Apply Islamic pension

Hejaz Financial Services Pension Member Application

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Personal Details

Employment Details

Current Super Funds

Beneficiaries

Personal Protection

Validation

This application allows you to establish an account with Hejaz Financial Services. By completing this application, you provide us consent to establish your new account. You request and consent to the transfer of superannuation as described in this application and authorise the superannuation provider of each fund to give effect to this transfer.

To begin, please click the "Next" button.

Employment Details

Occupation type*

Employee

Self-employed

Retired

Unemployed

Occupation*

Employer name*

Average annual income*

Current employment start date*

Highest level of qualification*

Hours worked per week*

Employment type*

Place of work*

Do you perform tasks of manual labour?*

Current Superannuation Funds

Do you have any Superannuation?*

Yes

Superannuation fund name

Account number

Balance

Do you have a second superannuation account?*

Yes

2 - Superannuation fund name

2 - Account number

2 - Balance

Do you have a third superannuation account?*

Yes

3 - Superannuation fund name

3 - Account number

3 - Balance

Beneficiaries

Who would you like your superannuation to be given to in case you pass away?

Please Note: the % of benefit MUST add up to 100% in total between beneficiaries.

1 - Full name*

1 - Relationship*

1 - Date of birth*

1 - % of benefit*

Would you like to add a second beneficiary?*

Yes

2 - Full name

2 - Relationship

2 - Date of birth

2 - % of benefit

Would you like to add a third beneficiary?*

Yes

3 - Full name

3 - Relationship

3 - Date of birth

3 - % of benefit

Would you like to add a fourth beneficiary?*

Yes

4 - Full name

4 - Relationship

4 - Date of birth

4 - % of benefit

Personal Protection

Do you wish to transfer your insurance cover currently held within your current superannuation fund?*

Yes

Do you have any pre-existing health issues?*

Have you smoked in the last 12 months?*

Your height

Your weight

Please specify which protection(s) you are interest in:*

Death Cover

Total & Permanent Disability Cover

Critical Illness (Trauma) Cover

Income Protection

This releases Hejaz Financial Services from liability relating to insurance not being taken out*

I agree to hold Hejaz Financial Services entirely free from any liability, including financial responsibility for any claims may occur. I also acknowledge that I have been offered a review of my risk insurance position to determine if Life Insurance, Total and Permanent Disability Insurance, Income Protection Insurance and Trauma Insurance are appropriate for me, but I have declined the cover offer.

Please provide 2 ID's

1 - Type of ID

File Upload

Drop files here or click to select

2 - Type of ID

File Upload

Drop files here or click to select

Declaration to proceed

I have read, understood and agreed to the Financial Services Guide v11.0, charges, and Product Disclosure Statement.

All details provided are accurate

Signature*

To begin, please click the "Next" button.

Personal Details

Residential Address

Postal Address

Employment Details

Current Superannuation Funds

Beneficiaries

Please Note: the % of benefit MUST add up to 100% in total between beneficiaries.

Personal Protection

Please provide 2 ID's

Declaration to proceed