NEW FUND APPLICATION FORM

asterisks (*) indicates mandatory fields

Proposed Fund Name	*
Postal Address	*
Contact Name	*	Telephone(H)	*
Mobile		Telephone(W)
Email	*	Fax

MEMBER AND/OR INDIVIDUAL TRUSTEES

Individuals

Title	*
Full Name	*
Address	*
DOB	*
Is the person a member?
Is the person a trustee?

Title
Full Name
Address
DOB
Is the person a member?
Is the person a trustee?

Would you like us to set up the company?
Yes No (If yes please provide preferred company name.)

Corporate trustee (if applicable)

Company Name
Registered Address
ACN/ABN/TFN

	Place of Birth	Occupation
Director 1
Director 2

NB:All members must be directors and all directors must be members. No member is allowed to be an employee of another member unless they are related.

ELIGIBILITY FOR TRUSTEESHIP

Are all trustees/directors eligible to hold the position of trustee/director in accordance with SIS Act Sec 120? Yes No

An individual is not eligible if:
(a)At any time: (i) the individual was convicted of an offence (in respect of dishonest conduct) against or arising out of law of the Commonwealth, State, a Territory or a foreign country; or (ii) a civil penalty order was made in relation to the person; or
(b) the person is an insolvent under administration.

CONTINUING ADMINISTRATION

Superannuation Services Pty Ltd is to be appointed administrator for this SMSF.

AUTHORITY TO PROCEED

Please proceed with the SMSF set-up. We/I have been supplied with Superannuation Services Pty Ltd fee schedule. We/I understand that Superannuation Services Pty Ltd is not a licensed investment advisor and has not provided any investment advice in relation to setting up this SMSF.

Signed Trustee/Director		Signed Trustee/Director
Referred by
Phone