Your gas account. · .--

C Your account summary.

r } Account name ••••••• .;=:::::·~c:s. Supply address .. 3 StClplypen ocf 3 Apr 2012 to 3 Jul 2012

Prevtous balance

Pa)l'llent recEIVed

Balance brought forward

New charges and credits (see overleaf for details)

Usage and supply charges

Creats iln::l rebiltes

Other charges

Total GST for new clwg!!S

Total amount due

$120.49

$ 12049cr

$0.00

$134 75

$3. 19cr

$1.09

$13.27

S145.92

late p11ymentsw~l tnrur a fl."<! of$ 1400 (net CST).I I you iJJ4:'Unablt- to pay. cal1'31 245

This bill could be wor th 145 flybuys points. As the off'tc.al fl)buys e'ner~ partnef, yD.J could now be rewarded for PfY!n9 your AGl household bdl" If you haven't 111teedy, ~~-you need to do 1S:

1. llegbt<.~ C01 r~ at flybuys.com.au 2. 1illlt )'Oir l),Gl hoLi54!1-dd accwnt()) and ftybuys ~~. h!n llgl up lo AGI. fnl'lgy Onllrto! .,d eBI_,g at fi)IIKI_p.com .. ul AGL

Then eAJOlJ ongomg fl)buys. pants when you pay Y,ourhous~hold energy .biHs.

6.

\

1.751 SUPPOOTING Ttl£ COPUilNlY

Looking baclt on 175 years of looking foPward. We'v-e been sharing our energy with Australia fOt 17 5 years. Discover our history at agl.com.au/175

Your account number

Total amount due

Due date

Getting il touch. Call 131 245

VISit agiLom.au

AGl AssiSt/Emergency Hot Water 131 7 66 1010_.~ 1~ ~"" IO)llif,emMI I<Kludlr\Q "obi

Fault s and Emergeft!=ies

CaM BOO 763 106 to contact APT Algas the distnbutor responstble tor the gas pipes and meters in your area.

TAX INVOICE • ~sued; , JLI :>01.?

., Pleese se• reveiR fot p.~yment optloftl

b 1635

-....... .... = iillll -.a -= -

,.--------- ·- ----~ ·o Vote for your favourite in Origin's AFL Goal of the Year compe tition and yoo and a mate could be at the 2012. Toyota AFL Grand Final.

oregrn AFL.COM.AU/GOAL {f;~;}t.j CDmf"'titO>rdo• .. U,DO(o>OOoii\E51 nn 11/'olfll ~ J Hlll lt'rrr\S•nd (u•ldit!ons .at\Y\VW.~,n GOI"n il\.1}\;~1

Servke Address: Meterlteiid: National Meter Identifier (NMI): QB061133542

Account summary: 31 Mar 12 to 29 Jun 12 Opening Balance Payments R!.celved-Thank Vou

Balance carried Forward

HewChiirB'!s Other Charges & AdjJstments (see ove1 far details)

Total Electricity Chilfges ind. Oiscounts(seeoverfordetall~)

Total Amount Due -Ind. Overdue Amount

New Charges Incl. GST charges of

"Payments received after the due date may Incur a feeof$12.00

Important Information

.$129.49

$129.49 CR

$0.00

$0.78

$176.S9

S17U7

$16.12

Some Origin energy pricesfor Queensland changed from 1 July 2012. lfthls change affects you, It will be set out In the usage details on thls'b iii.Qid Competition Authority estimates a 2012 13 carbon price impact on domestic tariffll as 2.4-c/kWh & economy tarlfs 31 0. 3i aS 2.S &. £.4 c:/kWh#-www.qc ... oqpou

++ we•u BE T~RE WHEN YOUR HOT WATER ISNtr. Ask about our IJUarant«d Jthourhot wab!r S)'ltlm rep(.act rn.nr' anclour 24 malt~ Inti: ~est free payment pllij:

C.lusonU00191461or buyonlinut orlglhonetSY.<O..UI&Ibtcal<l!own '--'.t14111Mol41M ... ...,...,.....,.b,_Cllltv• .... •t"'Mf.U......,.,S.~_,,...-~,. ~. ~ ..... , ............. ,l-Ait~;.· ...... ......... l, ,fl«4ii .... ,

Electrldty Tax Invoice: 15300001i550 ls5Ued: oud 11

a Enquiries lk moliCnB home ~ jfAM·UMLCIGIITirN "'llon lri)

"BZ461

-···-·· ·············--~··· .. ·······--· .. ··-···----·········._, .............. _ a Supply faults, caU Energex{24h~) 116Z6Z ~ Emergencies, call Energex (24hrs) U 19 6Z

fiiiiiiii Visa or MasterCard Payments 1:100 6SB 713 !:...=J li'rlletl<ill&f«moy~pply". seot.-.e)

\

Account No:

VOutfUa-t Energ Asreementls: Diii,S.• • 12 montl'lener.,plan. &lt•es rMY

apply durin a tNs period:. a.eflb Appled TD11111ArcCIWit: • Base Discount (I")

• fla-latll Discount

12

Your Average Daily Usage &Greenhouse Gas Emission Graph

Average Cost Per Day: $1.94

Average Daily Usage: 10.18 kWh

Same Time Last Year:

Total Greenhouse Gas Emissions (Tonnes)Generated For This Account:

Same Time Last Year (Tonnes):

Greenhouse Gas Emissions Saved With a Green Product for This Account:

NIA

0.98100T

NIA

N/A

For more Information on greenhouse Bas emissions visit origlnenergy.com.au or call us on U 24 61.

1636

Nl!ed help? Invoke number Bill datP. FOXJEI: Visit www.loxtel.com.au 98969699 07 Aug 12 o r<an 131 999 forassistance

JAX INVOICE

0351211108

1•1111•11Um11•11 11lnnllu•ll•ll,

WTIIU I $142.50

Questions about your bill?

Explore your bill online Visl www.lo~tetcom.au/support and dick 'Explore the new FOXTEL Bill' in ihe Top 'II FAQs for dl!tiiled information oo each section oWe bil.

Online billing My Acto nt is yo .. gateway to managing ·y0111 account online, at yotr own leisure. update y016 delails. pay 'fOil FOX TEl biB, View previous FOXTEL Mk, Clld even order FOXI£l On Demand and Main Event progranmes. Vlsl www.loxtel.com.a~/myaccounl and log in. II you ~e a ll!W user you will need yo.r account 111rrber t1 reglsll!r. whl:h cao be found abo¥e.

Save ~ to $36 a year with Easypay

.oJscnvery_ o.dllest Cetch o''lr· •• .. 15 Allgus~ 73Dpm

JHIS BIU {incl. GS0

$149.50

BALANCE BROUGHT FORWARD

SUBSCRIPTION

FOXTEL ON DEMANO

OTHER CHARGES

lOTAl HilS BILl (including GST)

TOTAl AMOUNT DUE

$0.00

$112.00

$34.50

$3.00

$149.50

s 149.50

For 11 more <letaied breakdown of yr:u account, ple~~Se refer I o lhe i!ppt~illte sec:llon on lhe next page.

FOXTEL's direct debit service makes paying your Foxra bill easy. You can set up Easypay quickly and easly at My Account. Visit www.foxtei.eom.au/myac:count

FOX TEL Cable television I td. AIJN 45 CH59 008 7n ·Trademark of Twentieth Century Fox Corporation used uoder license by fO)(lEl Management Pty Ltd.

FODEI: Payment Slip

For more payment options please see overleaf

~mber

FOXTEL Subscriber Payments locked Bag 14510 MELBOURNE VIC 8001

For credit of FOX TEL Cable Television Ltd ABN 45 069 008 797

Invoice number 98969699

1!111111 •a99 40432300

(ra~ooa 1

r.~-=so:::rC=ode===-----, ~Cu~s~tom~e~r ~Re~le~re~rrr;~·a~Nuo~Jt~U...~======J I Total $ 149.501

- I

1637

25 July, 2014

Dear--YOUR B.ENEFIT PAYMENT HAS BEEN APPROVED FROM BERT FUND No.2

Building Employees Redundancy Trust No. 2

Member m.mber:····

li

·= l=t T -II* I-LevEI1, 35 Astor lee POBox 80S SPRING HILL OLD 4004

Tel! 1300261 114 Fax: 07 3832 3799 Emal: enqulnesCibert.com.au Web: www.bert.oom.au

We are writing to advise that the BERT Trustee has approved the payment of your Financial Hardship benefit.

Please be advised, you have been paid $2,298.00 by EFT representing the amount of benefit payable from the fund.

The information contained in this letter is important information that should be read in conjunction with all the enclosed documentation.

Your benefit package includes the Employment Termination Payment Summary detailing the breakdown of the benefit payable to you into the necessary components for the calculation of tax.

If you require any further information or assistance regarding this matt er please contact us on 1300 261114. We will be happy to help you.

Yours Sincerely,

j' -. ) .... _'

William Wallace Gen eral Manager

BERT Pty UdABN82 010 917 281 BERTfllld No.2 ABN 19 269 091 435

1638

(

Employment Termination Payment Summary

Payment summary for the year ending 30 June 2013

Member's date of birth: ­

Member number;

Date of payment

liiille number

Tax free component

Taxable component

Death benefit

Employment Termination Payment (ETP)Code

Is this payment part of a payment made n an earlier income year for the same termination?

Payer details

NOTICE TO PAYEE

30/08/2012

I TOTAL TAXWITHIELD

. $1,998.00

$0.00

$4,296.00

N

0

N

Payer's ABN or INithholding payer number: 19 269 091 436 Branch N11rnber: 001

Payer's Name: BERT FUND No.2

u --~~. Buil<fng Employees Redundancy Trust No. 2 30/08/2012

Supporting the industJy B.E.R.T. Pty Lirrlted ABN 82 010 917 281 Trustee of Building Employees Redundancy Trust No. 2 ABN 19 269 091 436

BEAT"~ UdABN 112 01()917 281 B6H FundNo.2ABN 192890111435

Leve11, 35Aslor Tc:e PO 8(1)( 805 SPRING HILL Ol.O 4004

Tel: 1300 261 114 Fax: 07 3832 3799 Email: enquillesObertcom.au W.b: wwwhetl.com.au

PAGE 1 OF 1

1639

(~

_J 17-rrrJ tfZe /"y Ld. APPLICATION FOR PAYMENT OF ~K .3&vJ{, tfZlc!Jf£

Pteaae return thiS completoelfonn to: ~ ISEATA<*IIhlltlallOII, PQ SiolC806. sPAING HIU. Cl.O '100-' - UtWI f. 8$111totTctoSPAING HIU.QLO<tOO&

1tl: 13j)0281 1•4 I f'a(:0 7383237&P I w.b; ,.'WoN.bat.OOtn.u

IB ~d ZBS6t6BEL9

09nt page 1 or 2

ss:ee ltBl/BB/~l

1640

CLAIM TYPE ..... MEMBER NAME

I I ~ I

I I

1641

(

i ' ·-c t~

I

Hefitaoe S.n~ Urni!d ALtN 32al7 652 024 N'S. 24€9~.Mtretian ~·,u.m.c. 2~84 ..

LOAN OFFSET STATEMENT

Page 1 of3

ACCDUNTHAHE -

Opening. Balance $ 15.800R

03 JIA 2012

03Jul2012 04Jul2012

~ ~ 04 Jul2012 05 Jt.12012 OSJul2012 OSJ(JJ 2012 OS Jul 2012 05 Jul2012 os)ul20l2 06 Jli 2012 06J~ 2012 07 Jul2012 01 Jut2012 07 Jul2012 10Jul2012 11 Jul2012 11 Jul2012 (= 11 Jul2012 11 Ju12012 12 Jul40t2 12 JUI20l1 12 Jul2012 12Jul2012

Fees and Other Charges $3000

Opering Bltlance

Globallft1709

Total Credits $7887-0l

POS purChase 50;2870/0704065145 ww PETROl 22· POS P~rthase 73014010704082430 COLES UPPER e alance enqulfy 009424/0704140tt59 Heritage Garden City 121 ATM wit Hertage Garden Qty 121009425/070414052 POS purchese 00418510704181033 EASTERN Sl.e L Sa~;n:e enqury009496/0705133234 Hertage GanSen CityC21 ATM wdl Heritage Garden Cly 121 009ft97/070S13 330 POS purcha 17663310705142412 BIG TOP DISC T POS pu-dlase 1ID10t0705143702 c1&11STwARE ABCEBLF0;236356 POS'pnhase 193235/0705.195248 Al017 CARINDA P0S Pla'CMSl! Sa3513/0706065723 WN PETROl 22 P0S Pltdlafe 230326/07061ll224 CHEMIST WAAE llllarce enquiry 009656/0707064249 Heritage Garde'l City (2) AD4 wdl Heritage Galden Qty t2l 009658/070706435 POS ICrJ Pllchase 181 651L TEISTRA PAYBVPHON GlobetHR;1709 POS p!SChase 505379/0711~44 l2WNPETROL22 PO!i Jll:lrehaie 02084210711090134 OlfM!STWAI£ 8alence enQiiry 009937/0n 1123229 tterit age Garden City (2) ATM Well Heclage Gardentlly [2) 009938/071 ~12331 POS~ IDOS710711H262SSUPRe MOUNT POS putchase 025724/0n 1143609 TERRVWHITE C POS JQ'thase 012884/011117192 6 I!EACH HOOSE POS JU'dlilse 395557/071i!085344 ALDI 65 MACGR POS'purchiase 029225/0112141029 BARGAIN PlUS POSpurchase 34094810712142948 KMART MT. GAA ATMwrll009746/0712171249 9J,\CORP BANK\~

BSB Number

Account Numper

Statement oate Statement Numbet

Total Debits $7262.45

70.00 61.44

6-~ 260.00,, 175.00 25.76 13 10 24.60 27.98 39.]9

160.00 126.00

58.29 49.05

~~ 6.95

2900 4217 l3.95 62.50

100.00

Closing Balance $608.17 C:R

1470.47

1478.4?

206

-15.80

1454.67 1384.67 1323.23 1323.23 813.23 853.23 85123 59123 419.23 39147 379.l7 354.77 32£.79 287.40 287.40 127.40

1.40 1479.87 1421.S8 1372.59 1372.53

• ---·- .... 5-J2.53. . • . 542.53

535,58 505.78 463.51

• 449.56 387.0£ 287D6

\

We're giving away two $1000 pre-paid

Rel'er e ttieM or family member to Heritage \a~\ Gift Card _. and you·n both go loto the draw to win a ~

Visa gift cards each month!

$HDJ pre-paid Visa gift taro each! r- ~~~· · ':1·: If they open a home loan with Heritage within S 1 000 . ~ three months of being referred, you·11 also ~SA receive a $250 pre-paid Visa gift card each.

..

(li) 'IJW\IIhelftage.cu~nau wa~~I

_\........-

Cor~tiMtd Oyer Pilge .•

e PO 11011 '!10 T OOWt!OI®a QlD .mo

ZO!i6168£LO ss:se zrraz;aa/vc-;

,

1642

'f Jul · Opening Sblz1nc•

l~ :J.~J. ,"- ~49flSh,O&posit 31 J~[. ;: ·Ovvd-aft In terest

· .. 3:t.J~i7 ··. ·'Cio:lll:l~ B•lllnee ~~>••· ·-"' .. . ... ..

~:{ *'"?•. ~.·:-)• , • ,,.r •'l

. ' .... !ff{~, •·"·P'· ·~ !•'J> • · ·rt~L:: ~ . 't .. '· -: :. wt•....-!"'•...r •• •• ~\-+'• w,s~,, ,a,.,.(I.Ji~: "",;;;~ ;:~~:. • .. ~i·r .. ~:i :.,·;uM~:~ 111t.. :...t•;·c;~ t~•:•>Ju~ • 1\ .

3Y~.,;..,..,:i "' , <irolll'~ Prppu_::t~iv¥! ,

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PAGE 2of2

Debit Credi~ 8al~co ---·----------

. ::: .... :~-.,..:. ~::;~'t'l o/'~ l '.0.,.".-.,1 1.• • .&..+: .. ~·· Jfo h 00~~ It,

t-)1"-; f-'!",<•,tl ,:,••; •:.!· Jot: .. dttt~"' I if ~~ ~1}..

~S:t\1 f-i ·~ : i!-!•9" ~:-~ ~'ot: "f'l.to.

_ .. . Pilsaf~ ;.~·•:dr ftoi •' ; -=;i.;..• lf !fl•''"tt·!t . '•1 6

tl.is ~irittnern 11Mi .-:pc<: IIN' .. li~ . .. ,, •• b •:)·:~ 4.~ "'~-9~,._.;..,_, .., .. .':>b~ctt(l Ot1'1tt<lti!Aillcf\ "~ -~-!f ... ; a~d i! r.ec.ss-y, ~lattr.O~• "!iii"{'>-""~"' on 1linerb tement.

-..- s ' s.

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50.00 39.23

3,022.6S­Z.972.65-3.01 tBB·

J ,011.88·

.• ! ..... l..t~'oi"JJ- •• ·"':4... • .~ ,._ ~

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·• ·AI.·" '-'"'., X'· ... ~u·=- ,.,., .,., ,. .··~· ~ ·. ·"'· ..: ·«~·~ ... v·"b ... ~ .· '"'''! t.• ........ , ...... _1 ... ,..,... ; .....

.;.,u .. ; ..... :~;;.. ~~'1 f .. st .. ·.d C:.··""fl.!"" :;! ~ :..~t~ .. ~ ~ • "tr ir:t.GI"".ot i:w.nkHy r-r.+:.-·.--;.: : :1 ~~·:!!.a.£ ,. ... ~,, .. ~.:., ,. ·~ ~.; ._..

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24/98/2912 99:55 9738919592

Hf:il~t ~!a!* Unit~ ~ 32 087 652 024 I\FSl241m4 A:~a!w.. r"eodt UCIH'.c9 2/.038/.

1•11111111111111111111 lllll1111111111111tl111111ml .u,,,,ll, ·1l~

ACCil.INT NAME

Ai.l'OUI.T ;u· ' · ' , Opening Balance $1012.84 DR

Fees and Other Charges $3360

Total Credits $50.00

IGA WGABBA PAGE 94

HERITAGE VISA STATEMENT

Total Debits $3360

Account Number

Statement: Date Statem«t ~untler Credt Umil

Availllble Credit

Overdue/Ovtrlimit Annual Perartage ~ate

Dally Percenta·ge Rafe

DUE DATE

Closilg Balance S 996.440R

Page 1 of 2

10Aug2012

77

StOCXl

$4 SB.OO

16.150~

o.b4S9%

05 sep 2012

Minimum Payment Due $37.(1(1

Minimum Repayment w•rning: If you make only the minimum payment each month. you will pay more irterest and t will take yru longer to pay off your balance. For example:

If you make no additional c.h<~f9es using this card and each I'I10ilth you pay •. Only the minimum payment

$49.04

You will pay off the Oosing Balance shown on this statement In eboul~

9 years 9 months

2 years

And you will end up paying an esti~ted tctal of lnt&rest charges of_

$715.93

$1 80.64 a saving of $535.29

Having trouble making repayments? If you are having dlfficufty making credit card repayments. p111ase cortact us on 13 14 22. We may ~ able to as~lst you.

' II , I I , \ '1 ,. "td I L r I __. _ I

11 Jul201?.

11 JuiZ012 25 Jul2012

Opening Balance

Late Payment F1111

Cash dep at Gcrden City 81<11di 17255 20.00

50.00

·1012.94

1032.84 -982.8'

W I • • -e·fe ·g IV!nQ ·away- ·-· -f!efel:a friend crramilym~mbertoH~ritaaa · · ( .M~\GiftCard __

$1 000 "d and you'll both go Into the ctaw towln a ~ ~-

t~O . pre-par · $1ooopreiJaldV!sagirtcardeach! · ~tl V1sa grft' cards lf theyopenallOmeroanwithHe"lta~within 51000 ~

ttree months of being referred, you'l also ~ eaCh m 0 nth ! receive a $250 pre-paid Visa gift card each. \

'jist ntntaQUOINIU rormore lrtonnatt()fl an6 ttr~ e..O condihons. _,,.,.,,.

j l'ieta!n this portlcnlo' yi)X recO'lls aCld l!fl$UI'e~eu thtllluljdy ctleck 1111 tra.'1s&±ior'.s "~In~ your !~~.s. Aes2 a!1vlse v> ifT'f!ltdil~ely of lfff lisctt~Parc~s. ..... §,. ...................... _........ ...................... . ---··--· · ---- .. .. -- --- .. .. ...... --- ...... .... --- · ..... ... .. --- - ·---. --.......... -- ----- .. ... .... -----·- ....... - ---· .... ................... ................. .. ---:. -~ 2 f j

~ !

PaymertSip

({) B14 22

@ "'""'.heritage. com .au

~ POBox190 'C) TCJJ.oo:ll'ba QLO 4350

1314 2Z

TiHpllcne &rote r--..<n< ..... lilt,.,....,." .. ,...-. ....... rt. ...... .bo>07.-

- ti'AY -Lod/Stolen Ollds i!f. Ho~n (Austr!llial 1800 076 037

1644

24/08/2B12 08:55 073B9195B2 PAGE 1 of2

IGA WGABBA PAGE BS

j Com~ in for a Bi Che~k today.

1M&\ ~~ ClTM3

Phone 13 29 30

~- 007616 ()QQ Ema• qtmb@qtmb.com.au

I •11'1111rl11tll11· h 11111111h 1111111"' ·I II Ill II I' Web www.qtmb.com.au

Financial Statement 31 July 2012

Account Summary

Account Ac:oount Ntmber

Current Account 1146377 Current Overdraft Rate is 15.44% p.e.

_,..--.­,-----..,

, angBala~ )

$3,011.88· I ~

OT Mut~al Btonk Llrrited 454 St Paul'$ Terrace. Fortitude Vdey a.o 4006. PO Box929, Fortitude Valley OL04006. i

Tel: 13 2930 F;x: 07 3252 7053 qtni:>Oqtmb.com.au www.qtml:·.eom.au ABN 83087 651 OS4AFSL24119S ~

16 1645

25 July, 2014

?,o:>\~ \ )0 IV

YOUR BENEFIT PAYMENT HAS BEEN APPROVED FROM BERT FUND No.2 Building Employees Redundancy Trust No. 2

Member number:-

L.evel1, 35 Aster Tee PO Box805 SPRING HLL Cl.D «l04

Tel: 1300261 114 Fax: 073832 3799 Emat ~irlesObert.com.au Web: www.bert.com.au

We are writ ing to advise that the BERT Trustee has approved the payment of your Financial Hardship benefit.

Please be advised, you have been paid $2,514.00 by EFT representing the amount of benefit payable from the fund.

The information contained in this letter is important information that should be read in conjunction with all the enclosed documentation.

Your benefit package includes the Employment Termination Payment Summary detailing the breakdown of the benefit payable to you into the necessary components for the calculation of tax.

If you require any further information or assistance regarding this matter please contact us on 1300 261114. We wiU be happy to help you.

Yours Sincerely,

I\ -~ J .L..___;

William Wallace General Manager

BERT P1V Ltd ABN 82 0 10917281 BERT Fund No.2 ABN 1926'il091 436

1646

0

Employment Termination Payment Summary

Payment sumnary for the year ending 30 June 2013

Member's date of birth: ••••

Member number:-

Date of payment

Payee's tax file number

Tax free component

Taxable component

Death benefit

Employment Ternination Payment (ETP) Code

Is this payment part of a payment made In an earlier Income year for the same termination?

Payer detans

NOTICE TO PAYEE

30/08/2012

I TOTALTAXWITHtELD $2.186.00

$0.00

$4,700.00

N

0

N

Payer's ABN or withholding payer m.rnber: 19 269 091 436 Branch Number: 001

Payer's Name: BERT FUND No.2

Building Employees Red~.~tdancy Trust No. 2 30/08/2012

Supportln9 the Industry B.E.R.T. Ply Limited ABN 82 010 917 281 Trustee of Building Employees Redundancy Trust No. 2 ABN 19 269 091 436

BEl'ITPty UdABN 820111917281 SERr FtJnd N<>Z ABN 111 2e90i1 438

B E A T __ .. _ Level 1, 35 Astor T cs POBox805 SPRIIIG HILL QLO 4004

Tet 1300 261 114

Fax: 07 3832 3709 Email: en~lrteeOt.teom.au WIHJ: www.bert.com.eu

l

PAGE 1 OF 1

1647

~- APPLICATION FOR PA

Please mark thebOlll'OU are dalmlrlo (It)

Redundancy

L•_!ling the lnclllt ry

Re ... _,.

Dl•bflity I "•

Name of yoor lasl employer con!rib.it.,g for you into BERT t; (\eu._..: \

&nployer's telephone

Emai adctess

Date yolA' employment with tns OO"Pioyer ceased

- • YOU HAVE TWO OPTIONS FOR PAYM£NT Of YOUR cu.... \.j. ., Oi!> ~J;t'!, - ot •• ""''""" ""'' '"""•IEF11 • tt• '""""''""''"""""'"'~a~ receive . u. lf'lf~*J:-~ Please indicate (If) how much of your entltlemont you require: ~ •

•

..,., ~~ n'~~ Patial withdrawal Amount $ -' . Pte~ oftaJt)

at- ~OFTION 1 - To reoeive payment via F.H, we reqlire a copy of your bank statement wtlch clearly dsplays

~ idM ~ lho following: NAME OF BANK ! BSB NUMBER I ACCOUNT NUMBER I ACCOl-NT NAME

:t~ NAA~nk ,.=~-10 il)li,a~abaie.

Please note: It details provided are Incomplete, insufficient. illegible a Inaccurate a cheque will be issued.

.. · .

Belrn~~--­lwlillllU..., .. .-.. "'*"*'-Mflllll 1111 ~all,..,t

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OPTION :t - I request a ct1eque be se,nt to me at I he above addtess .

Please return 1hls completed form to: ~ BERT Adm!stration. PO Box805, SPRING HILL OLD 4004 f& ~ Levell. 35 Asta Tee, SPRING HU OlD 4004

Tot 1300261114 I FBJC 0738323799 I Web:w-.bert.com.au _j ""'"" ---..... ,.. .. , )

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MEMO OF ACTION TAKEN

CLAIM TYPE MEMB - -

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