CSC
AFSL 238069
RSEL L0001397
ABN 48 882 817 243
1922 Scheme
CSS
RSE R1004649
ABN 19 415 776 361
DFRB Scheme
MilitarySuper
RSE R1000306
ABN 50 925 523 120
DFRDB Scheme
ABN 39 798 362 763
PSS
RSE R1004595
ABN 74 172 177 893
PNG Scheme
PSSap
RSE R1004601
ABN 65 127 917 725
DFSPB
The informaon provided in this form is general advice only and has been prepared without taking account of your personal objecves, nancial situaon or needs. Before acng on any such general advice,
you should consider the appropriateness of the advice, having regard to your own objecves, 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
Defence Force
Rerement and Death
Benets Scheme
ABN: 39 798 362 763
Australian Defence
Force Superannuaon
ABN: 90 302 247 344
RSE: R1077063
Commonwealth
Superannuaon Scheme
ABN: 19 415 776 361
RSE: R1004649
Public Sector
Superannuaon
accumulaon plan
ABN: 65 127 917 725
RSE: R1004601
Military Superannuaon
and Benets Scheme
ABN: 50 925 523 120
RSE: R1000306
Australian Defence
Force Cover
ABN: 64 250 674 722
Public Sector
Superannuaon Scheme
ABN: 74 172 177 893
RSE: R1004595
1922 Scheme
DFRB Scheme
PNG Scheme
DFSPB
CSC rerement income

EC
02/19
FOR
EMPLOYER
USE

Only use this form and explanatory notes if you are a contributing member of
PSS (and are not on leave without pay that does not count as service) and
wish to cease PSS membership to join an alternative scheme (PSSap if you
are eligible – check with your employer).
Before completing this application form you should read the
 and the 
 factsheet at  or call .
It is important to note that once you have made a valid election
to cease your PSS membership, we will preserve your benefit and
there is .

These notes are intended to assist you in completing the attached
form. They are not intended to provide a detailed explanation about
your option to cease PSS membership.


Please refer to our publications outlined on page 1 when you are deciding on your options. There are also
factsheets,
and calculators available at 
Other sources of information include the following:
Our Customer Information Centre:
Phone: 1300 000 377
Email: members@pss.gov.au
It is in your interest to seek professional advice before you make a decision. For information on the personal advice service
available to you, please refer to the first page of this information leaflet.

Take care when completing this form. If you do not complete the application form correctly we may declare it void.


Obtaining professional advice from an
experienced financial planner can help you
reach your financial goals.
CSCs authorised financial planners provide
‘fee for service’ advice, which means you receive
a fixed quote upfront. There are no obligations,
commissions or hidden fees.
To arrange an initial advice appointment
please call during
business hours.
EC 1 of 13


Please complete all the boxes in . This enables us to identify you and tell us where to contact you.

Please provide details of your relationship status, including same sex or opposite sex de facto relationships. You may wish
to include a copy of your marriage certificate or registered relationship certificate with your application. This would speed
up the process in the event that a spouse’s benefit becomes payable.
For the definition of a spouse for death benefits, see the  factsheet at 

This postal address is where we will send all correspondence to you.
We also require contact phone numbers, in case we need to contact you. Your current work number, an email address,
either at work or at home, is useful for us to contact you quickly.

Please provide the details of your current employer so we can contact them if required.


To guard against fraud, money laundering, terrorism financing, you need to provide us with information to verify your
identity before your request can be processed. The identification documents you send us will be verified electronically
using a Document Verification System, or you can provide certified copies of your documents with your application.
If you supply certified documents, the person certifying them must attest that the documents are true copies, and that
you are the valid holder of the identification. Copies of your documents will be scanned and stored on our secure
document management system.


Please complete this to acknowledge that you have received and understood sufficient information to be able to make an
informed choice about your election to cease PSS membership.
You are making a formal election under the provision of the Superannuation Act 1990. This election is binding and you
cannot change it.
We you make use of the information sources outlined at the start of the 
you complete this section.


When you elect to cease PSS membership, one of the following two options will apply to you:
if you are eligible to be a member of PSSap you will automatically join PSSap
or
if you are not eligible to be a member of PSSap you can elect to join a superannuation fund of your
choice provided your employer agrees to make superannuation contributions on your behalf into
that superannuation fund.
It is very important that you discuss with your employer your intention to cease PSS membership and the options available
to you to join another superannuation scheme. Your PSS membership will not cease until you have become a member of
another superannuation scheme. It is not sufficient that you elect to cease PSS membership; you must also become a member
of another superannuation scheme for the cessation of your PSS membership to take effect.
You should tick which statement applies to you in this section.


If you have a transfer amount you can pay it into an accumulation scheme. There are two types of transfer amounts:
post 1995 transfer amounts
pre 1996 transfer amounts.
Be aware that if you don’t elect to rollover your transfer amount (on this election form) it will be included in the amount
left preserved in PSS and you will not be able to access any part of your benefit until you meet a condition of release.
EC 2 of 13



For taxation purposes, your lump sum benefit is called a Superannuation Lump Sum Payment.
The start date relates to the date your eligible service period (ESP) started and is used to calculate the various components
of your Superannuation Lump Sum Payment for taxation purposes.
Generally, your ESP is the number of days between the date you started your current employment (which may be earlier
than the date you joined CSS or PSS), and the date your payment is made. If you were formerly a CSS member who started
membership before 1 July 1983 and you have a long service leave start date that is earlier than your CSS start date, that earlier
date applies as your ESP start date.
Earlier periods of employment for which you paid a transfer value into CSS or PSS are added to your ESP. If this is the case,
please fill in the start date of that earlier service.
If you do not show a date in this section, we will use the date on which you joined PSS as your start date (unless you
transferred from CSS, in which case we will use your CSS start date). If you are leaving your entire benefit (including any
transfer amounts) preserved in PSS you do not need to fill out this section.


In accordance with the Taxation Laws Amendment (Tax File Numbers) Act 1988, we are required to deduct PAYG tax at the
top marginal rate plus the Medicare levy from benefits if a person does not provide a TFN.
If you have not been issued a TFN you should lodge an Australian Taxation Office (ATO) application/enquiry form with the
ATO. Forms are available at  or all ATO branches. You must provide proof of identity at the time you lodge the form.

We will provide your TFN to the receiving fund unless you instruct us not to. Please note that there are consequences for
not supplying your TFN to a fund.
 We are required to validate your TFN with the ATO’s records to confirm the TFN provided is yours and correct. Your TFN
will be validated before your benefit can be rolled over to another fund or paid using the SuperTICK validation service. If you
do not provide your TFN, the processing of your benefit payment may be delayed.
G



Your PSS membership will not cease until you have become a member of another superannuation scheme. It is not sufficient
that you elect to cease PSS membership; you must also become a member of another superannuation scheme for the
cessation of your PSS membership to take effect. Therefore, your cessation date is the day BEFORE the date you join your
new fund.


When you have completed  and F of this form please give the form to your personnel section so they
can complete the relevant section. Your personnel section will forward the completed form to us.

Personal information that you or a third party provide, such as your employer, is collected, held, used and disclosed as required
or authorised by law in accordance with the privacy policies and notice, available via or by contacting us on
, for the purpose of managing your super. This includes the management of superannuation investments,
providing superannuation products and information, the administration of accounts, conducting market research and product
development. The privacy policies and notice contain important information about how personal information is handled,
including rights to access and update that information and how a complaint about a breach of privacy can be made.

We will preserve your benefit in PSS and it is important that you advise us of any change in your postal address. This will
enable us to forward information to you each year regarding your benefit.
 if you are a preserved benefit member and don’t advise us of your change of address, we may treat you as a
‘lost member. This may ultimately result in your benefit being classed as ‘unclaimed’ once you reach 65.
EC 3 of 13
This page is intentionally left blank
EC 4 of 13
CSC
AFSL 238069
RSEL L0001397
ABN 48 882 817 243
1922 Scheme
CSS
RSE R1004649
ABN 19 415 776 361
DFRB Scheme
MilitarySuper
RSE R1000306
ABN 50 925 523 120
DFRDB Scheme
ABN 39 798 362 763
PSS
RSE R1004595
ABN 74 172 177 893
PNG Scheme
PSSap
RSE R1004601
ABN 65 127 917 725
DFSPB
The informaon provided in this form is general advice only and has been prepared without taking account of your personal objecves, nancial situaon or needs. Before acng on any such general advice,
you should consider the appropriateness of the advice, having regard to your own objecves, 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
Defence Force
Rerement and Death
Benets Scheme
ABN: 39 798 362 763
Australian Defence
Force Superannuaon
ABN: 90 302 247 344
RSE: R1077063
Commonwealth
Superannuaon Scheme
ABN: 19 415 776 361
RSE: R1004649
Public Sector
Superannuaon
accumulaon plan
ABN: 65 127 917 725
RSE: R1004601
Military Superannuaon
and Benets Scheme
ABN: 50 925 523 120
RSE: R1000306
Australian Defence
Force Cover
ABN: 64 250 674 722
Public Sector
Superannuaon Scheme
ABN: 74 172 177 893
RSE: R1004595
1922 Scheme
DFRB Scheme
PNG Scheme
DFSPB
CSC rerement income

EC
02/19


Reference number (AGS)
Cessation date
M M Y Y Y Y
/ /
Title
Mr Mrs Ms Miss Other
Surname
Given name(s)
Date of birth
M M Y Y Y Y
/ /
Previous memberships
Have you had any other
periods of PSS membership?
If so, please list the reference
(AGS) number(s) for each of
those memberships.
1
2
3
4

Married Single De facto
Spouse’s name




Read the  and each section of the form carefully before filling it in
Use CAPITAL LETTERS and a blue or black pen
Sign your name where needed. If you don’t sign the relevant sections of the form, we will
return it to you.

EC 5 of 13
Start date of de facto
relationship (if applicable)
M M Y Y Y Y
/ /
Spouses date of birth
M M Y Y Y Y
/ /

Address

SUBURB STATE 
Phone
 

Would you like to receive an SMS to confirm we have received your application?
No Yes
Email
@

Name of employing
department or agency


To confirm your identity, we need some information from you—this is to protect your benefit against
fraud, money laundering and terrorism financing, under the Anti-Money Laundering and Counter-Terrorism
Financing Act 2006.

You can authorise us to verify your identification electronically using the Document Verification
Service (DVS). DVS is a national online system that allows approved government agencies and
organisations to compare a members identifying information with a government record. It is
not a database and does not store any personal information. Requests to verify a document
are encrypted and sent via a secure communications pathway to the document issuing
authority for checking.



DVS is only compatible
with some identification
documents, these have
been listed below.
An electronic copy of your identification documents will be stored in a secure environment and hard
copies will be securely stored off-site. All copies will only be used for the purpose of confirming your
identity. You need to send in identification with every application.

If youre providing certified documents, the certifying authority must confirm in writing you are the valid holder of the
identification you are presenting, and any copies are true copies of the original.
IThe certification must include the name, signature, qualification and registration number of the certifying
authority (if applicable), and the date of the certification.

EC 6 of 13

The following sample of certifying authorities can certify your documents in Australia:
Dentist
Employee of a Commonwealth authority engaged on a permanent
basis with five or more years of continuous service who is not specified
elsewhere in this document
Financial Adviser or Financial Planner
Justice of the Peace (JP)
Legal Practitioner
Medical Practitioner
Member of the Australian Defence Force who is:
an Officer
or
a Non-Commissioned Officer within the meaning of the Defence Force
Discipline Act 1982 with five or more years of continuous service
or
a Warrant Officer within the meaning of that Act.
Midwife
Notary Public
Nurse
Occupational therapist
Physiotherapist
Psychologist.
For a full list of certifying authorities refer to  of the Statutory Declarations
Regulations 2018 available at 

We require a copy of
both sides of your
identification document.

You only need to provide  document from the  category.
If you can’t provide any you will need to provide  secondary
identification document from List A AND secondary identification document from List B. We can
only accept documents that are listed below for identification purposes.
If the name we hold on file for you is different to the name on your identification, or two pieces of
identification are in different names, please provide a certified copy of your  or 
.
If you would like us to use DVS to verify your identification, please provide authorisation below.
I confirm that I am authorised to provide the personal details presented and I consent to the
information being checked with the document issuer or official record holder via 3rd party systems
for the purposes of confirming my identity.
You must provide a copy* of  of the following:

DVS compatibility is shown as or
A current Australian Driver’s Licence.
A current Australian Passport (or one which has expired within the last two years).
A current Australian Proof of Age card (issued under a State or Territory law).

Only provide these documents if you’re unable to provide  of the
 documents.

Your Australian Birth Certificate or extract issued by a State or Territory.
Birth Certificate extracts and Birth Certificates issued before 1970 may not be verified by DVS.
Your Citizenship Certificate issued by the Commonwealth.
Your current Pensioner Concession Card issued by the Department of Human Services.
If your documents are
incompatible with DVS,
don’t forget to provide
certified copies.
EC 7 of 13


I have been advised to read the PSS and  before completing this form.
I understand that:
I have been advised to read the explanatory notes and seek financial advice based on my personal
situation and needs
in electing to cease PSS membership in order to become a member of an alternative scheme I am
making a formal election to cease PSS membership under the provisions of PSS legislation and that
 this election
I will become a member of PSSap (Commonwealth Superannuation Corporation’s accumulation
fund) or, if I am not eligible to join PSSap, a superannuation fund of my choice and the accrual of
my superannuation benefit will be subject to the rules of those superannuation funds
my insurance arrangements will be different in PSSap compared to those in PSS. This means
I will receive the default cover and will be subject to limited cover for the first 12 months of
membership; I am aware that if I wish to increase my level of insurance cover in PSSap it will be
subject to underwriting
my entire PSS benefit will be preserved in PSS until I become eligible under PSS rules to claim it
if I have any transfer values and wish to roll them out of PSS into an accumulation plan I need to do
so in this form (see )
while preserved, my member and productivity components, any amounts I transferred into PSS
and my cocontributions (if applicable) will accrue at the earning rate of the fund; my employer
component will accrue in line with CPI
once my election to cease membership has been accepted I will no longer have an entitlement to
rejoin PSS, regardless that I remain a PSS preserved benefit member
I understand that by making this election I do so in respect of all my PSS memberships including
any concurrent memberships
I have attached a copy of my marriage certificate or registered relationship certificate (if I have one).


M M Y Y Y Y
/ /


Your notice issued by the Australian Taxation Office (ATO) within the last 12 months that shows
your name, current residential address, and records an amount payable either to or from the ATO.
Your notice issued by a local council or utilities provider in the last three months showing the
provision of services and current residential address.  rates notice, electricity or
water bill.
Your notice issued by the Commonwealth or a State or Territory government within the last
12 months showing your name and current residential address, and the provision of a financial
benefit.  a Centrelink letter.

If you live overseas and need to have documents certified, it needs to be done by a person authorised
as a notary public in a foreign country, or by a person who is on a list of persons before whom a
statutory declaration may be made and who has a connection to Australia. : a doctor who
is registered in Australia and working overseas, or an Australian Consular Officer. Refer to and
 for more information. Documents provided in a foreign language must be accompanied by a
certified translation completed by an accredited translator.
Persons residing overseas and foreign residents may need to contact us.

EC 8 of 13



I,

hereby elect to:
Leave PSS and join PSSap (Commonwealth Superannuation Corporation’s
accumulation fund)
Leave PSS and join a superannuation fund of my choice. My employer has informed
me that I am not eligible to join PSSap and has agreed to pay employer contributions
on my behalf to that superannuation fund.


M M Y Y Y Y
/ /
E


I,

whose refernce (AGS) number is

elect to have my transfer amount(s) paid out of PSS, rather than leaving this amount
preserved in PSS with the balance of my PSS benefit.
Post 1995 transfer amount
Pre 1996 transfer amount


M M Y Y Y Y
/ /
Note: If your transfer includes a compulsorily preserved component you must provide us
with the name of a rollover fund or retirement savings account (RSA).

Name of first nominated fund
or RSA
ABN for fund or RSA

Membership number (known
as Member Client Identifier)
for fund
USI for fund or RSA

(These numbers can be obtained from the rollover fund or RSA concerned.)


EC 9 of 13
The amount you would like to be paid to this rollover fund or RSA:
a dollar amount of
$
(gross)
OR
a percentage
%
OR
the balance of my lump sum benefit.

Name of second nominated
fund or RSA
ABN for fund or RSA

Membership number (known
as Member Client Identifier)
for fund
USI for fund or RSA

(These numbers can be obtained from the rollover fund or RSA concerned.)
The amount you would like to be paid to this rollover fund or RSA:
a dollar amount of
$
(gross)
OR
a percentage
%
OR
the balance of my lump sum benefit.
EC 10 of 13
F


1. What is your start date for taxation purposes?
See  in the 
M M Y Y Y Y
/ /
2. Providing your TFN is voluntary. If you choose not to provide it you will not commit an offence.
The consequences of not providing your TFN are:
tax will be deducted from your benefit/s at the highest marginal rate
the trustee of another superannuation scheme or RSA provider holding your benefits now or in the
future may not be able to locate, amalgamate or identify your benefits in order to pay you.

PSS is authorised to collect your TFN under the provisions of the Superannuation Industry (Supervision) Act 1993. We will treat
your TFN as confidential and will only use it for legal purposes, which include:
disclosing it to the trustee of an eligible superannuation entity, regulated exempt public sector
superannuation scheme or RSA provider to which your benefits are transferred in the future,
unless you specifically instruct us not to
finding or identifying your superannuation benefits where other information is insufficient
calculating tax on your benefits
providing information to the Commissioner for Taxation
• validating your TFN with the ATO’s records to confirm the TFN provided is yours and correct.
Your TFN will be validated before your benefit can be rolled over to another fund or paid using
the SuperTICK validation service. If you do not provide your TFN, the processing of your benefit
payment may be delayed.
Note that the lawful purposes may change in the future as a result of legislative change.
If you have already provided your TFN to us you are under no obligation to provide it again when making
an application for benefits. However, if your TFN is NOT recorded by us, payment of your benefits may be delayed.
3. Select this box if you do not want us to pass on your TFN
What is your Tax File Number?
We are authorised to collect your TFN under the provisions of the Superannuation Industry (Supervision) Act 1993.
 of the  summarises the legal uses of your TFN.

Have you


filled in all the sections applicable to you?
completed the identification requirements in ?
signed the declaration in ?
signed an election option in ?
completed rollover nomination details at ?
provided an ‘ESP start date’ (if appropriate) in ?
provided your TFN in ?
attached a copy of your marriage certificate or registered relationship certificate?
You have now completed this form. Please return it, with any attachments, to for
completion of the Departmental report and forwarding to us.



EC 11 of 13
G



Members name
Reference number (AGS)
Date of election to cease
PSS membership
M M Y Y Y Y
/ /
Date joined new super fund
M M Y Y Y Y
/ /
Name of new super fund
Salary for superannuation benefit purposes at date of exit:
Salary for superannuation benefit purposes at 1 July 1999
$
Salary for superannuation benefit purposes at date of exit
$
Note: This is the member’s salary for superannuation benefit purposes as at the date of exit. This can be greater than the
salary for superannuation contribution purposes at the last birthday.
Last three superannuation variations including the payday that contributions were ceased (usually the payday after
the date of exit).


 




1.
+
2.
+
3. NIL
+



YES

Employee’s signature and date of birth confirmed
Superannuation history card or computer print–out attached
Is the employee receiving an allowance (or did they receive such an allowance in the past three years)
that increases salary for superannuation purposes?
If , is the allowance automatically recognised as salary for superannuation purposes? If the allowance
is not automatically recognised as salary for superannuation purposes, please attach form or .
Has the member ever worked part–time hours? If , please attach details.
Has the employee had any periods of LWOP in the two years prior to date of exit? If , attach details of
starting and ceasing date(s), and type of leave.
EC 12 of 13
Email
employer.service@admin.csc.gov.au
employers@pssap.com.au
Phone
 1300 338 240
 1300 308 806
Fax
 (02) 6272 9996
 1300 364 144
Web
eac.csc.gov.au
Fax
(02) 6272 9613

employer.service@csc.gov.au

1300 338 240

(02) 6275 7010

Employer Service
GPO Box 2252
Canberra ACT 2601

csc.gov.au

+61 2 6275 7000

1300 277 777

I confirm that the information in this form is correct and that the member checked the correct box in . If the
member is ineligible to join PSSap, we hold a copy of the membership details and their chosen fund.
Employer
Contact number
 

Full name of delegate signing
this form:


M M Y Y Y Y
/ /
Fax to us on  as soon as possible. It is very important that we receive all forms to process in a timely manner.



EMAIL employer.service@csc.gov.au
 1300 338 240
FAX (02) 6275 7010
MAIL Employer Service
GPO Box 2252
Canberra ACT 2601
WEB csc.gov.au
EC 13 of 13
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