SUPERANNUATION FORM

"*" indicates required fields

Company

This field is for validation purposes and should be left unchanged.

Choice of superannuation (super) fund

I request that all my future super contributions be paid to:*

The APRA fund or retirement savings account (RSA) I nominate

The self-managed super fund (SMSF) I nominate

I do not have a Super Fund and request to use the one nominated by my employer

Your details

Full Name*

First Last

TFN*

Details of your nominated fund

Fund ABN*

Fund Name*

Fund Address*

Unique superannuation identifier (USI)

Your account name (if applicable)

Member number*

Self-Managed Super Fund

Fund electronic service address*

Fund bank account: BSB*

Fund bank: Account Number*

DECLARATION

Required documentation You need to attach a document confirming the SMSF is an ATO regulated super fund. You can locate and print a copy of the compliance status for your SMSF by searching using the ABN or fund name in the Super Fund Lookup service at http://superfundlookup.gov.au/ If you are the trustee, or a director of the corporate trustee you can confirm that your SMSF will accept contributions from your employer by making the following declaration (place an ‘X’ in the box below):

Declaration

I am the trustee, or a director of the corporate trustee of the SMSF and I declare that the SMSF will accept contributions from my employer.

If you are not the trustee, or a director of the corporate trustee of the SMSF, then you must attach a letter from the trustee confirming that the fund will accept contributions from your employer.

File

Max. file size: 20 MB.

Candidate Signature

Date