Office use only

5011

Departing Australia Superannuation

Payment (DASP) application.
December 2019

Complete this form if you are requesting a Hostplus benefit of more than $5,000 to be paid, you will also need to apply online
using the ATO online system at ato.gov.au/departaustralia.
If your current account balance with Hostplus is less than $5,000 please apply using only the ATO online system at
ato.gov.au/departaustralia
You must have entered Australia as a temporary resident and have since departed Australia to qualify for this type of benefit.
Complete all fields marked with an asterisk (*). Please use BLOCK letters in black or blue pen.

1 Individual details

Hostplus membership number* Title

Mr Mrs Ms Dr Other

Date of birth* My Tax File Number is*

Given names*

Surname*

Date ceased employment in Australia* Date departed from Australia*

Your curent postal address (outside Australia) to which all correspondence will be sent*

Suburb State P/C

Country

Telephone
Office hours (include country code) After office hours (include country code)

Email address

1193.8 F DASP Application ISS3 1219.indd 1 20/12/19 2:35 pm

 2 Provide your account details

Funds can be electronically transferred to you (EFT) if you have an open Australian bank account. Please provide your bank details
and proof of account, such as a certified copy of a bank statement, to accept funds through EFT. Please note payments will be
made in $AUS.
Financial institution’s name*

Address

Suburb State P/C

Country

Name of account (for example John Smith)*

BSB number* Account number*

Visa number Visa type

3 Sign the declaration

Your privacy your personal information to overseas recipients. Please see the
Hostplus has collected and may collect further personal AAS Privacy Policy at www.aas.com.au for further information.
and sensitive information from you in order to assess and Where you have provided personal information about
determine your benefit application. This information is likely third parties (people other than yourself, for example your
to include your name, address, date of birth, tax file number, beneficiaries), it is your responsibility to inform these
visa details, financial details and immigration details. We need people that you have provided Hostplus with their personal
to collect the requested personal and sensitive information information. You should refer them to the Hostplus
from you to assess and make a determination about your privacy policy.
benefit application. If you do not provide us with the requested
information, we may be unable to properly assess your benefit · I authorise my Departing Australia Superannuation Payment
application. Your personal and sensitive information will only be (DASP) to be paid by Hostplus.
disclosed to Hostplus staff involved in the assessment of your · I understand that when my full benefit is paid, the fund shall be
benefit application, our administrators Superpartners and/or released from all claims, liabilities, and obligations in respect of
our legal or other professional advisors if reasonably necessary. my interest in the fund.
The Hostplus privacy policy provides information about · I understand that upon cashing my cheque in my country of
overseas disclosure of personal information, how you may residence I may incur fees and charges.
access and seek correction of your personal information as · I am aware that I have the right to request any further
well as how you can make a complaint about a breach of the information that I require in order to understand my benefit
Australian Privacy Principles or the Privacy Act 1988. You entitlements in the fund, including any fees and costs that may
can access the Hostplus privacy policy at hostplus.com.au/ apply to the benefit withdrawal.
privacy. For all privacy related questions or privacy related · I understand that my insurance arrangements with Hostplus
matters you can contact Hostplus on 1300 467 875 or via email will cease from the date that the benefit is fully paid and my
at privacy@hostplus.com.au account is closed.
Hostplus usually discloses your personal information to our · I declare that to the best of my knowledge all information given
administrator AAS, mail houses and the ATO. AAS may disclose on this form is true and correct.

Signature of applicant*

Date*

 axed or scanned forms cannot be processed. However photocopied forms can be processed if signed with an
F
original signature.
When you have completed this form please send it to: Hostplus, Locked Bag 5046, Parramatta NSW 2124

Issued by Host-Plus Pty Limited ABN 79 008 634 704, AFSL No. 244392, RSEL No. L0000093 as trustee for the Hostplus Superannuation Fund ABN 68 657 495 890, RSE No. R1000054, MySuper
No. 68657495890198, ® Registered to BPAY Pty Ltd ABN 69 079 137 518. 1193.8 12/19 ISS3

1193.8 F DASP Application ISS3 1219.indd 2 20/12/19 2:35 pm

 Departing Australia Superannuation
Payment (DASP) guide.
December 2019

3a. If you are unable to complete the ATO online system
Important information before you complete
then in addition to documents in steps 1 and 2 you will
the application. be required to provide a written statement from the
If you have entered Australia on an eligible temporary resident Department of Home Affairs known as ‘Certification
visa, and then departed Australia, you may be able to receive of Immigration Status – 1194’. To obtain this statement
payment for any superannuation benefits you may have you’ll need to download and complete the ‘Certification
accumulated in any Australian superannuation funds. of Immigration status – 1194’ form available from the
Home Affairs website at www.homeaffairs.gov.au or the
A completed DASP application authorises us to release your Australian Taxation office website at www.ato.gov.au
Hostplus benefit to you.
Once completed, this form and an application fee should be
However, we cannot release these benefits to you until all of forwarded to Home Affairs at super.payment@homeaffairs.
the required information has been received. gov.au

Submitting your application for payment. Once your application is approved, you will receive a cheque
in Australian dollars (Please note, you may incur charges by
To be eligible for the payment, you must: your overseas bank when your cheque is processed into the
· have an expired or cancelled visa; currency of your country of residence).
· have permanently departed Australia; and
Important information on certifying
· NOT be a permanent resident or citizen of Australia
or New Zealand.
documents (Departing Australia
Superannuation Payment).
How to claim your Departing Australia Once your application is approved, we will notify you via
Superannuation Payment. email that your cheque in Australian dollars has been issued
and mailed to your overseas address. Please note that as an
Account balance less than $5,000 alternative we can pay you via EFT into an account held in your
If you have an account balance with Hostplus of less than name with an Australian banking institution.
$5,000, you will need to apply using the Australian Taxation
When submitting forms to Hostplus you may be required to
Office online system – what’s more you won’t need to supply
provide documentation so we can verify your identity.
any certified identification. For more information on how to
apply for your DASP and applicable taxation visit the Australian To help you provide the right documentation, we’ve
Tax Office (ATO) website ato.gov.au. Once you’ve completed provided more information below on how to certify your
the online ATO application, please allow up to 28 days to identification documents.
receive the cheque or funds into your nominated Australian
Bank account. Certified documents.
Account balance more than $5,000 What is a certified copy?
If you have an account balance with Hostplus of more than A certified copy is a copy of an original document, which has
$5,000 (at the time you make the application) you’ll need been certified and signed by a person who is authorised to
to provide: certify that it is a true and correct copy of the original.
1. A completed Hostplus Departing Australian How do I obtain a certified copy of a document?
Superannuation Payment Application attached.
You will need to take your original document(s) and a clear and
2. An original certified copy of your passport. legible photocopy of both sides of the original document to a
person who is authorised to certify proof of identity documents.
3. Complete the Australian Taxation office online system.
For more information on how to apply for your DASP and What do the certifiers need to do?
applciable taxation visit the ATO website ato.gov.au.
The certifier will need to compare your copy with the
original, then stamp or write ‘This is a true and correct copy
of the original’.

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 On every page of your proof of identity the certifier must Member residing overseas.
include all of the following:
For members residing overseas, the persons who are
1.  Certifier’s writing or stamp declaring ‘this is a true and authorised to certify identification documents are:
correct copy of the original or ‘certified true copy’
· An Australian Consular Officer or Australian Diplomatic Officer
2.  Certifier’s signature (within the meaning of the Consular Fees Act 1955).
3.  Certifier’s name, qualification/current position held · An employee of the Commonwealth or the Australian Trade
and address Commission who is authorised and exercises his or her
function in that place.
4.  Date of authorisation
· A person authorised as a notary public in a foreign country.
5.  Certifier’s stamp or registration number (if applicable)
· Any person who is in a country or place outside Australia and
is currently licensed or registered in Australia (under a State or
A commercial organisation may be used to Territory law) to practise in an occupation listed in Part B.
independently verify your identification details. All · Members residing overseas must have their identification
documents provided to us will be stored securely documents certified by a person who has an Australian
and will only be used for the purpose of proving your connection (as set out above). Any documents certified
identity in relation to this claim. by a person who is licensed or registered to practise in an
occupation listed in Part B in a foreign country (and not in
Australia), or who holds a position in a foreign country, will not
be accepted by Hostplus (except for a foreign notary public).

What does a certified identity document

look like? Important note.
This is what a certified proof of identity document should · All pages of your proof of identity documents must be
look like: certified.
· The certification must be on the copy of the document,
not on the back of the page or a separate page attached
to the document.
· The certified copies of your proof of identity
documents must contain an original signature. Faxed or
emailed copies will not be accepted.
· If any documents are written in a language other than
English, they must be accompanied by an English
1 This is a true and correct copy translation prepared by an accredited translator.
of the original document’
· Documents certified more than 12 months ago will not
2 be accepted.
3 Sam Sample · The person certifying your documents can not be the
Justice of the Peace
Registration number: 012345
benefactor or be connected to any organisation you are
123 Sample St using to assist you in obtaining access to your super,
Sampletown, QLD 4321
5 even if they are authorised to certify documents.
4 1 May 2014
· If these conditions are not met, Hostplus will be unable
to process your request. If you need more information
about certifying a document, simply call +61 3 9624
7370, 8am–8pm (AEST), Monday to Friday.

Find someone to certify your documents.

Only certain people are authorised to certify identification
documents. For a complete list of people permitted to
Checklist.
certify documents go to hostplus.com.au/id. A few common
examples are: C
 ertified copy of your Passport or similar ID
· Police officer containing photo and signature (in English)
· Agent of the Australian Postal Corporation who is in charge 
Completed Hostplus Departing Australia
of, or a permanent employee with two or more years of Superannuation Payment application
continuous service with, an office supplying postal services
to the public 
Proof of Australian bank account, such as a copy
· Pharmacist of Bank Statement (if you wish to receive your
funds via EFT).
· Legal practitioner
· Medical practitioner 
A Certificate of Immigration Status – 1194 (if not
· Justice of the Peace applying via the ATO online system).

Issued by Host-Plus Pty Limited ABN 79 008 634 704, AFSL 244392 as trustee for the Hostplus Superannuation Fund (the Fund) ABN 68 657 495 890, MySuper No 68 657 495 890 198.
1193.8 12/19 ISS3

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