Investment Options Change Form

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E147
Investment Options Change Form
for Beneficiary Account members
Who should use this form?
You should complete this form if:
•• You are a Beneficiary Account member, and
•• You want to change your investment choice for your Beneficiary Account.
Note: This change will only apply to your Beneficiary Account. If you want to change your investment choice for an Accumulation Plan or Income Stream
account, you need to complete the relevant Investment Options Change Form for that product.
Before you start
Your completed form must be received by ESSSuper by close of business on the 20th day of the month to take effect from the first day of the
next month (e.g. if received by 20 June, the effective date will be 1 July). If the 20th day of the month is not a business day, your completed form
must be received by close of business on the last business day prior to the 20th. If your form is received after the 20th day of the month, the
change will take effect from the first day of the month following the next month (e.g. if received on 21 June, the effective date will be 1 August).
If you have a Member’s Online Account, confirmation of your investment option selection can be found in your transaction history and
once the selection takes effect it can be viewed on your investment summary page.
Please complete this form in pen using CAPITAL letters and mark with an [ ] where applicable.
Section 1
Your personal details
Member number
Title
Mr
Mrs
Ms
Miss
Other (please specify)
Surname
Given names
/
Date of birth
/
Postal address
Suburb
State
Postcode
Mark with an [ ] if your postal and residential address are the same. If your residential address is different, please specify below.
Residential address
Suburb
State
Telephone (business hours) (
Postcode
)
(after hours) (
)
Telephone (mobile)
Email address
By providing your email address you are authorising ESSSuper to send communications to that address.
This authorisation will apply until it is revoked by you.
Issued by: Emergency Services Superannuation Board ABN 28 161 296 741 as Trustee of the Emergency Services Superannuation Scheme ABN 85 894 637 037
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Investment Options Change Form for Beneficiary Account membersE147
Section 2
Please indicate
how you want
your account
to be invested
Member declaration and signature
Shares Only
%
High Growth
%
Growth
%
Balanced
%
Conservative
%
Defensive
%
Cash
%
Total (must equal 100%)
Section 3
1
0
0 %
Declaration
•• I acknowledge that information regarding my investment options is contained in the Beneficiary Account
Product Disclosure Statement available from ESSSuper.
•• I understand the information provided by ESSSuper is of a general nature and does not constitute personal
financial advice.
•• I accept the investment risks and returns of the investment choice I have made and understand that neither
the Emergency Services Superannuation Board nor the Victorian Government is responsible
for the decision I have made.
•• I understand that the investment choice I have made on this form will apply until I make a new investment choice.
•• Once your request takes effect it cannot be reversed. ESSSuper does not accept responsibility and will not be
liable for any loss due to an investment choice made by you.
Signature
 Please sign here
Date
/
/
Please forward this completed form to
ESSSuper GPO Box 1974, Melbourne Vic 3001
T 1300 650 161 | F 1300 766 757 | www.esssuper.com.au
At ESSSuper, we treat the privacy and confidentiality of our members’ personal information seriously. We are committed to complying with the
guidelines of the Privacy and Data Protection Act 2014 and the Health Records Act 2001 (Vic). To obtain a copy of ESSSuper’s privacy policy go to our website
at www.esssuper.com.au
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