Superannuation Savings Account
Eligibility to Contribute
Section 1 – Personal details
Title Mr
Mrs Miss
Account number
Given name(s) Surname
Postal address
State Postcode
Daytime telephone Mobile number
Evening telephone Email address
Date of birth
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 132015 between 8.30am and
6.00pm (Sydney time), Monday to Friday.
Post to
Superannuation Savings Account
GPO Box 3306
Sydney NSW 2001
Section 2 – Eligibility to contribute
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
Member Signature
Emailing a scanned copy to
Page 1 of 1003-462 010720 (CIL1472)
( )
( )