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

(section 99)

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]