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BALDWINS

Australian Lawyers and Consultants

ABN: 52 616 703 441

LEVEL 6, 313 LATROBE STREET

MELBOURNE, VICTORIA, AUSTRALIA 3000

Telephone: (03) 9606 0022 Fax: (03) 9606 0882

Email: mail@baldwins.com.au

Website: www.baldwins.com.au

NEW SELF-MANAGED SUPERANNUATION FUND (‘SMSF’) with four or fewer members.

*Please complete all details in block letters

NAME OF FUND

Section A: Person ordering fund

Person ordering fund

Signature

(documents and invoice will be directed to this person, unless otherwise stated)

Firm name (if applicable)
Street address
Postal address, if different
Phone	Fax	Email

Section B: Trustee details

If the Trustee is a Company then complete section B(i) only. If the Trustees are individuals then complete Section B(ii) only.

Section B(i): Trustee information where trustee is a company

Name	ACN	- -
Address of Registered Office

Full names of all directors of trustee company

T1		T2
T3		T4

Go to section C on next page

Section B(ii): Trustee information where trustees are individuals

If individual trustees, their full names:

T 1	Full Name
T 1	Street Address

T 2	Full Name
T 2	Street Address

T 3	Full Name
T 3	Street Address

T 4	Full Name
T 4	Street Address

Any member who is employed by another member or related entity must be a director of the employer-sponsor or a relative of such a director. Also persons previously convicted of an offence involving dishonesty are disqualified from being admitted to an SMSF. Severe penalties can be imposed for any breach.

Section C: Details of each Employer that contributes to the fund

If no employer contributes to this fund then go directly to Section D.

Employer details

If this employer is identical to the corporate trustee information in Section B(I) then tick here and go directly to section D.

Name	ACN	- -
Address of Registered Office

Complete section D

Section D: Details of each member

M1	Full name T1?	Occupation	Name of dependant M2?
Street address		Date of birth (dd/mm/yyyy) / /	Relationship to member *Spouse?*
Street address		Tax file number - -	Dependant's percentage *100%?*

M2	Full name T2?	Occupation	Name of dependant M1?
Street address		Date of birth (dd/mm/yyyy) / /	Relationship to member *Spouse?*
Street address		Tax file number - -	Dependant's percentage *100%?*

M3	Full name T3?	Occupation	Name of dependant M4?
Street address		Date of birth (dd/mm/yyyy) / /	Relationship to member *Spouse?*
Street address		Tax file number - -	Dependant's percentage *100%?*

M4	Full name T4?	Occupation	Name of dependant M3?
Street address		Date of birth (dd/mm/yyyy) / /	Relationship to member *Spouse?*
Street address		Tax file number - -	Dependant's percentage *100%?*

Please tick here if you do not require a ring-binder.

Note that Baldwins and its associates, affiliates and sub-contractors are not licensed to provide financial product advice under the Corporations Act 2001 (Cth).