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Apply Islamic Pension
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Hejaz Financial Services Pension Member Application
This form is being automatically saved so you can come back later on, and be able to continue from where you left off.
Start
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.
Personal Details
Title
*
Mr
Ms
Dr
Mrs
Miss
Other
Gender
*
Male
Female
Full given name(s)
*
Surname
*
Mobile number
*
Phone number
Email
*
Date of birth
*
Country of birth
*
City of birth
Tax file number
*
Residential status
*
Please select
Australian citizen
Permanent resident
Temporary resident
Other
Residential Address
Street address
*
Suburb
*
Country
*
State
*
Post code
*
Is your postal address the same as your residential address?
*
Yes
No
Postal Address
Postal street address
*
Postal suburb
*
Postal country
*
Postal state
*
Postal post code
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
*
Please select
Full time
Part time
Casual
Contract
Place of work
*
Please select
Office
Home
Work site
Underground
Other
Do you perform tasks of manual labour?
*
Please select
Yes
No
Current Superannuation Funds
Do you have any Superannuation?
*
Yes
No
Superannuation fund name
Account number
Balance
Do you have a second superannuation account?
*
Yes
No
2 - Superannuation fund name
2 - Account number
2 - Balance
Do you have a third superannuation account?
*
Yes
No
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
*
Please select
Spouse
Son
Daughter
Mother
Father
Brother
Sister
1 - Date of birth
*
1 - % of benefit
*
Would you like to add a second beneficiary?
*
Yes
No
2 - Full name
2 - Relationship
Please select
Spouse
Son
Daughter
Mother
Father
Brother
Sister
2 - Date of birth
2 - % of benefit
Would you like to add a third beneficiary?
*
Yes
No
3 - Full name
3 - Relationship
Please select
Spouse
Son
Daughter
Mother
Father
Brother
Sister
3 - Date of birth
3 - % of benefit
Would you like to add a fourth beneficiary?
*
Yes
No
4 - Full name
4 - Relationship
Please select
Spouse
Son
Daughter
Mother
Father
Brother
Sister
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
No
Do you have any pre-existing health issues?
*
Please select
No
Yes
Have you smoked in the last 12 months?
*
Please select
No
Yes
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
Please select
Driver licence
Passport
Medicare card
Birth certificate
Pension card
File Upload
Drop files here or click to select
% Completed
0
2 - Type of ID
Please select
Driver licence
Passport
Medicare card
Birth certificate
Pension card
File Upload
Drop files here or click to select
% Completed
0
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
*
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