APPLICATION BY MEMBER TO COMMUTE PENSION AND 
ADD TO ACCUMULATION ACCOUNT

To Trustees,
<<FundName>>
<<FundAddress1>>								.
<<FundAddress2>>								.							
<<Date>>

I hereby make an irrevocable request to the trustees that my existing Account Based Pension in <<FundName>> be commuted back into accumulation mode. The details are as below: 

Pension 1 (copy the below for each pension)

TERMS	DETAILS	
DATE TO STOP PENSION
(COMMUTATION)	<<Date when pension has to be commuted >>	
TYPE OF PENSION	<<Account Based Pension>>	
START DATE OF ORIGINAL PENSION	<<DATE >>	
PURCHASE PRICE OF PENSION AT COMMENCEMENT	<<$    >>
	
TAX FREE COMPONENT AT COMMENCEMENT	<<$    >>	
REVERSIONARY [YES/NO]	<<Sender’s comments>>	
NAME OF REVERSIONARY BENEFICIARY	<<Sender’s comments>>	
DATE OF BIRTH OF REVERSIONARY BENEFICIARY	<<Sender’s comments>>	
RELATIONSHIP	<<Sender’s comments>>	
BALANCE OF PENSION ON DATE OF COMMUTATION	<<$   >> plus all the income of the fund including realized gain and unrealized gain on assets valued at market price allocated to the pension account from 1st July <<Year>> to <<this date>> Less any withdrawals and other debits to the pension account during the financial year to <<this date>>.	
AMOUNT OF COMMUATION	100% of the amount which is above $1.6 Million of the balance in Pension Account on date of commutation.
	
DEATH BENEFIT BENEFICIARY OF ACCUMULATION ACCOUNT	<Binding / non binding death benefit nomination attached to this letter / as per discreation of the remaining trustees of the fund>	

Yours Faithfully

<<Signature of Pensioner>>
<<NAME OF PENSIONER>>
MINUTES OF THE MEETING OF THE <<FundName>> HELD ON THE <<DATE 	>> AT <<FundAddress									>>

PRESENT:	<<TrusteeName>>
	
REQUEST TO COMMUTE 
PENSIONS:	It was noted that <<NAME OF MEMBER>> has made an application to the trustees to commute/rollback the following pension to accumulation account of the member:

Pension : <<Pension 1>>
Date Commenced <<Date >>
Balance as on commutation date <<$    >> on <<Date    >> plus all the income of the fund including realized gain and unrealized gain on assets valued at market price allocated to the pension account from 1st July to <<this date>>, less any withdrawals and other debits to the pension account during the financial year to <<this date>>.

Date of commutation   <<Date >> 
Amount of Commutation <<$     >> 100% of the amount which is above $1.6 Million of the balance in Pension Account on date of commutation.
	
REQUEST ACCEPTANCE:	IT WAS RESOLVED to accept the member’s request to commute/rollback the Pension in accumulation account in the fund. It was also duly noted that the trust deed of the fund dated,    <<date >> permits the internal rollover of pensions back into accumulation account in the fund.
	
DETERMINATION OF CAPITAL VALUE OF PENSION;	IT WAS RESOLVED to request the fund’s administrator to calculate the capital value of the pension that has to be commuted, having regard to the minimum amount of the pension that must be paid for the period from 1st July <<YEAR>> to <<DATE JUST BEFORE ROLL BACK DATE>>
.
The capital value of the pension will then combine with the balance of the member’s accumulation account as on <<that date>>. After the commutation the pension will continue as per the terms of the pension dated <<date when pension started>>	
		
PRODUCT DISCLOSURE STATEMENT	IT WAS RESOLVED by the trustees that the member has access to all the information that a product disclosure statement (PDS) would require to disclose and therefore no PDS will be issued pursuant to section 1012D (2A) of the Corporations Act 2001 (Cth). The member acknowledges that he is aware of his situation and has taken appropriate financial advice to commute his pension.	

DEATH BENEFIT
BENEFICIARY	
IT WAS RESOLVED to accept death benefit nomination from the member for his accumulation account. It is also noted that 
<<Pension 1              >> is a reversionary pension and  <<Name of the reversionary beneficiary>> born on <<Date>>    is the <<spouse / child>> of  <<name of the member>>.	

<<ChairMan Signature>> 
<<CHAIRMAN Name>>
(Chairman)