(DRAFT) - APPLICATION FOR TRANSITION TO

RETIREMENT (SUPERANNUATION) ARRANGEMENT

1. PERSONAL DETAILS 3. WORK RESPONSIBILITIES
Surname: ______________________________ Detail proposed changes to position, duties and/or
classification. (Attach new duty statement if
Given name(s):__________________________ required)

Postal address: __________________________ _______________________________________

_______________________________________ _______________________________________

_______________________________________ _______________________________________

Postcode: ________________________ _______________________________________

Date of birth: _____/_____/_____________ 4. CHANGES TO FRACTION OF TIME /

DAYS WORKED
Super ID: ________________________
Current Fraction of time: _____________
Email: ________________________________
Proposed Fraction of time: _____________
Telephone WORK ___________________________________

HOME ___________________________________ Days to be worked:_______________________

MOBILE ___________________________________ (A new work pattern must be completed and
Name of agency submitted to Payroll if applicable)

_______________________________________ 5. EMPLOYEE DECLARATION

I understand that:
Employee no:____________________________ – In signing this agreement, I acknowledge that I
have sought financial advice about the impact
Current position title and classification:________ Transition to Retirement (Superannuation) will
have on my salary and on my superannuation
_______________________________________ and I understand its effect on my public sector
employment.
Please complete all the details on this form and – Working part time accrues leave on a pro-rata
after line manager and delegate approval basis.
forward to Super SA. – This agreement is subject to the provisions of
my employment contract with the South
Australian Government. Together with this
Contact details
agreement this contract may be varied or
Website www.supersa.sa.gov.au
terminated, with the agreement of both parties.
Email supersa@saugov.sa.gov.au
Telephone (08) 8207 2094 (for calls from within
______________________________________
the State Government Network)
Signature of Employee
or 1300 369 315
6. APPROVALS
2. EFFECTIVE DATES
______________________________________
Start date: ___________________ Line Manager Date:
End date: ___________________ ______________________________________
Delegate Date: