Equity Trustees Superannuation Limited ABN 50 055 641 757 AFSL 229757 (ETSL)
The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809 AFSL 235035 (CMLA)
Commonwealth Personal Superannuation and Rollover Plan
Eligibility to Contribute form
Section 1 – Personal
Surname Full given name(s)
Mrs Miss Ms Other
Other names known by (if any) Date of birth
Evening telephone Mobile number
If you are aged 67 or older and wish to make member contributions to your superannuation, each year you must conﬁrm
your eligibility to contribute.
So that we can accept your contributions, please return the completed form to us using one of the following options:
Should you require further information, simply call our Customer Service Representatives on 132015 between 8.30am and
6.00pm (Sydney time), Monday to Friday.
Commonwealth Financial Services
GPO Box 3306
Sydney NSW 2001
‘Commonwealth Financial Services’ is used under licence by CMLA.
Section 2 – Eligibility to contribute – complete this if you are aged 67 or above
I declare that I am aged 67 to 74.
I declare that (cross only one of the boxes):
I have met the work test prior to making the contribution because I have worked in paid employment for at
least 40 hours over 30 consecutive days this financial year.
I have met the work test exemption because:
• I met the work test last financial year, and
• I had a total superannuation balance (across all my superannuation accounts) of less than $300,000 at the end of last
financial year, and
• I have not claimed the work test exemption in any previous financial year.
I have not met either the work test or the work test exemption*.
*If you do not meet either the work test or the work test exemption, deposits cannot be accepted.
In order for this Declaration to be valid it MUST be signed and dated
Emailing a scanned copy to
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