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DASP Application WMCA 01 | PDF | Taxation | Payments
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DASP Application WMCA 01

This document is an application form for departing Australian superannuation payment (DASP) from a super fund or retirement savings account. It requests information such as the applicant's name, date of birth, contact details, tax file number, previous and current addresses. The applicant must complete a separate form for each superannuation fund.

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martin
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50 views1 page

DASP Application WMCA 01

This document is an application form for departing Australian superannuation payment (DASP) from a super fund or retirement savings account. It requests information such as the applicant's name, date of birth, contact details, tax file number, previous and current addresses. The applicant must complete a separate form for each superannuation fund.

Uploaded by

martin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application for departing Australia

superannuation payment (DASP) from a


super fund or retirement savings account
WHEN COMPLETING THIS APPLICATION Remember, you must complete a separate claim form for
n Print clearly in BLOCK LETTERS using a black or blue
each fund that holds an account for you. This form must be
pen only.
lodged with your super fund, not with the Australian Taxation
n Place X in all applicable boxes. Office (ATO), or Department of Immigration and Border
Protection (DIBP).

Section A: Temporary resident’s details


1 Australian tax file number (TFN)
4 1 9 6 3 8 9 4 4
2 Name
Title: Mr x Mrs Miss Ms Other
Family name
Canales ayala
First given name Other given name/s
Walter Martin
3 Previous name
If there is insufficient space, write the details on a separate page and include it with this application.
Title: Mr Mrs Miss Ms Other
Family name

First given name Other given name/s

If you have changed your name since you first entered Australia, remember to include certified evidence of your
name change (for example, your marriage certificate) with this form.
4 Date of birth
Day Month Year

3 0 1 2 1 9 7 7
5 Current postal address
Calle Talara 158, Dpto 102

Suburb/town/locality State/territory Postcode


Santiago de Surco - Lima -
(Australia only) (Australia only)
Country if outside Australia
PERU
6 Phone and fax numbers
Office hours After hours
(Country code) (Area code) (Phone number) (Country code) (Area code) (Phone number)

5 1 1 9 9 3 6 9 7 0 2 6
Fax
(Country code) (Area code) (Fax number)

7 Email address
martincanalesayala@yahoo.com
8 Last address in Australia or address shown on your last superannuation fund statement
7 Burraga Place

Suburb/town/locality State/territory Postcode


Lindfield N S W 2 0 7 0
NAT 7204-10.2015 Sensitive (when completed) Page 1

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