Form 1—Notice to trustee that non‑memberForm 1—Notice to trustee that non‑member spouse’s entitlement under agreement or order satisfied

## Form 1—Notice to trustee that non‑member spouse’s entitlement under agreement or order satisfied (subregulations 14H(2) and (3)) NOTICE TO TRUSTEE THAT NON‑MEMBER SPOUSE’S ENTITLEMENT IS SATISFIED IN RESPECT OF PARTICULAR PAYMENT SPLIT TO the trustee of \[name of eligible superannuation plan\]: IN RELATION TO the payment split, of which you were notified on \[date when superannuation agreement, flag lifting agreement or splitting order was served on the trustee\], in respect of the superannuation interest of \[name of member spouse\], date of birth \[date of birth of member spouse\] Part A—Superannuation interest in a regulated superannuation fund, exempt public sector superannuation scheme, approved deposit fund, RSA or superannuation annuity \[Complete Part A if the superannuation interest is in a regulated superannuation fund, exempt public sector superannuation scheme, approved deposit fund, RSA or superannuation annuity\] I, \[name\], the non‑member spouse in relation to the above superannuation interest, of \[postal address\], born on \[date of birth\], give notice that: \*1. I have received from \[name of member spouse\] the amount of \[amount\] in satisfaction of my entitlement in respect of the payment split. OR \*1. \[Name of member spouse\] has paid the amount of \[amount\] to a regulated superannuation fund or an RSA, to be held for my benefit, in satisfaction of my entitlement in respect of the payment split. 2. I received independent legal advice from a legal practitioner explaining that the payment to me is in substitution for: (a) any entitlement I have to receive an amount of money from a splittable payment that becomes payable in respect of the superannuation interest; or (b) any right I have to make a request under the payment split provisions of the Superannuation Industry (Supervision) Regulations 1994 to have a new interest created in the eligible superannuation plan in which the member spouse has the superannuation interest, or to request the trustee of that plan to transfer an amount to another eligible superannuation plan to be held for my benefit. Part B —Superannuation interest in a superannuation fund other than an interest in a regulated superannuation fund or an exempt public sector superannuation scheme \[Complete Part B if the superannuation interest is in a superannuation fund that is not a regulated superannuation fund or exempt public sector superannuation scheme\] I, \[name\], the non‑member spouse in relation to the above superannuation interest, of \[postal address\], born on \[date of birth\], give notice that: 1. I have received from \[name of member spouse\] the amount of \[amount\] in satisfaction of my entitlement in respect of the payment split. 2. I received independent legal advice from a legal practitioner explaining that the payment to me is in substitution for any entitlement I have to receive an amount of money from a splittable payment that becomes payable in respect of the superannuation interest. DATED: \[signature of non‑member spouse\] \* Omit if not applicable