NEST Employee Claim Form

Before you begin

Please note this application form is for employees who have been directed by their employer to claim entitlements directly from NEST.

If your employer ordinarily pays your entitlements to you, please put in your entitlements claim with your employer in your usual way or contact your HR/Payroll department for further assistance.

Need help?

If you require any assistance with completing your application form please get in touch with NEST Administrator Coverforce Pty Limited on nest@coverforce.com.au or by calling 1300 302 555.

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1. Your Details

First Name *

Last Name *

NEST Member ID (If known)

Email Address for Claim and account communication *Please ensure this is an email you check regularly and that is secure. We will send information about your claim through via this email.

Your Employer Business Name *

2. Claim Details

If you do not wish to claim all of your entitlements, please select no below and further options will be available such as sick leave, annual leave and long service leave.

Are you ending your employment with your current employer and requesting the full payout of your entitlements held in NEST? *

YesNo

You have selected other, please specify the reason for your claim *

Further Comments

3. Bank and Taxation Details

Please confirm the bank account you would like your claim to be paid into.

Important Note: Our NEST Administrator Coverforce may contact you to verify these details ahead of your payment as part of our cyber security measures. Please ensure you comply with any request for verficiation to avoid payment delays.

Account Name *

BSB *

Account Number *

All NEST claims are subject to relevant tax laws, please provide your tax file number:

Tax File NumberImportant Note: Providing your tax file number (TFN) is voluntary but if we don't have your TFN, contributions, earnings and withdrawals may be taxed at a higher rate.

4. Acknowledgements and Employee Declaration

Important Notice

NEST is committed to complying with the requirements of the Anti-Money Laundering and Counter-Terrorism Financing Act 2006

Privacy Collection Statement

Please read this Privacy Collection Statement to see how NEST uses your personal information.

NEST Nominees Pty Ltd (ABN 51 624 226 711) of Locked Bag 5273, Sydney NSW 2001, collects your personal information (PI) to operate, and administer your account, improve our products and services and keep youinformed. If we can't collect your PI we may not be able to perform these services. PI is collected from you but sometimes from third parties like your employer and your financial adviser (if applicable). We will only share your PI where necessary to perform our activities with ouradministrator (Coverforce Pty Ltd, ACN 067 079 261, AFSL 238874), service providers, as required by law or court/tribunal order, or with your permission. Your PImay be accessed overseas by some of our service providers and, where applicable to your circumstances, by third-party service providers ofyour financial adviser. Our Privacy Policy details how to access and change your PI, as well as our privacy complaints process.

For complete details go to https://www.nest.net.au/privacy-policy.php or call us on 1300 302 555.

I confirm that I have read and understand the above Privacy Collection Statement, I consent to the collection and handling of my personal information in accordance with this statement. *

Employee Declaration

I confirm that my employer has not already paid these entitlements to me and has requested I claim directly from NEST. I understand that my employer will be notified of this claim and any attempt to claim entitlements that have already been paid, or would ordinarily be paid to me by my employer will be considered a duplicate claim and payment will not be made by NEST. *

I declare that, to the best of my knowledge, all information given on this form is true and correct and acknowledge that:

1. I have read the NEST Information Guide and this application is made subject to any terms and conditions contained in that information.
2. I have satisfied the necessary condition of release for the payment of any benefit claimed.
3. NEST may in its discretion accept or reject this application.
4. I have provided NEST with certified proof of identity documents (if applicable) to prove my identity.
5. I authorise NEST to transfer and/or pay my entitlements as instructed on this form.
6. The transfer of funds resulting from this application takes the place of any payment to which I would otherwise be entitled to from the Fund.
7. I discharge NEST from all further liability in respect of the benefits transferred and/or paid. *

Signed by the applicant

Signature *

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