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Issued by AustralianSuper Pty Ltd ABN 94 006 457 987 AFSL 233788 Trustee of AustralianSuper ABN 65 714 394 898
Change my details
1264.3 05/21 ISS5 page 1 of 4
How to complete this form
Compulsory details
Please complete your member number, full name and date of birth
details. If you don’t know your member number, please complete
your full name and date of birth to help us find your account.
Change of name or date of birth
Complete sections 1, 2 and 6.
What do I use to prove my change of name or date
of birth?
If you have changed your name or are updating your date of birth,
you’ll need to provide certified proof.
Certified copies of the following documents may be used to prove:
• Change of name: Marriage certificate, deed poll, decree nisi,
or change of name certificate from the Births, Deaths and
Marriages Registration Oce.
• Date of birth: Driver’s license or birth certificate.
Change of address or email
Complete sections 1, 2 and 6. You don’t need to provide any
supporting documents.
How to certify your documents
Read this section if you choose to attach paper copies of certified
documentation for providing proof of your identity.
1. Go to your local police station
Take both the ORIGINAL and a photocopy of your CURRENT
driver’s licence or passport to your local police station. If you
are using your driver’s licence, you’ll need to photocopy
BOTH sides.
All ID must have the same name and mailing address that we
have for your super account.
2. Ask them to certify your identification (ID)
To certify your ID, the authorised person needs to compare the
photocopy to the ORIGINAL and include the following details
on the copy:
• stamp or write ‘This is a true and correct copy of the
original’
• their qualification (such as police ocer)
• their name
• their address and phone number, and
• their signature and the date it was signed. The documents we
receive from you must have been certified and dated within
the last 6 months. Undated documents will be rejected.
If you can’t get to a police station, a number of other people
can certify your ID for you. Go to australiansuper.com/IDHelp
for more information.
Nomination of preferred beneficiary
Complete sections 1, 3 and 6.
Further information about nominating your preferred beneficiaries
To make sure that your nomination of preferred beneficiaries is valid,
please read the following information.
Who can I nominate?
Under the AustralianSuper Trust Deed, benefits payable in the event of
your death may only be paid out to your dependants, or to your legal
personal representative. It is important that you take account of who
may qualify as a dependant in your nomination.
The definition of ‘dependant’ under AustralianSuper Trust Deedincludes:
• your spouse (including de facto);
• your children of any age (including step, adopted or ex-nuptial);
• any other person who is or was wholly or partially financially
dependent on you; or
• your interdependants (those with whom you have a close personal
relationship; you live with; and you provide them or they provide you
with financial support, and domestic and personal care. You also have
an interdependent relationship if you have a close personal relationship
but are unable to meet the other requirements because one or both
of you suer from a physical, intellectual or psychiatric disability).
Who decides?
Under the Trust Deed, the Trustee alone is generally responsible for
deciding to whom, and in what proportion, your death benefit should
be paid. In making this decision however, the Trustee will take into
account your nomination of preferred beneficiary(ies).
For your nomination to be eective, it is important that you keep it up
to date, particularly if your family or marital circumstances change. If
you have no eligible dependants to whom the benefit can be paid, the
Trustee may pay the benefit to your legal personal representative for
inclusion in your estate.
Can I make a binding nomination?
Yes, you can make a binding beneficiary nomination by completing
and returning the Binding death nomination form available at
australiansuper.com/forms
Choice Income members can make a binding nomination or reversionary
beneficiary nomination by visiting australiansuper.com/forms, selecting
Forms in the Retirement tab and completing the relevant form.
Change of bank account (Choice Income and
TTR Income only)
Complete sections 1, 4 and 6.
Change payment instructions (Choice Income
and TTR Income only)
Complete sections 1, 5 and 6.
Declaration
You must sign and date Section 6 before returning this form.
OFFICE USE ONLY
Member number
1264.3 05/21 ISS5 page 2 of 4
Issued by AustralianSuper Pty Ltd ABN 94 006 457 987 AFSL 233788 Trustee of AustralianSuper ABN 65 714 394 898
Please complete in pen using CAPITAL letters and print
7
to mark boxes. Read the Privacy Collection Statement on
this form to see how AustralianSuper uses your personal information.
1. EXISTING MEMBER DETAILS
Last name Mr Ms Mrs
Miss
Dr
X
X
X
X
X
First name Date of birth
D
D
M
M
Y
Y
Y
Y
Street address
Suburb State Postcode
Telephone (business hours) Telephone (after hours)
Email
Please supply your member number and/or account number – whichever is relevant to the account you currently hold. If you have
more than one of the same type of account, you’ll need to complete another form.
Member number – Super account Account number – Choice Income / TTR Income
2. UPDATED MEMBER DETAILS
Please only fill in the details that you want us to change.
If you’ve made changes to your name or your date of birth is dierent from your current details, you need to provide evidence.
To update your address or email, you don’t need any supporting documents.
I’m changing my:
X
Name: I have attached my certified proof of identity to this application (e.g. marriage certificate, deed poll, decree nisi or
change of name certificate from the Births, Deaths and Marriages Registration Oce).
X
Date of birth: I have attached my certified proof of identity to this application (e.g. driver’s license or birth certificate).
Please ensure that you provide photocopies of your original identification documents and that they are correctly certified.
The documents we receive from you must have been certified and dated within the last 6 months. Undated documents will be
rejected. For instructions on how to get your ID documents certified, go to australiansuper.com/IDHelp
Last name Mr Ms Mrs
Miss
Dr
X
X
X
X
X
First name Date of birth
D
D
M
M
Y
Y
Y
Y
Street address
Suburb State Postcode
If you’d like to change your mobile phone number please call us on 1300 300 273.
Email
Change my details
Issued by AustralianSuper Pty Ltd ABN 94 006 457 987 AFSL 233788 Trustee of AustralianSuper ABN 65 714 394 898
3. NOMINATION OF PREFERRED BENEFICIARIES
Benefits payable in the event of your death may only be paid out to your dependants, or to your legal personal representative. It is
important that you take account of who may qualify as a dependant in your nomination. See ‘Who can I nominate?’ on page 1 for
more information. You can nominate more than one person and you can change this at any time in writing. The Trustee will take
this nomination into account but is not bound by it, as it must consider all dependants at the time of your death.
Name % of benefit Relationship
TOTAL 100% (must be whole numbers)
If you have more than six nominees, please photocopy this page, add your additional nominees, initial and attach to this form.
4. CHANGE YOUR BANK ACCOUNT DETAILS
If you want to have your payments made to a dierent bank account enter the new account details here.
To change your bank account details, you’ll need to provide proof of your identity.
X
I have attached my certified proof of identity to this application.
Please ensure that you provide photocopies of your original identification documents and that they are
correctly certified. For instructions on how to get your ID documents certified, go to australiansuper.com/IDHelp
Name of bank, building society or credit union BSB number
Your account name (this must be a personal account, held solely or jointly in your name) Account number
X
Mark this box if you’ve provided a copy of your bank statement so we can double check your details to avoid any payment delays.
Choice Income
and TTR Income
members only.
1264.3 05/21 ISS5 page 3 of 4
1264.3 05/21 ISS5 page 4 of 4
5. LET US KNOW HOW YOU WANT TO BE PAID
Tell us how much and how often you want to receive payments.
a) When I’d like to receive my payments:
Please choose (7) one option only, and fill in month and choose a start date where applicable.
X
Fortnightly (next available payment date)
X
Monthly. Choose one (✗) start date:
X
15th
X
28th
X
soon as possible (next scheduled payment date)
X
Quarterly from
M
M
Choose one (✗) start date:
X
15th
X
28th
X
soon as possible (next scheduled payment date)
X
Half-yearly from
M
M
Choose one (✗) start date:
X
15th
X
28th
X
soon as possible (next scheduled payment date)
X
Yearly from
M
M
Choose one (✗) start date:
X
15th
X
28th
X
soon as possible (next scheduled payment date)
b) I’d like my payment amount to be: Please choose (7) one option only.
X
Option 1 (Default): the minimum amount allowed*
X
Option 2: a specific amount
†
for each payment $
,
For this specific amount, how much do you want to this payment amount to increase by each year?
‡
Choose one (✗) below
X
0% (Default)
X
1%
X
2%
X
3%
X
4%
X
5%
X
Consumer Price Index (CPI)
X
Option 3 (TTR Income members only): the maximum amount* (10% of your account balance)
Your payments will start on the next available nominated pay date, once your application is fully processed. This can take up
to four weeks, or longer in some circumstances. For details on payments see the Choice Income and the TTR Income Product
Disclosure Statements (PDS). You can change your payment options at any time by logging into your online account.
* By law, there is a maximum limit (for TTR Income members only) and a minimum limit on the payment amount you can withdraw from your account balance each year,
and this varies with your age. Your limits are determined by the actual amount rolled into your account, and are recalculated every year based on your balance on 1 July.
For details see the Choice Income or TTR Income PDS. You’ll be paid the minimum amount as the default option if the boxes above are not ticked. The minimum
payment amount will also be pro-rata (proportionate) by default in the first financial year. This means that in your first financial year, you’ll receive a proportion of the
minimum annual amount spread over the rest of that first financial year.
† If you’re a TTR Income member your chosen payment amount must be between your minimum and maximum limits for that year; if you’re a Choice Income member,
your chosen amount must be more than your minimum limit for that year. If you choose an amount that is smaller than the minimum, or more than the maximum (for
TTR Income members), we’ll contact you.
‡ If no relevant box is selected for an annual increase in payment amount, the default option is 0%.
6. SIGN THIS FORM
The information I have provided is correct and I have read the Privacy Collection Statement below and I understand how
AustralianSuper will use my personal information.
Sign here:
Date
D
D
M
M
Y
Y
Y
Y
Print full name
Please return this completed form to: AustralianSuper, GPO Box 1901, MELBOURNE VIC 3001
or upload a scanned copy of your completed form to us via our website at australiansuper.com/email
Questions? Telephone 1300 300 273 Web australiansuper.com
Privacy Collection Statement
Please read this Privacy Collection Statement to see how AustralianSuper uses your personal information.
AustralianSuper Pty Ltd (ABN 94 006 457 987) of GPO Box 1901, Melbourne, Victoria 3001, collects your personal
information (PI) to run your super account (including insurance), improve our products and services and keep you informed.
If we can’t collect your PI we may not be able to provide these services. PI is collected from you but sometimes from third
parties like your employer. We will only share your PI where necessary to perform our activities with our administrator
(Australian Administration Services Pty Ltd, Link Group), service providers, as required by law or court/tribunal order, or
with your permission. Your PI may be accessed overseas by some of our service providers. A list of countries can be found
at the URL below. Our Privacy Policy details how to access and change your PI, as well as the privacy complaints process.
For complete details on the above go to and australiansuper.com/privacy or call us on 1300 300 273.
Choice Income
and TTR Income
members only.
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Completed 21 April 2022

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