Transition Application Form (Health and Charity)

Transition Application Form

Complete this form to request Maxxia to begin establishing your salary packaging account. Please visit http://www.maxxia.com.au/transition for further information on Maxxia and the transition from your current salary packaging provider.

Employer name

Site

Employee Information

Title

First Name

Last Name

Gender

Address

Suburb

State

Postcode

Mobile number

Date of birth

Email address

Position

Payroll Cycle

Next Pay Date

Payroll Identification Number?

1A. Regular Benefit Payments

• Health is a maximum of $9,010 per FBT Year or $346.54 per fortnight or $750.81 per month
• Charity is maximum of $15,900 per FBT year or $611.54 per pay fortnight or $1337.50 per month

Mortgage Payment

Deduction (per pay cycle)

Deduction (% per pay cycle)

^{Casual Employees Only}

Rent Payment

Deduction (per pay cycle)

Deduction (% per pay cycle)

^{Casual Employees Only}

Personal Loan Repayments

Deduction (per pay cycle)

Deduction (% per pay cycle)

^{Casual Employees Only}

1B. Living Expenses - Maxxia Wallet

• Health is a maximum of $9,010 per FBT Year or $346.54 per fortnight or $750.81 per month
• Charity is maximum of $15,900 per FBT year or $611.54 per pay fortnight or $1337.50 per month

The Maxxia Wallet is the simple way to package your everyday living expenses, like groceries and bills. If you want to salary package the Maxxia Wallet for living expenses, please tick the below box and nominate the amount you would like to allocate to the card each fortnight.

Living Expenses - Maxxia Wallet

Deduction (per pay cycle)

Deduction (% per pay cycle)

^{Casual Employees Only}

The charge is $4.40 per benefit, per month (GST incl). This will be salary packaged and your deductions automatically increased to cover the charge. International transaction fees and disputed transaction fees apply. Please refer to the Wallet’s product disclosure statement for more information available at live.maxxia.com.au/pds.

2A. Meal Entertainment - Maxxia Wallet

• Maximum of $2,650 per FBT Year or $101.92 per fortnight or $220.83 per month

The Maxxia Wallet is the easy way to package your dine-in meal expenses. If you want to salary package the Maxxia Wallet for meal entertainment, please tick the below box and nominate the amount you would like to allocate to the card each fortnight.

Meal Entertainment - Maxxia Wallet

Deduction (per pay cycle)

Deduction (% per pay cycle)

^{Casual Employees Only}

2B. Meal Entertainment - Manual Claims

• Maximum of $2,650 per FBT Year or $101.92 per fortnight or $220.83 per month

You can submit manual claims for the below benefit items via the Maxxia app and Maxxia Online.

Venue Hire - Allows you to claim for accommodation expenses and venue hire

Deduction (pay per cycle)

Deduction venue hire casual

^{Casual Employees Only}

Meal Entertainment - Allows you to claim all your dine-in expenses

Deduction (per pay cycle)

Deduction (% pay per cycle)

^{Casual Employees Only}

Nominated account for reimbursements of claims and regular payments such as mortgage, rent and personal loans:

Account Name

BSB Number

Account Number

Employee Declaration (name and date required)

• You accept all terms and conditions of your Employer’s salary packaging program which will be provided by Maxxia Pty Ltd (Maxxia)
• You will be ineligible to claim a taxation deduction for all salary packaging payments made in relation to otherwise deductible items
• You will meet any cost including an FBT liability that may arise from your salary packaging arrangements
• You will maintain all records for a period of five (5) years in relation to any payments made by Maxxia
• You will make these records available to Maxxia, your employer, or the Australian Taxation Office as and when required.
• By completing this form, I agree to Maxxia contacting me about its products, services and offerings. Maxxia will handle your information in accordance with its Privacy Policy.

If you add or make changes to your mortgage or rent arrangements:
• You are not salary packaging mortgage repayments that are linked to an interest offset facility account.
• You hold the necessary substantiation for your mortgage, including a copy of the loan contract, and statements of the mortgage account evidencing the payment of the mortgage.
• If you are renting, you are currently renting under an official lease agreement.
• You retain and maintain all records in relation to any payments made by Maxxia in respect of your mortgage for a period of five (5) years.
• You undertake to make these records available to Maxxia, your employer, or the Australian Taxation Office if requested.
• You will immediately notify Maxxia of any change to the status of your mortgage account.
• Where Maxxia is reimbursing you for your mortgage benefit, you acknowledge that you have made arrangements for your financial institution to direct debit this account for payment to your mortgage.

Fees:
Fees are agreed upon between Maxxia and your employer for the provision of salary packaging services. You will receive an email — ‘Your Benefit Statement Summary’ — detailing your specific fees, so check your inbox (and possibly your junk/spam folder)

Employee Full Name (print)

Date

DISCLAIMER
Maxxia provides administration and referral services on behalf of employers. It does not provide any form of financial, taxation or financial product advice to employees on the relative merits of package programs or on any other basis. Some information on taxation matters may be provided to illustrate possible advantages, but is of a general nature only. You should seek your own independent professional advice on how packaging programs may impact your particular financial, taxation and welfare benefit circumstances. Maxxia may receive commissions or rebates in connection with some services it provides or arranges to be provided by third parties. By appointing and utilising Maxxia services, you consent to its receipt of such commissions and rebates. Tax laws regarding the treatment of salary benefits may change, which could adversely impact your financial, taxation or welfare benefit decisions.

Maxxia Wallet is issued by EML Payment Solutions Limited ABN 30 131 436 532 AFSL 404131. Maxxia Pty Ltd ABN 39 082 449 036 is an Authorised representative of EML Payment Solutions Limited Australian Financial Services Authorised Representative number 000278683. Consider if the card is right for you. Read the PDS at live.maxxia.com.au/pds for more information. Mastercard and the Mastercard brand mark are registered trademarks, and the circles design is a trademark of Mastercard International Incorporated.

PRIVACY STATEMENT
Maxxia Pty Ltd ABN 39 082 449 036 (Maxxia) is part of the McMillan Shakespeare Limited Group (MMS Group) and collects your personal information from you when you submit this form to us. We collect this information to provide and promote our products and services to you, and we may be unable to do so if you do not disclose all or part of the information requested in this form. Your personal information may be disclosed to other entities in the MMS Group, our agents, contractors and service providers (including our web and IT administrators, mail houses and advisers) and may be sent to MMS Group’s service providers located in the United States of America, Ireland and the Philippines. The MMS Group's Privacy Policy contains important information about how we collect, hold, use and disclose personal information, the security of your personal information and how you can make a complaint. If you do not wish to receive promotional material from us, or would like a copy of our Privacy Policy, please contact us on 1300 649 515 or email us at privacy@maxxia.com.au

Maxxia Pty Ltd | ABN 39 082 449 036.