Form 5—Waiver notice in respect of paymeForm 5—Waiver notice in respect of payment split

## Form 5—Waiver notice in respect of payment split (regulation 60) Family Law Act 1975 subsection 90XZA(2) or 90YZQ(2) WAIVER NOTICE 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 \[date of birth of member spouse\] I, \[name\], of \[postal address\], born on \[date of birth\], give notice that I waive my entitlement to future payments under that payment split. DATED: \[signature of non‑member spouse\]