super refunds
APPLICATION FOR DEPARTING AUSTRALIA SUPERANNUATION PAYMENT
PERSONAL DETAILS
Privacy Policy
Full Name
TFN and Birthdate
Email
Telephone
PASSPORT NUMBER
VISA SUBCLASS EXPIRY DATE
VISA CANCELLATION
Please Cancel Visa Early
Your Address
Address Australia
Address Overseas
SUPERANNUATION FUND DETAILS
SUPER FUND
MEMBER DETAILS
SUPER FUND 2
MEMBER DETAILS 2
SUPER FUND 3
MEMBER DETAILS 3
EMPLOYER DETAILS
EMPLOYER
EMPLOYER ADDRESS
employer address
EMPLOYER 2
EMPLOYER ADDRESS
employer address
EMPLOYER 3
EMPLOYER ADDRESS
employer address
PAYMENT DETAILS
THE FEE IS A FLAT $95 PER CLIENT PLUS $20 IF AN EARLY VISA CANCELLATION IS ALSO REQUIRED
ENTER CARD DETAILS:
mastercard
visa
Card Number
expiry mm/yy
DECLARATION & CONSENT
I wish to apply to the trustee of the abovenamed fund for a Departing Australia Superannuation Payment. I declare that the information given in this application is complete and correct. I have engaged BC Accountants to attend to this application on my behalf, and authorise them to provide my Tax File Number, Passport details and other personal information to any government agency or superannuation provider as required.
DECLARATION APPROVED
PRINT A COPY
PREPARE RETURN
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CONTACT US - phone 1300 019 801 or International 617 4041 5633 or email tax@eto.net.au
YOU CAN ALSO LODGE BY FAX OR MAIL - fax to 1300 019 871 or mail to BC Accountants PO Box 2973 Cairns 4870