~returnName~

~sectorName~

CERTIFICATE BY TRUSTEE

Authentication Code: ~MD5Checksum~

The trustee(s) of: ~superFundName~

Australian Business Number: ~superFundABN~

certifies that to the best of its information, knowledge and belief

(a) the particulars contained in this return are true; and

(b) the internal controls in relation to the fund were/were not* adequate and were/were not* operating satisfactorily during the 2002/2003 year of income.

*(strike out whichever is not applicable)

The trustee must certify the accuracy of the annual return by EITHER affixing its common seal OR having two of its directors sign it on its behalf

EITHER:

The common seal of: ~trusteeName~

was affixed to this document in accordance with its articles of association in the presence of:


Director


Director / Secretary

[NOTE: If the body corporate's articles of association of other governing document provides for another method of affixing the common seal, that method must be used.]

Common Seal

Date:

/

/

OR:

Signatures of directors

Print the names of the directors alongside their signatures





Date:

/

/

State:

Office Use Only

Trust Cert

Aud Rpt

Aud Qual

Date Recd








Notice of Contravention


If you have indicated that the fund did not satisfy all the relevant requirements under SIS, please provide the following information in respect of each contravention. You may use this page or a photocopy of this page to accompany your return. If you attach additional pages, please ensure that the fund's Australian Business Number, Superannuation Fund Number (where applicable) & name are printed clearly on each page.

    1. Specify the requirement(s) contravened.
    2. Indicate the year(s) of income to which each contravention relates.
    3. Indicate the circumstances of the contravention.
    4. Include any other submission you consider relevant to the case (in particular, any submission that is relevant to the matters mentioned in paragraphs 42(1A)(a) and (b) of the SIS Act) and any previous correspondence received from the APRA in relation to the contravention.

Year of Return to which contravention relates: ___________________________________________________
Superannuation Fund Number: (where applicable) ___ ___ ___ ___ / ___ ___ ___ / ___ ___
Australian Business Number: ___ ___ / ___ ___ ___ / ___ ___ ___ / ___ ___ ___
Name of Fund: ___________________________________________________
Details of contravention(s):