KiwiSaver Enrolment Form

Important Notes Please Read

1. Please only complete, sign and return this form if you have received the investment statement from your adviser direct from AXA, or another location other than the Inland Revenue.
2. Please print clearly, and complete all sections unless otherwise instructed.
3. You do not need to complete this form if you received it from the Inland Revenue, or if your employer has chosen the AXA KiwiSaver Scheme as its preferred KiwiSaver Scheme as part of the automatic enrolment process for KiwiSaver.
4. Once signed, please mail or fax to:
   Pension Transfers Limited
   P.O. Box 31519
   Lower Hutt 5040
   New Zealand
   
   FAX +64 4 939 0900

Postal Address

Phone numbers

If you work for more than one employer, please write their names, addresses, IRD numbers and contribution rates on a separate piece of paper and attach it to this enrolment form. Remember, if you are employed you must contribute at a rate of 2%, 4% or 8% of your gross total salary or wages.

You do not need to complete the direct debit form included in this booklet if you are only making contributions from your salary or wages.

If you are employed but do not nominate an employer on this form, the Inland Revenue will request that all of your employers make contributions from your salary or wages at 2%.

To help you complete this section, you may find the "Choosing the Investment that is Right for You" questionnaire helpful. It's included in the investment statement. We recommend that you also talk to a financial adviser. To find a financial adviser near you, simply call 0800 29 27 28.

Please show how you would like your contribution(s) invested, including any amount transferred from another superannuation scheme.

A few important things to note:

• Show whole percentages (ie no decimal points) for each portfolio.
• If the percentages you specify do not add up to 100%, we will automatically invest the balance in the KiwiSaver Income Plus Portfolio if you have been automatically enrolled with the Scheme by the IRD under its default allocation process or the KiwiSaver Conservative Portfolio if you have chosen the Scheme as your KiwiSaver scheme or have become a member as a result of your employer selecting the Scheme as its "employer choice" scheme.
• If you leave this part of the application form blank or incomplete, we will invest 100% of your money in the KiwiSaver Income Plus Portfolio if you have been automatically enrolled with the Scheme by the IRD under its default allocation process or the KiwiSaver Conservative Portfolio if you have chosen the Scheme as your KiwiSaver scheme or have become a member as a result of your employer selecting the Scheme as its "employer choice" scheme.

*If you have attached a cheque to invest please indicate how you would like to be invested.

If you are making a lump sum contribution, send your completed enrolment form along with a cheque, if applicable, to the address noted below, and make the cheque payable to "AXA New Zealand" and crossed "Not transferable – account payee only". Make sure you fill in the lump sum portfolio column above.

Note: If you are making a contribution into your AXA KiwiSaver Scheme and into another person’s scheme, please write the name, your IRD number and the amount on the back of the cheque.

Send your enrolment form (and cheque if aplicable) to: AXA KiwiSaver Scheme, FREEPOST AXA, PO Box 1692, Wellington 6140

I give approval for my existing provider to transfer my savings to the AXA KiwiSaver Scheme and authorise the Administration Manager to make contact with that provider and take whatever action is required in order to effect the transfer (including, but not limited to, notifying the Commissioner of Inland Revenue of the transfer).

The personal information collected on this form will be used to:

1. evaluate your application for membership
2. administer the Scheme
3. maintain relevant statistical records
4. provide you with information about other products and services offered, managed or distributed by companies in the Global

AXA Group, and in signing this enrolment form you authorise the use of your personal information for these purposes. The information will be held by the administration manager, National Mutual Corporate Superannuation Services Limited ("Administration Manager") at 80 The Terrace, Wellington. Under the Privacy Act 1993 you have the right to access and to request correction of, any personal information about you held by the Administration Manager. The information will only be disclosed to another party to the extent necessary for one or more of the purposes set out above, where required by law, or as otherwise authorised by you.

I APPLY for membership of AXA KiwiSaver Scheme ('Scheme') (or, where I have already been allocated to the Scheme by the Commissioner of Inland Revenue, confirm my membership of the Scheme). I agree to be bound by the terms and conditions of the trust deed governing the Scheme, as amended from time to time, and by the requirements of the KiwiSaver Act 2006 and any regulations or notices promulgated under that Act. I direct the Administration Manager to invest contributions made by or in respect of me in the manner indicated on this form or as later indicated by me to the Administration Manager from time to time in accordance with the trust deed governing the Scheme. I acknowledge that neither the trustee of the Scheme nor the Administration Manager will be liable to me for any loss as a consequence of any such investment direction. I declare that all the information contained in this form is true and correct and acknowledge responsibility for its accuracy whether the information was written by me or another person.

• I have received and read an investment statement for the AXA KiwiSaver Scheme
• the Administration Manager's sole obligation with respect to contributions made to the Scheme by or in respect of me is to apply the contributions received from the Commissioner of Inland Revenue in accordance with the KiwiSaver Act 2006 or directly from me, that there is no contractual arrangement between my employer(s) (if any) and the Administration Manager as to the payment of employer contributions, and that the Administration Manager is under no obligation to verify the appropriateness of the amount of any contributions it receives