Hejaz Financial Services Pension Service Application

This application allows you to establish an account with Hejaz Financial Services (FOC). By completing this application, you provide us with consent to establish your new account. Your request and consent to the transfer of superannuation as described in this application and authorise the superannuation provider of each fund to give effect to this transfer.

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First name *

Last name *

Email *

Phone number *

Personal Details

Title *

MrMrsMsMissDrOther

Please specify

Gender *

MaleFemale

Country of Birth *

City of Birth *

Tax File Number *

Date of birth *

Residential status *Australian CitizenPermanent ResidentTemporary ResidentOther

Please specify

Residential Address

Street Address *

Postal Code *

Is your postal address the same as your residential address? *

YesNo

Postal Address

Street Address *

Postal Code *

Employment Details

Occupation Type *

EmployeeSelf-EmployedRetiredUnemployed

Occupation *

Employer Name *

Average Annual Income *

Current Employment Start Date *

Highest Level of Qualification

Hours Worked Per Week

Employment Type *

Full TimePart TimeCasualContract

Place of Work *

OfficeHomeWork SiteUndergroundOther

Please specify

Do you perform tasks of manual labour? *

YesNo

Current Superannuation Funds

Do you have any Superannuation? *

YesNo

Please note, we require a minimum superannuation balance of $6,000 to open an account.

Your Superannuation Details

Superannuation Fund Name

Account Number

Balance $

Add another Superannuation Fund

Superannuation Fund Name

Account Number

Balance $

Beneficiaries

Who would you like your superannuation to be given to in case you pass away?

Please Note: the % of benefit MUST add up to 100% in total between beneficiaries.

Beneficiary 1

Beneficiary Name *

Relationship *SpouseSonDaughterMotherFatherBrotherSister

Date of Birth *

% of Benefit *

Add Another Beneficiary

Beneficiary 2

Beneficiary Name *

Relationship *SpouseSonDaughterMotherFatherBrotherSister

Date of Birth *

% of Benefit *

Add Another Beneficiary

Beneficiary 3

Beneficiary Name *

Relationship *SpouseSonDaughterMotherFatherBrotherSister

Date of Birth *

% of Benefit *

Add Another Beneficiary

Beneficiary 4

Beneficiary Name *

Relationship *SpouseSonDaughterMotherFatherBrotherSister

Date of Birth *

% of Benefit *

Personal Protection

Do you wish to transfer your insurance cover currently held within your current superannuation fund? *

YesNo

Do you have any pre-existing health issues? *

NoYes

Have you smoked in the last 12 months? *

NoYes

Your Height *

Your Weight *

Please specify which protection(s) you are interest in *

Death CoverTotal & Permanent Disability CoverCritical Illness (Trauma) CoverIncome protection

Waiver of Liability

This releases Hejaz Financial Services from liability relating to insurance not being taken out. *

I agree to hold Hejaz Financial Services entirely free from any liability, including financial responsibility for any claims may occur. I also acknowledge that I have been offered a review of my risk insurance position to determine if Life Insurance, Total and Permanent Disability Insurance, Income Protection Insurance and Trauma Insurance are appropriate for me, but I have declined the cover offer.

Validation - Please provide 2 ID's

Method of providing ID's *

Upload OnlineEmail: info@hejazfs.com.au

ID Number 1

Type of ID

Driver LicencePassportMedicare CardBirth CertificatePension Card

ID 1

Browse

ID Number 2

Type of ID

Driver LicencePassportMedicare CardBirth CertificatePension Card

ID 2

Browse

Declaration to proceed

I have read, understood and agreed to the Financial Services Guide v11.0, charges, and Product Disclosure Statement.

All details provided are accurate

Declaration

 

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