REPACKAGE ADVICE FORM

SOUTH AUSTRALIAN GOVERNMENT EMPLOYEES

Package Number Name

NO CHANGES NECESSARY

Please continue my package with the current benefit items and amounts

CHANGING / ADDING TO YOUR EXISTING PACKAGE

Please list items to be packaged New Amount Account Number where funds are to be paid (only for new
for the coming year (existing Item benefit items)
and any new benefits). p.a ($)
(Y/N) Branch code (BSB) Account Number

Total
Please note:-

If you are making changes or adding new benefits, we may need to contact you to obtain
additional documentation

Signature Date / /

Please return this completed form together with Confirmation of Salary form to:
REMUNERATOR, PO Box 1247 CAMBERWELL VIC, 3124
or fax to (03) 9882 5522
 FORM 4
SOUTH AUSTRALIAN GOVERNMENT
CONFIRMATION OF EMPLOYEE’S SALARY
(For the purposes of entering into a Salary Sacrifice Agreement)
CONFIDENTIAL

TO THE NOMINEE: REMUNERATOR

(Form to be completed by the Employee and relevant Employer, Human Resources/Payroll
Department and forwarded to the Nominee by the Employee)

Surname: ………………………………… Given names: …………………………….

Address: …………………………………………………………………………………………

Phone No. ………………………………. Employee Payroll ID No. ………………. ……….

Position: ………………………………. Substantive Classification: ………………………

Department:……………………………………………………………………………………
A salary sacrifice limit applies of fifty (50%) of Total Annual Earnings. The 50% includes salary sacrifice of
contributions directly to SA Government Superannuation Schemes, all other selected benefit item(s), associated
Fringe Benefits Tax liability and any Nominee Administration Fees.

Are you contributing or planning to make salary sacrifice contributions directly to a SA

Government Superannuation Scheme? yes / no
If yes, please provide the following details
Name of Superannuation Scheme: ………………………………. $ ……..………………

Are you likely to receive any fringe benefits from your employer outside of any salary
sacrifice arrangement? yes / no
If yes, please provide details including an estimate of the Reportable Fringe Benefits provided to you
item(s):…….………………………………………………………… $ ……..………………

IMPORTANT: Employees in PBIs must take into account the possible impact of other fringe
benefits outside of any salary sacrifice arrangement provided to them by the employer as they will
reduce the available FBT exempt threshold.

Employment Status: (please tick appropriate category)

Full-time … Part-time … Casual … Other … please specify

If Part Time, please indicate substantive hours of employment (per fortnight): ..............................……..

Are you currently receiving a higher duty allowance or appointed to a higher level
position for a temporary period? yes / no (if yes, please provide dates and amount details)

from……………… to………………… applicable annual salary $………………….

Are you due for a salary increment? yes / no (if yes, please provide details)

effective date …………………………… applicable annual salary $………………….

IMPORTANT: PLEASE SUPPLY ALL ADDITIONAL DOCUMENTS FOR TAXATION PURPOSES

PLEASE COMPLETE AND SIGN THE ATTACHED “FORM 4” DOCUMENT REQUIRED BY SOUTH AUSTRALIAN GOVERNMENT
 HUMAN RESOURCES/PAYROLL CONFIRMATION
The above employee is eligible to participate in salary sacrifice: YES / NO

Current Annual Salary: $…………………..….

(as prescribed in the relevant Salary Schedule of the appropriate Enterprise Agreement and adjusted according to
part-time substantive hours)

Current Fortnightly Salary: $……………………. Next Pay Date:……………………

(Current Annual Salary / 313 x 12 = Fortnightly Salary)

Due for an Enterprise Agreement salary increase: ……………………. $……………..……..

(effective date) (*applicable annual salary)
PBI Status of Employer: PBI (Hospital) … PBI (Non-Hospital) … Non PBI …

Verified By: ………………………………………………….

(Name of Human Resource Consultant/Payroll Officer)

……………………………………………………. Date: ………………

(Signature of Human Resource Consultant/Payroll Officer)

EMPLOYEE TO COMPLETE EITHER OPTION 1 OR OPTION 2 BELOW NOT BOTH. PLEASE CONTACT YOUR
NOMINEE OR FINANCIAL ADVISER IF REQUIRED TO COMPLETE THESE DETAILS.

EMPLOYEE CONFIRMATION (if applicable) FOR

OPTION 1: BASE SALARY – FIXED FORTNIGHTLY DEDUCTION
IMPORTANT: THIS SECTION TO BE COMPLETED BY EMPLOYEE ONLY WHEN
OPTION 1 IS SELECTED

Employee’s Annual Salary $………………………………

(as defined in Item 3 of Schedule 3 to the Salary Sacrifice Agreement, can include pro-rata of Enterprise
Agreement increases and increments)

Verified By: …………………………………………………….

(Name of Employee)

……………………………………………………. Date: ………………

(Signature of Employee)

EMPLOYEE CONFIRMATION (if applicable) FOR

OPTION 2: TOTAL ANNUAL EARNINGS – PERCENTAGE BASED DEDUCTION
IMPORTANT: THIS SECTION TO BE COMPLETED BY EMPLOYEE ONLY WHEN
OPTION 2 IS SELECTED

Employee’s Estimate of Annual Variable Payment $………………………………

(as defined in Item 3 of Schedule 3 to the Salary Sacrifice Agreement, can include overtime, shift penalties
and/or allowances)

Employee’s Total Annual Earnings $………………………………

(as defined in Item 3 of Schedule 3 to the Salary Sacrifice Agreement, including annual Base Salary and
annual Variable Payment)

Verified By: …………………………………………………….

(Name of Employee)
……………………………………………………. Date: ………………
(Signature of Employee)

IMPORTANT: PLEASE SUPPLY ALL ADDITIONAL DOCUMENTS FOR TAXATION PURPOSES

PLEASE COMPLETE AND SIGN THE ATTACHED “FORM 4” DOCUMENT REQUIRED BY SOUTH AUSTRALIAN GOVERNMENT