United Technologies Corporation Retirement Plan Application for Benefit Payment You MUST complete this section.

Section 1: Your personal details Surname: ____________________________________________________ Given Names: ________________________________________________ Date of Birth: ________________

Member Number:

Address: _____________________________________________________ ____________________________________________________________ Contact telephone number: ______________________________________ (during working hours)

Your tax file number You may have already quoted your Tax File Number to the Trustee, in which case you do not need to quote it again. If you are in any doubt, however, it is recommended that you quote your Tax File Number here to ensure that the payment of your benefit can be attended to as promptly as possible, and to ensure that your benefit qualifies for any concessional superannuation tax rates that may apply. My tax file number is

_______ / _______ / _______

Retiring from the workforce Are you retiring permanently from the workforce?

Yes

No

Note – this information is only required if you are aged between age 55 and 60 and you would like to cash some of the “preserved” portion of your benefit (see over for details about preservation). If you knowingly provide false information in order to cash your preserved benefit, you may be subject to penalties from the Australian Taxation Office.

Australian Resident Status Did you come to Australia on a temporary resident visa which is still valid or was valid at the time you left Australia? Yes No

UTCO_BP Form.doc

Section 2: Your decision Your Leaving Service Benefit Statement (enclosed with this form) shows:  

how much of your superannuation benefit you cannot take as cash (the “preserved” part), and how much you can take as cash if you wish to (the “non-preserved” part).

By law, you must keep the “preserved” part of your superannuation in a fund (either in this Fund or another superannuation fund) until you reach age 60*. You can choose to take the ‘non-preserved’ part of your super as cash, or save it with your preserved part. *If you are aged between 55 and 60 and decided its time to retire, you can take all your super as cash. If when leaving service you are over age 60, you can take all your super as cash, even if you continue working. You can receive advice about rollover funds from a number of sources including banks, insurance companies, and from financial planners such as the Watson Wyatt Financial Planning Service. To speak with a licensed financial adviser from Watson Wyatt in Melbourne, contact Susan Rio on (03) 9655 5222. In Sydney, Watson Wyatt has engaged ipac securities limited ABN 30 008 587 595 to provide financial planning services. To speak with a licensed financial adviser from ipac, contact ipac on 1800 080 494. For further information about your benefits, including the fees and charges which may apply, or the impact of the payment of your benefit entitlements, contact the Administrator on 02 9253 3333. Tell us your decision below (by completing one of the three options - A, B, or C and ticking the appropriate box). You may be required to provide proof of identity –see Section 3 for further information. Please remember to confirm your decision by signing Section 6 on the back page of this form.

I want to: OPTION

A

Leave all of my super in the Retained Benefit Section of the Fund (The Information for Members Leaving Service notice shows more information about the Fund’s Retained Benefit Section.)

OPTION

B

Move all of my super to the following super fund(s)

If you want to move your super to more than one other fund, please photocopy this form and give us the details below for each of the other super funds. Name of your chosen super fund: Address:

__________________________________

____________________________________________________ ______________________ Telephone No _________________

SFN or ABN of your chosen super fund:

_______________________________

Your SPIN or member no in your chosen super fund: __________________________ (Your chosen fund is able to give you this information and payment can not be made until it is received. The SFN is a 9 digit number, the ABN an 11 digit number and the SPIN a 9 digit number.)

Cheque should be made payable to:

________________________________

(Your chosen fund will be able to give you this information.)

Amount you want to put in this fund:

all of it (ie 100%) or

$________ ________%

UTCO_BP Form.doc

OPTION

Take some of my super as cash now, and save the rest

C

Your Leaving Service Benefit Statement shows how much of your super you can take as cash now (the “non-preserved” part). If you are aged between 55 and 60 and you are permanently retiring from the workforce, you may be able to take all of your super as cash. Please check your statement before completing this section. Tell us how much you want to take as cash. Please pay to me: The maximum amount that I can take as cash (this will be paid to you less tax). OR $ _________________ (this will be paid to you less tax). Any cash payment will be drawn from your taxable and tax free components in proportion to your total benefit. If the amount you nominate is more than the maximum amount you can take in cash, you will only be paid the maximum cash amount available. Tell us what to do with the rest of your super. The rest of my super should be moved to:

the Retained Benefit Section of the Fund (The information for Members Leaving Service notice shows more information about the Fund’s Retained Benefit Section.) OR

the rollover fund(s) I’ve listed below If you want to move your super to more than one other fund, please photocopy this form and give us the details below for each of the other super funds. Name of your chosen super fund: Address:

__________________________________

____________________________________________________ ______________________ Telephone No _________________

SFN or ABN of your chosen super fund:

_______________________________

Your SPIN or member no in your chosen super fund: __________________________ (Your chosen fund is able to give you this information and payment can not be made until it is received. The SFN is a 9 digit number, the ABN an 11 digit number and the SPIN a 9 digit number.)

Cheque should be made payable to:

__________________________________

(Your chosen fund will be able to give you this information.)

Amount you want to put in this fund:

remaining balance, or

$________ ________%

UTCO_BP Form.doc

Section 3: Proof of Identity Are you a member now requesting part or all of your benefit to be paid in cash or rolled over to a Self Managed Superannuation Fund? Yes No Are you requesting for some or all of your entitlement to be paid from this fund as a pension? Yes

No

If you have answered Yes to either of the above questions you will need to provide the following proof of identity before we can pay your benefit. You need to provide certified copies of (please tick the items provided) One of the following documents only:  Driver’s licence issued under State or Territory Law  Passport Or One of the following documents: One of the following documents:  Birth certificate or birth  Letter from Centrelink regarding a extract Government assistance payment  Citizenship certificate  Notice issued by Commonwealth, issued by the State or Territory Government or local Commonwealth council within the past twelve months  Pension card issued by that contains your name and Centrelink that entitles the residential address. For example: person to financial o Tax Office Notice of benefits. Assessment o Rates notice from local council.

AND

Certification of Personal Documents All copied pages of original proof of identification documents (including any linking documents) need to be certified as true copies by any individual approved to do so. The following can certify copies of the originals as true and correct copies:             

A permanent employee of Australia Post with five or more years of continuous service A finance company officer with five or more years of continuous service (with one or more finance companies) An officer with, or authorised representative of, a holder of an Australian Financial Services Licence (AFSL), having five or more years continuous service with one or more licensees A notary public officer A police officer A registrar or deputy registrar of a court A justice of the Peace A person enrolled on the roll of a State or Territory Supreme Court or the High Court of Australia, as a legal practitioner. An Australian consular officer or an Australian diplomatic officer A judge of a court A magistrate, or A Chief Executive Officer of a Commonwealth court A member of the Institute of Charter Accountants in Australia, CPA Australia or the National Institute of Accountants with 2 or more years of continuous membership.

Section 4: Bank account details UTCO_BP Form.doc

You only need to complete this section if you have requested payment of your pension benefit to be paid directly by electronic funds transfer into your bank account. If you chose this option please note that the account you nominate below must be in your name. You will need to provide a certified copy of the bank statement verifying the account details below . The same certification as outlined in Section 3 above is to be completed. Name of Acount: BSB Number:

______________________________________________

_______________ Account Number: ____________________

Section 5: Your signature I authorise the Trustee of the Fund to pay my superannuation benefit in the manner which I have instructed on this form. In completing this form, I confirm that I do not require any further information regarding my benefit entitlements. I understand that upon payment of my benefit from the Fund, the Trustee of the Fund is released from all further claims, liabilities and obligations whatsoever in relation to my interest in the Fund. ____________________________________ Your signature

_________________________ Date

All done? Then send this form back to us at: United Technologies Corporation Retirement Plan C/- IBM SuperLife Pty Limited GPO Box 4346 Sydney NSW 2001

UTCO_BP Form.doc