Apply for Islamic PensionGreat choice.Form is successfully submitted. Thank you!Hejaz Financial Services Pension Member ApplicationThis form is being automatically saved so you can come back later on, and be able to continue from where you left off.StartPersonal DetailsEmployment DetailsCurrent Super FundsBeneficiariesPersonal ProtectionValidation Personal DetailsTitle*MrMsDrMrsMissOtherGender*MaleFemaleFull given name(s)*Surname*Mobile number*Phone numberEmail*Date of birth*Country of birth*City of birthTax file number*Residential status*Please selectAustralian citizenPermanent residentTemporary residentOtherResidential AddressStreet address*Suburb*Country*State*Post code*Is your postal address the same as your residential address?*YesNoPostal AddressPostal street address*Postal suburb*Postal country*Postal state*Postal post code Employment DetailsOccupation type*EmployeeSelf-employedRetiredUnemployedOccupation*Employer name*Average annual income*Current employment start date*Highest level of qualification*Hours worked per week*Employment type*Please selectFull timePart timeCasualContractPlace of work*Please selectOfficeHomeWork siteUndergroundOtherDo you perform tasks of manual labour?*Please selectYesNo Current Superannuation FundsDo you have any Superannuation?*YesNoSuperannuation fund nameAccount numberBalanceDo you have a second superannuation account?*YesNo2 - Superannuation fund name2 - Account number2 - BalanceDo you have a third superannuation account?*YesNo3 - Superannuation fund name3 - Account number3 - Balance Please Note: the % of benefit MUST add up to 100% in total between beneficiaries.1 - Full name*1 - Relationship*Please selectSpouseSonDaughterMotherFatherBrotherSister1 - Date of birth*1 - % of benefit*Would you like to add a second beneficiary?*YesNo2 - Full name2 - RelationshipPlease selectSpouseSonDaughterMotherFatherBrotherSister2 - Date of birth2 - % of benefitWould you like to add a third beneficiary?*YesNo3 - Full name3 - RelationshipPlease selectSpouseSonDaughterMotherFatherBrotherSister3 - Date of birth3 - % of benefitWould you like to add a fourth beneficiary?*YesNo4 - Full name4 - RelationshipPlease selectSpouseSonDaughterMotherFatherBrotherSister4 - Date of birth4 - % of benefit Personal ProtectionDo you wish to transfer your insurance cover currently held within your current superannuation fund?*YesNoDo you have any pre-existing health issues?*Please selectNoYesHave you smoked in the last 12 months?*Please selectNoYesYour heightYour weightPlease specify which protection(s) you are interest in:*Death CoverTotal & Permanent Disability CoverCritical Illness (Trauma) CoverIncome ProtectionThis 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's1 - Type of IDPlease selectDriver licencePassportMedicare cardBirth certificatePension cardFile UploadDrop files here or click to select% Completed02 - Type of IDPlease selectDriver licencePassportMedicare cardBirth certificatePension cardFile UploadDrop files here or click to select% Completed0Declaration to proceedI have read, understood and agreed to the Financial Services Guide v11.0, charges, and Product Disclosure Statement. All details provided are accurate Signature* NextNeed help completing the form? Call us on 1300 043 529
