The informaon provided in this form is general advice only and has been prepared without taking account of your personal objecves, nancial situaon or needs. Before acng on any such general advice,
you should consider the appropriateness of the advice, having regard to your own objecves, nancial situaon and needs. You may wish to consult a licensed nancial advisor. You should obtain a copy of the
relevant Product Disclosure Statement (PDS) and consider its contents before making any decision regarding your super.
Commonwealth Superannuaon Corporaon (CSC) ABN: 48 882 817 243, AFSL: 238069, RSEL: L0001397
Commonwealth
Superannuaon Scheme
ABN: 19 415 776 361
RSE: R1004649
Military Superannuaon
and Benets Scheme
ABN: 50 925 523 120
RSE: R1000306
Public Sector
Superannuaon Scheme
ABN: 74 172 177 893
RSE: R1004595
Defence Force
Rerement and Death
Benets Scheme
ABN: 39 798 362 763
Public Sector
Superannuaon Scheme
ABN: 74 172 177 893
RSE: R1004595
Commonwealth
Superannuaon
Corporaon rerement
income
Australian Defence
Force Superannuaon
ABN: 90 302 247 344
RSE: R1077063
Important information about this form
Use this form if you wish to give a third party the right to access your personal super entitlement
information or act on your behalf.
How long is an authority valid?
Your authorisation will be valid indefinitely or until you revoke it by advising us verbally or in writing.
Alternatively you can supply us with another form and your authorisation details will be updated.
How to use this form
Please use CAPITAL LETTERS and a black or blue pen.
Mark boxes like this
with a
or
then fill out the next question or section.
A
Authority to release information
to a third party
AGS or service number
Scheme
CSS
PSS
Military
Super
DFRDB
ADF
Super
PSSap
CSCri
ADF
Cover
Please note: You should select each scheme this authority applies for.
Title
Mr Mrs Ms Miss Other
Your name
GIVEN NAME(S)
SURNAME
Date of birth
D D M M Y Y Y Y
/ /
Your postal address
SUBURB STATE POSTCODE
Residential address
SUBURB STATE POSTCODE
AUTH
09/19
Third party authority
Section A continued on next page
AUTH 1 of 3
Phone numbers
BUSINESS HOURS
MOBILE NUMBER
AFTER HOURS
Please update my contact details
B
Personal representative
I authorise the Commonwealth Superannuation Corporation (CSC) or its administrator, Mercer,
to release information about my super entitlements to:
Representative
Personal representative
Financial representative
Relationship
Financial Advisor
Solicitor
Accountant/tax adviser
Power of Attorney
Administration/Financial
Management Order
Public Trustee
Note: Powers of Attorney, Administration or Financial Management Order or Public
Trustee requests must accompany this authority form in order for information
to be released.
Other (please specify)
For the purposes of
Receiving/accessing
information only
Acting on my behalf Both
Name
GIVEN NAME(S)
SURNAME
Date of birth
D D M M Y Y Y Y
/ /
Organisation
(if applicable)
You authorise access to your
account details to
any representative of the organisation OR only the named individual
Postal address
SUBURB STATE POSTCODE
Phone
HOME PHONE MOBILE NUMBER
Email address
@
Financial Services
Licence Number
(Financial representative)
ABN
Allow access from
D D M M Y Y Y Y D D M M Y Y Y Y
/ / to / /
(only specify an end date if applicable)
AUTH 2 of 3
C
Consent
SIGNATURE
Date signed
D D M M Y Y Y Y
/ /
Privacy
Your privacy is important to us. We are collecting information on this form to administer your super.
If youd like to read CSCs privacy and security statement, visit csc.gov.au
Sign
D
Submit your form
We can accept your completed form by email or post.
by email to:
CSS, PSS, DFRDB, MilitarySuper and ADF Cover
please email your form to: formsandapplications@csc.gov.au
PSSap
please email your form to: formsandapplications@pssap.com.au
ADF Super
please email your form to: formsandapplications@adfsuper.gov.au
CSCri
please email your form to: formsandapplications@cscri.com.au
by post to:
CSS, PSS, DFRDB, MilitarySuper and ADF Cover
please post your form to: GPO Box 2252, Canberra, ACT 2601
PSSap
please post your form to: Locked Bag 9300, Wollongong, NSW 2500
ADF Super
please post your form to: Locked Bag 9400, Wollongong DC, NSW 2500
CSCri
please post your form to: Locked Bag 8840, Wollongong, NSW 2500
End form
AUTH 3 of 3
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