CBA791 011119
GUARANTEED ANNUITIES
LIFESTREAM GUARANTEED INCOME
SUPERANNUATION BENEFIT TRANSFER REQUEST
Issue date: 1 November 2019
Use this form to request another institution to transfer your super money to a Lifestream Guaranteed Income annuity.
USE BLACK OR BLUE PEN AND CAPITAL LETTERS.
You should contact your other super fund/s to find out if there are any fees, charges or other consequences for transferring
your super out of that fund, such as losing any insurance cover. Please note, legislation limits the amount of superannuation
monies that can be used to purchase a Lifestream Guaranteed Income annuity. We recommend you speak to a financial
adviser or Tax Adviser before making a decision to transfer your benefit/s. If you would like more information about
your benefit, simply call us on 1800 624 100 between 8:30 am and 6pm (Sydney time) Monday to Friday. * These fields
are mandatory.
If you know that the address held by your From fund is different to your current residential address, please give details below.
*Residential address (PO Box is not acceptable)
State Postcode
*Family name
*Given name(s)Title
State Postcode
Previous address
Email address
Other names known by (if any)/Previous names *Date of birth *Gender
Male
Female
Tax file number
#
Telephone number
( )
Fund address
*Fund name
From:
*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’
ABN
12 004 021 809
Unique Superannuation Identifier (USI)
12 004 021 809 320
The Colonial Mutual Life Assurance Society Limited
To:
SECTION 1 – PERSONAL DETAILS
SECTION 2 – FUND DETAILS
State Postcode
# You are not obliged to disclose your tax file number, but there
may be tax consequences.
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CBA791 011119
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:
NewBusinessAnnuity@cba.com.au
1300 852 094
*Name (Print in block letters)
*Signature
*Date
/ /
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
to CMLA.
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.
Fund address
*Fund name
From:
*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’
ABN
12 004 021 809
Unique Superannuation Identifier (USI)
12 004 021 809 320
The Colonial Mutual Life Assurance Society Limited
To:
SECTION 2 – FUND DETAILS
State Postcode
SECTION 3 – AUTHORISATION
SECTION 4 – PROOF OF IDENTITY
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