• How do I complete this form?

    Section A: Temporary resident's details

    Question 1

    Australian tax file number (TFN)

    Provide your Australian TFN.

    Question 2

    Name

    Provide your full name.

    Question 3

    Previous name

    Provide details of all other names you were known by whilst in Australia. If there is insufficient space, write the details on a separate page and include it with this application.

    If you have changed your name after you entered Australia on the temporary resident visa you travelled on, you need to provide certified evidence of your name change – for example, a marriage certificate, deed poll or change of name certificate from the Births, Deaths and Marriage Registration Office or equivalent in your country.

    Refer to section D of these instructions for information about certifying copies of documents.

    Question 4

    Date of birth

    Provide your date of birth.

    Question 5

    Current postal address

    Provide your current postal address.

    Question 6

    Phone and fax numbers

    Provide your daytime phone and fax numbers, including the country and area codes.

    Question 7

    Email address

    Provide your email address.

    Question 8

    Last address in Australia or address shown on your last super fund statement

    Provide your last Australian residential address or the address shown on your last super fund statement.

    Section B: Superannuation fund details

    If you wish to claim super money from more than one super fund, you must complete a separate application for each super fund.

    Question 9

    Superannuation fund name

    Provide the full name of your super fund (as it appears on the latest statement or correspondence issued by the fund)

    Question 10

    Superannuation fund Australian business number (ABN) (if known)

    Provide your superannuation fund’s Australian business number, if you know what it is.

    You may find your superannuation fund’s ABN:

    • on correspondence the super fund has sent you
    • on the super fund’s website
    • on superfund lookupExternal Link website
    • by contacting your super fund.

    Question 11

    Member account number/s with this super fund

    Provide your member account numbers with this super fund..

    Section C: Details of employer/s who contributed to the account/s

    Only provide details for the employer/s that contributed to the super fund account/s you have listed in Section B.

    Note: If you had more than one employer that contributed to this super fund, provide details of each employer (covering questions 12 - 15) on a separate sheet of paper and attach it to this application. Make sure you include your name and member account number on each page.

    Question 12

    Employer Australian business number (ABN) (if known)

    Provide the ABN of the Australian employer/s who made super contributions on your behalf.

    Note: You can obtain your employer's ABN from your Payment Summary, copy of your Tax File Number Declaration or from a pay slip they issued

    Question 13

    Employer business name

    Provide the full business name of your Australian employer/s.

    Question 14

    Employer business address

    Provide the business address of your Australian employer/s.

    Question 15

    Period of employment

    Provide the dates of your employment with your Australian employer/s.

    Section D: Supporting documentation for temporary resident

    Your fund will require evidence in support of your DASP claim. This will include evidence of your immigration status and your identity.

    Evidence of immigration status

    You need to apply to DIBP to issue Certification of immigration status to your fund.

    However, if your withdrawal benefit is less than AUD $5,000 you have the option of providing certified copies of the following documents instead of applying for Certification of immigration status:

    • your visa, or evidence that you were the holder of a temporary visa which has ceased to be in effect
    • your passport containing the departure stamp you obtained when you left Australia (note: from 1 December 2012 a stamp must be requested upon your departure, if required).

    If you have changed your name since you first entered Australia you must provide certified copies of documents showing how you changed your name (for example, your marriage certificate) regardless of the amount claimed.

    For more information about providing certified copies of documents, continue reading under the heading ‘Certification of personal documents’ below.

    Certification of immigration status is an electronic certificate that DIBP will issue to your super fund/s at your request, to confirm your immigration status is eligible to apply for a DASP. You only need to lodge one request with DIBP and they will issue Certification of immigration status to all the funds you have listed on the Form 1194. They will also send a copy to you.

    DIBP charges a fee for issuing the Certification of immigration status.

    For more information (including details of the fees payable) and to apply for Certification of Immigration Status:

    go to SuperannuationExternal Link. Complete the relevant section of the 'Certification of Immigration Status and/or request to cancel a Temporary Resident visa' (Form 1194).

    GPO Box 1496
    Hobart TAS 7001
    Australia.

    DO NOT send the Form 1194 to your super fund, or to the ATO.

    Evidence of your identity

    Your fund also requires proof of your identity. Contact your fund to confirm what they require.

    Certification of personal documents

    You must have all copies of your original documents certified by an authorised person. If the original document is not written in English, there are extra requirements detailed below.

    The authorised person certifying your documents must sight the originals and certify on the copies that each page is a true copy by writing or stamping 'certified true copy', followed by:

    • their signature
    • their printed name
    • their qualification (for example, 'Justice of the Peace')
    • the date.

    In Australia, you can have copies of your documents certified by a:

    • barrister
    • Commissioner for Declarations (Tasmania and Queensland only)
    • Commissioner for Oaths (Northern Territory)
    • doctor
    • judge
    • Justice of the Peace
    • minister of religion who is authorised to celebrate marriages
    • police officer
    • bank, building society or credit union officer with at least five years of service
    • sheriff's officer
    • solicitor.

    In Australia, if the original document is not written in English, you must have an approved translation service (for example, the Department of Immigration and Border Protection, an appropriate embassy or professional translation service) provide you with an official true and correct written translation of the document.

    You must then provide certified copies of both the original document and the written translation to the fund.

    If you are outside Australia, you can have copies of your documents certified by consular staff at an Australian:

    • Embassy
    • High Commission
    • Consulate.

    If you are unable to reach an Australian Embassy, High Commission or Consulate, you can have your documents certified by a:

    • notary public
    • Justice of the Peace
    • judge of the court
    • registrar or deputy registrar of a court.

    In the case where you are outside Australia and none of the above is available to certify a document, you should check with your fund to see if they will consider other forms of certification

    If you are outside Australia and your original document is not written in English, you must have an approved translation service provide you with an official true and correct written translation of the document. You must then provide your fund with certified copies of both the original document and the written translation. You can obtain the name of an approved translation service from your nearest Australian:

    • Embassy
    • High Commission
    • Consulate.

    Section E: Payment options

    Payment will be made by cheque to your current postal address provided at Question 5 on the claim form.

    Alternatively, you can request the fund makes payment to your Australian bank account by electronic funds transfer (EFT), or to your financial institution overseas by international money transfer (IMT).

    Not all super funds make electronic transfers, so you should check with your fund to confirm the payment methods they offer before you make such a request.

    Electronic funds transfer (EFT) to your Australian bank account

    If you want to request payment to your Australian bank account, provide the following:

    Complete the following:

    • Bank state branch (BSB) number: This six-digit number identifies your financial institution (do not include spaces or hyphens).
    • Account number: This number should not have more than nine characters, and should not include spaces.
    • Account name: Your account name should be shown on your bank account records. It should include spaces between each word and between initials. If your account name exceeds 32 characters, provide the first 32 characters only.

    International money transfer (IMT) to your financial institution overseas

    If you want to request payment to your financial institution overseas by international money transfer, provide the following:

    • Bank code
    • Full name and address of the financial institution that you want to transfer to
    • Account name
    • Your address, exactly as it is registered with this account
    • Account number or International Bank Account Number (IBAN)
    • Currency you require payment to be made in.

    Note: Check with your fund and overseas financial institutions before requesting an IMT to confirm they make payment by this method, if they require any additional information, and whether there are fees and charges (including currency conversion fees) payable for this type of transfer.

    Section F: Declaration by temporary resident

    This section must be completed and signed by the temporary resident who is claiming their super.

    Read the declaration at Section F. If it is correct, print your full name, then sign and date the declaration.

    If you have been authorised to claim on behalf of the temporary resident you must complete Section G of the form and sign the declaration at Section H.

    Section G: Authorised representative details

    Complete this section ONLY if you have been authorised to claim DASP on behalf of the temporary resident named in Section A of this form.

    You must provide the fund with supporting documentation for the temporary resident you are claiming on behalf of (as explained in Section D of the Instructions) and also proof of your identity and evidence of your authority to make the claim on their behalf.

    Contact the super fund to confirm what evidence they require.

    Section H: Declaration by an authorised representative

    This section is to be completed if you are the authorised representative of the temporary resident named in Section A of this form.

    Check that you have provided all your details as requested in Section G of the form, and then read the declaration at Section H. If it is correct, print your full name, then sign and date the declaration.

    Temporary residents claiming on their own behalf must not complete Section G and H of the form.

    Where do I send the completed application?

    Send this form and all certified supporting documentation (as outlined in Section D) to your super fund. Do not send this form to the ATO, or to DIBP.

    Keep a copy of your application and certified documents for your own records.

    Last modified: 27 Oct 2015QC 16612