Salary Sacrifice Form 7 - SuperFacts.com

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I, the Employee named above, elect tosacrifice salary by authorising my employerto contribute directly into the followingSouth Australian GovernmentSuperannuation Scheme:Superannuation member ID:The amount of my proposed SalarySacrifice per pay period is:Compulsory ContributionsThe Expiry Date of this Salary Sacrifice of Superannuation Agreement shall be the datespecified below, or such other date as determined pursuant to the terms of the SalarySacrifice of Superannuation Agreement.Expiry Date:2. EMPLOYEE DECLARATIONI, the Employee named in section 1 of this Form 7, confirm that the details in section 1 are true andcorrect, and I acknowledge and agree that I:1. understand that no limit is placed onsalary sacrifice contributions to acomplying superannuation fund.2. understand that the employer is notliable to the Employee either directly orindirectly in respect of any mattertouching or concerning thecontributions, unless liability cannot beabrogated by statute.3. will indemnify the employer from andagainst:(a) any income tax or any othertaxation liability whatsoever(including any administrative penalty,fine or other amount) that maybecome payable pursuant to anyrelevant taxation legislation andrulings,b) any other liability whatsoevernot otherwise described in clausenumber 3(a) above, in respect of thesaid contribution by the employer,which includes any informationsupplied by the employer includingbut not limited to any estimate ofsalary and the amount of thecontributions and any matter nototherwise described herein, and(c) all charges, costs, damages,disbursements, fees, losses sufferedor incurred by the employer inrelation to any matter touching orconcerning the contribution by theemployer.4. have sought advice in respect of thisAgreement as necessary, the obtainingof such advice being the soleresponsibility of the Employee with theEmployer having no role orresponsibility in respect of it.5. understand that an administration feeof $44.00 including GST is payable tothe employer from the Employee’s posttax salary at the commencement of thisAgreement and any subsequent SalarySacrifice of SuperannuationAgreement.6. agree to give the employer not lessthan twenty-one (21) days prior writtennotice seeking the employer’sagreement to terminate this SalarySacrifice of SuperannuationAgreement at any time prior to theExpiry Date.
Employee Signature:Date: day of 20..3. EMPLOYER DECLARATIONThe employer described below agrees and acknowledges as follows:• that upon the Employee signing anddelivering this agreement to the employerthe employer will commence making thededuction and the contributions in themanner as outlined herein.Agency Name:Contact Person:Address:Email Address:Telephone:Facsimile:Signature:Date: Day of 20
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Salary Sacrifice Form 7 - SuperFacts.com

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