Mail To: Smartsalary Pty Ltd GPO Box 4244 Sydney NSW 2001

Page 1 of 2

Version Date: 18-Dec-2016

Request to Pay Novated Lease Registration

Given Name(s)

Contact Number

Employer

Log in to your online Smartsalary account at www.smartsalary.com.au to find your account number

Smartsalary Account Number

Payroll No.

Surname

Vehicle Registration Number

Registration Renewal Date

If it was required, a Safety Check has been completed and a copy of the report is attached

Where my vehicle required a safety check I have provided an original copy of my safety report to the Motor Registy and this has been recorded against my vehicle (NT and ACT)

A copy of the registration renewal is attached. Please submit a copy of your renewal, as original renewal documents will not be returned.

My registration payment is not due within the next 10 days (If your payment is due in less than ten days time you should make this payment and seek reimbursement)

Not Applicable

Section D - Employee Declaration* The information provided is true and correct to my knowledge; * I have read and understand the information about the Smartsalary Registration Program on the Smartsalary website; * All of the required documentation to allow my vehicle to be registered is attached to this request; * I accept that if my vehicle is registered in a state where an owner may make a choice in their CTP provider, Smartsalary will make that selection; * I have read and accepted the Smartsalary Terms and Conditions available on the Smartsalary website; and, * I authorise Smartsalary to alter my deductions in accordance with the requirements of my salary package. * I agree to contact Smartsalary to confirm my registration status on or just before the due date if I have not received confirmation of payment

DateSignature:

IMPORTANT: This section must be signed otherwise the vehicle will not be registered under the program

Section A - My Personal Details

Section B - My Vehicle Details

Section C - Checklist Yes

State

Amount owing (excl. GST)

GST on amount due

Important: We will only be able to renew your registration if we receive all documentation by no later than 5.00pm (AEST) 10 days before the registration expiry date. By signing the below declaration, you acknowledge and accept that you are responsible for ensuring that the vehicle is registered and insured at all times. Any liability incurred as a result of a failure to register or insure your vehicle is your sole responsibility.

Mail To: Smartsalary Pty Ltd GPO Box 4244 Sydney NSW 2001

Page 2 of 2

Version Date: 18-Dec-2016

Request to Pay Novated Lease Registration

Authority to act

Please accept this letter as authorisation for Smartsalary Pty. Ltd. to act on my behalf on matters relating to vehicle registration certificates and re-registration of the below mentioned vehicle.

This authority is valid until revoked by myself or the vehicle ownership is transferred.

Should you require further information please do not hesitate to contact me.

Name

Address

Daytime contact number

Plate Number

Description

VIN Number

Driver License Number

DateSignature:

IMPORTANT: This section must be signed otherwise the vehicle will not be registered under the program

Important: We will only be able to renew your registration if we receive all documentation by no later than 5.00pm (AEST) 10 days before the registration expiry date. By signing the below declaration, you acknowledge and accept that you are responsible for ensuring that the vehicle is registered and insured at all times. Any liability incurred as a result of a failure to register or insure your vehicle is your sole responsibility.