these principles. The organisation collecting information about you is HLRA. We can be contacted at the address shown above, either
in writing, by telephone or by fax. If you ask us, we must provide you with access to the personal information we hold about you. We may be
entitled to refuse access to some information as set out in the Act. Your right to access this information is set out in our Privacy Policy Document,
which is available on request. The information we collect will be used to assess and process your application for life insurance. We may also
use the information if a claim is submitted by you, or by someone acting on your behalf. The information we collect may be disclosed to other
organisations, including but not limited to, medical and legal practitioners, health service providers, other insurance or reinsurance companies
including our parent company, legal tribunals, investigation organisations, the trustees of a superannuation fund you belong to, an organisation
that is duly appointed to manage the administration of such fund and interpreters. If you fail to provide us with all or part of the information we
require, we will be unable to assess and process your application.
Consent
I understand that in order to assess and process my application, HLRA may need health and employment information about me. I consent to
HLRA obtaining information about me from any medical practitioner or health professional that I have or may consult in the future, or that
HLRA appoints to examine me, and from my employers. I further understand that if I apply for increased or different insurance cover, HLRA
may require further information about me. I now consent to HLRA obtaining such further information as and when required, from any medical
practitioner or health professional that I have consulted or may consult in the future, or that HLRA appoints to examine me, and from my
employers. I understand that if I or anyone else on my behalf, makes a claim for a benefit, HLRA will need information about me in order to
assess and process the claim. I hereby consent to HLRA obtaining information about me from any of the following: medical practitioners that I
have consulted at any time and any that HLRA wishes to appoint to examine me, legal practitioners, health service providers, legal tribunals and
courts, investigation organisations, accountants or other consultants, HLRA’s parent company, other insurance or reinsurance companies, the
trustees of my superannuation fund, any organisation appointed by the trustees of my superannuation fund to receive or give information, my
past and present employers and interpreters. For the purpose of this application and any future application and any claim for a benefit, I also
consent to HLRA disclosing information about me to any of the organisations mentioned above, insofar as such disclosures are necessary for
HLRA to perform its functions.
DUTY OF DISCLOSURE
Duty of Disclosure
Before you enter into a contract of life insurance with an Insurer, you have a duty, under the Insurance Contracts Act 1984, to disclose to the
Insurer every matter that you know, or could reasonably be expected to know, is relevant to the Insurer’s decision whether to accept the risk of
insurance and if so, on what terms. You have the same duty to disclose those matters to the Insurer before you renew, extend, vary or reinstate
a contract of life insurance. Your duty, however, does not require disclosure of a matter that diminishes the risk to be undertaken by the Insurer;
that is of common knowledge; that your Insurer knows, or, in the ordinary course of its business, ought to know; as to which compliance with
your duty is waived by the Insurer.
Non-disclosure
If you fail to comply with your duty of disclosure and the Insurer would not have entered into the contract on any terms if the failure had not
occurred, the Insurer may avoid the contract within three (3) years of entering into it. If your non-disclosure is fraudulent, the Insurer may avoid
the contract at any time. An Insurer who is entitled to avoid a contract of life insurance may, within three (3) years of entering into it, elect not
to avoid it but to reduce the sum that you have been insured for in accordance with a formula that takes into account the premium that would
have been payable if you had disclosed all relevant matters to the Insurer. Your Duty of Disclosure continues until the contract of life insurance
has been accepted by the Insurer and confirmation is issued in writing. Please ensure all applicable questions are fully answered.
32 | Page
Declaration
•
I have received and read the Product Disclosure Statement dated 01 March 2014;
•
I consent to the collection and disclosure of information about me for the purposes outlined in the Privacy section above;
•
I have read and understand the Duty of Disclosure section above;
•
I understand that I may be sent additional documentation which I need to submit before my application for insurance is complete;
•
I understand that insurance cover will commence from the date I am advised in writing; and
•
I declare that all of the details I have provided on the insurance application are correct.
Signature
Date
D
D
/
M M
/
Y
Y
Y
Y
Privacy Policy – The information you are providing in this form is subject to the Privacy Amendment (Private Sector) Act 2000. The Act sets
out principles for dealing with personal information which includes standards for collection, storage, accuracy and use of information and for
disclosure required by the Australian Tax Office as well as your right to access your personal information which we hold. MAP has developed
polices for complying with this legislation which you may view on request.
Please send the completed form to: MAP, Reply Paid 1130, Brisbane QLD 4001
MAP Funds Management Ltd (ABN 85 011 061 831, AFSL 240753) (‘MAP’) is the trustee and issuer of the MAP Superannuation Plan and the
MAP Pension Plan (ABN 71 603 157 863); and the MAP Pooled Superannuation Trust (ABN 92 209 339 241). The Product Disclosure Statements
(‘PDS’) are available at www.mapfunds.com.au or by calling 1800 640 055. This document may contain advice which is general in nature and
not specific to your particular circumstances. Before making an investment decision or acting on general advice you should consider your own
financial situation, the PDS and whether the particular financial product is right for you. Financial planning advice can be obtained from MAP
Financial Planning Pty Ltd (ABN 91 090 411 537, AFSL 239117), a wholly owned subsidiary of MAP. (REF - MAPFM 0613)
33 | Page