How do you complete this election?
Section A: Your fund’s details
Complete all the details of the super fund into which you are paying your contributions.
Section B: Your details
Provide your personal details to your super fund.
The ATO does not collect the personal details you provide on this form. This form is to assist you in providing details to your super fund. Your super fund is authorised to request your personal details, including your TFN, under the Superannuation Industry (Supervision) Act 1993.
It is not an offence not to provide your TFN. However, if you do not provide your TFN and your super fund does not already hold your TFN, they will not be permitted to accept the contribution covered by this election. For more information about your privacy please contact the super fund you are providing this form to.
Section C: Legal representative’s details
If your legal representative completes this form on your behalf, they must provide their details.
Your super fund may need your authorisation to deal with your legal personal representative.
Section D: Amount
Provide the amount from your personal injury payment that you wish to exclude from your Non-concessional contributions cap.
Section E: Declaration
Read the declaration thoroughly. If it is correct, print your full name, sign and date the declaration. The date is important and must be the actual date you sign the election. If you make a false declaration, you may be penalised. If the form is completed by your legal representative, they will need to sign the declaration on your behalf.
Give your signed and dated election to your fund with or before your contribution is made. If you lodge it late – after making your contribution – it won’t be valid and your super fund will have to reject it.
Do not send this election to the ATO. It’s only valid if you give it to your super fund. Your super fund will report to us that you have made the election when it reports all your contributions for the year.
Form and instructions for superannuation fund members who have received an eligible personal injury payment and want to contribute all or part of the amount to super without it counting towards their non-concessional contributions cap. (NAT 71162)Last modified: 01 Mar 2016QC 19583