Issued by The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809 AFSL 235035 (CMLA). ‘CommInsure’ is used under licence by CMLA.
No identiﬁcation is required for rollovers where your TFN is validated via the ATO SuperTic service. If your TFN cannot be validated,
no identiﬁcation will be required, so long as your name, date of birth and address details provided on your request corresponds with
the other funds and our records. If there is a discrepancy in your name, date of birth or address, we, or the other fund, may request
that you provide further proof of your identity.
Post eProcess (adviser use only) Fax (adviser use only)
CommInsure Guaranteed Annuities
PO Box 320
Silverwater NSW 2128
Scan and email forms to:
1300 852 094
*Name (Print in block letters)
By signing this request form I am making the following statements:
• I declare I have fully read this form and the information completed is true and correct.
• I am aware I may ask my superannuation provider for information about fees or charges that may apply, or any other information
about the effect this transfer may have on my beneﬁts.
• I consent to my tax ﬁle number being disclosed for the purposes of commencing my account.
• I discharge the superannuation provider of my Super fund of all further liabilities in respect of the beneﬁts paid and transferred
• I request and consent to the transfer of superannuation as described above and authorise the superannuation provider of each fund
to give effect to this transfer.
*Membership or Account number
Australian business number (ABN) Unique Superannuation Identifier (USI)
If you have more than two super accounts to transfer from you will need multiple copies of this form.
If relevant make cheques payable to ‘CMLA Guaranteed Annuities’
12 004 021 809
Unique Superannuation Identifier (USI)
12 004 021 809 320
The Colonial Mutual Life Assurance Society Limited
SECTION 2 – FUND DETAILS
SECTION 3 – AUTHORISATION
SECTION 4 – PROOF OF IDENTITY
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