Robert Rushford : Service Agreement

Page 1

Service Agreement This Agreement is between Release My Super and the client indicated by signature below for the provision of services to assist in applying to the Department of Health and Human Services for early release of superannuation for either compassionate or financial hardship circumstances and as defined by regulation under federal law. Release My Super acts as my Agent with my full Authority and may contact any party deemed necessary in achieving a positive outcome for my application.

Declaration By signing this Agreement, I acknowledge that l fully understand this Agreement, am over 18 years of age and an Australian resident with access to a superannuation account. I understand that the success of my application will depend on the accuracy of the information l provide to Release My Super and that the final decision on my application lies with the Department of Health and Human Services. I also indemnify Release My Super should my application be denied by the Department of Health and Human Services. I also acknowledge that l have no other means to financially support my reasons for applying for early release of my superannuation. I understand that if the Department of Health and Human Services agrees to release any or all of my funds under the early release regulations, that l must use those funds for the purpose as outlined within my application and for no other use. I also understand that if l do misuse funds released to me, l may be prosecuted by the Commonwealth Government. I acknowledge that l must pay a one off up front fee of $600.00 (Ex GST) to Release My Super prior to my application being activated and submitted for consideration by the Department of Health and Human Services. This fee is non refundable. I have been advised by Release My Super to seek independent financial advice and acknowledge that Release My Super are not a Legal or Financial advisor and have not provided any such information in assisting with my application.

Signed:______________________________ Date:____________________ Full Name:________________________________ Address:_________________________________


Credit Card Authority to Pay Fees

I ____________________________ (Insert Name) authorise a payment from my credit card detailed above to Release My Super for the amount of $660.00 (Inc. GST).

Signed:________________________________ Date:__________________________________


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