I acknowledge that offers of membership of Christian KiwiSaver Scheme are restricted as outlined on page 6 of the Product Disclosure Statement.

I confirm that I meet the general eligibility criteria for joining a KiwiSaver scheme and that (as applicable):

• I understand I am eligible to become a member of the Scheme by reason of my employer’s primary activities being (in the opinion of the Scheme’s manager) Christian mission or ministry (but that this may require verifying); and/or
• I am eligible to become a member of the Scheme by reason of a personal or immediate family commitment to a Christian faith and to Christian community involvement.

I consent to receive communications from the Scheme (including annual reports, annual member statements, annual tax statements, notices and any other documents) by email or any other electronic means. I understand that statements and other communication materials will be sent by email, unless I request they be sent by post. If no email address is supplied, I understand statements and other communication materials will be sent to my postal address.

I have received, read and understood the Scheme’s Product Disclosure Statement (PDS). I agree to be bound by the terms and conditions set out in the PDS and the Trust Deed for the Scheme, this form and any register entry (at www.disclose-register.companiesoffice.govt.nz) relating to the Scheme. I apply to become a member of the Scheme.

If I am signing this form under Power of Attorney I enclose original certified copies of the Power of Attorney and a certificate of non-revocation. These must be certified and dated within the last three months.

I acknowledge that if I was referred to Christian KiwiSaver Scheme through a third party then the manager may pay that third party a commission or fee, provided that the third party has advised me of and obtained my consent to that payment. I agree to any such payment and I acknowledge it will not be deducted from my account balance in the Scheme.

I confirm that I am authorised to provide the personal details presented and I consent to the information being passed to and checked with the document issuer, official record holder, a credit bureau and authorised third parties (including, but not limited to, the Department of Internal Affairs, NZ Transport Agency, Land Information NZ, Centrix, White Pages, the Dow Jones WatchList and illion) for the purposes of verifying my identity, address and whether or not I am a politically exposed person.

I understand that my personal information (whether provided in this form or in future) will be collected and held by the Scheme manager for the purpose of managing and administering my Scheme membership and complying with any laws applying to the manager or the Scheme. I consent to the disclosure of this information to third parties, including government authorities, service providers or referral partners, as necessary to comply with applicable laws, manage or administer my membership, or facilitate my participation in the Scheme. This may include sharing information with any third party who referred me to the Scheme. I acknowledge that I have the right to access and request correction of my personal information by contacting the Scheme manager at the address set out in section 7 of the PDS.

I acknowledge that choosing an investment fund (or funds) is solely my responsibility, that the manager is not to be regarded as representing or implying that any particular fund (or funds) is (or are) appropriate for my personal circumstances, and that my choice of an investment fund (or funds) is a binding direction from me to the manager. I understand that neither the Scheme manager nor any other person guarantees the performance of or returns from the Scheme or the repayment of any capital, and that my investment is subject to investment and other risks, including possible delays in withdrawal payments and loss of income or principal invested.

I understand that if (or to the extent that) I do not choose an investment fund, my contributions will be automatically invested in the Balanced Fund.

If I am applying to transfer to the Scheme from another retirement scheme, I authorise the manager and/or supervisor of that scheme to provide the Scheme manager with any of my personal information necessary to complete the transfer. I have compared the features of my current scheme with those of this Scheme before deciding to transfer.

I acknowledge that the Product Disclosure Statement for the Scheme does not give financial advice and that if I am unsure about choosing an investment strategy I can seek advice from a financial advice provider.