Fillable SPC-PSSap-Application-for-issue-of-invalidity-retirement-certificate PSSap Application for issue of invalidity retirement certificate

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SPC-PSSap-Application-for-issue-of-invalidity-retirement-certificate PSSap Application for issue of invalidity retirement certificate

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The SPC-PSSap-Application-for-issue-of-invalidity-retirement-certificate PSSap Application for issue of invalidity retirement certificate form is 3 pages long and contains:

  • 0 signatures
  • 7 check-boxes
  • 53 other fields

Country of origin: AUSTRALIA
File type: PDF

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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
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
PSSap Applicaon for issue of
invalidity rerement cercate
SPC-PSSap
11/18
FOR
EMPLOYER
USE
A
Member’s details
PSSap member number
Title
Mr Mrs Ms Miss Other
Surname
Given name(s)
Date of birth
We cannot issue an invalidity
retirement certificate to
PSSap customers over age 60
D D M M Y Y Y Y
/ /
Address
SUBURB STATE POSTCODE
Phone
BUSINESS HOURS AFTER HOURS
MOBILE NUMBER
All sections to be completed by Employer.
We’re committed to protecting your privacy. We collect your personal information for the purposes of providing
superannuation services to you, improving our products and keeping you informed. We will only share your personal
information where necessary for providing superannuation services to you. This may include disclosing your personal
information to our scheme administrator, service providers or government or regulatory bodies. Your personal information
may be accessed overseas by our service providers. Please see our privacy policy for full details. Your personal information
will not be otherwise used or disclosed unless required or permitted under law. A full copy of our privacy policy as well as
the privacy complaint process is available at csc.gov.au/privacy/
Your privacy is important to us
1 of 3
Email
@
B
Employer’s details
Employer’s name
Employer’s address
SUBURB STATE POSTCODE
Case manager surname
Case manager given name(s)
Email
@
Payroll officer
C
Employment and superannuation details
Date on which
employment started
D D M M Y Y Y Y
/ /
Date member started leave
for a continuous period
because of a serious
medical condition
D D M M Y Y Y Y
/ /
Is member in receipt of
compensation benefits
in respect of the
current condition?
Yes No
Has member applied for
compensation benefits?
Yes No
2 of 3
Email
CSS and PSS: employer.service@admin.csc.gov.au
PSSap: employers@pssap.com.au
Phone
CSS and PSS: 1300 338 240
PSSap: 1300 308 806
Fax
CSS and PSS: (02) 6272 9996
PSSap: 1300 364 144
Web
eac.csc.gov.au
Fax
(02) 6272 9613
Email
employer.service@csc.gov.au
Phone
1300 338 240
Post
PSSap
Locked Bag 9300
Wollongong NSW 2500
Web
csc.gov.au
Overseas Callers
+61 2 4298 6030
End Form
D
Checklist of attachments to this form
Sick leave records
Duty statement
Reports from at least two registered medical practitioners dated within the last 12 months
Employee’s resume
Any other medical reports or documentation, such as rehabilitation reports, graduated return to work programs, etc
Documents related to compensable conditions (e.g. Comcare decisions or medical reports)
E
Declaration by case manager
I certify that the above information is correct and that the member has been provided with information about
invalidity retirement.
SIGNATURE
Date signed
D D M M Y Y Y Y
/ /
Send this completed application form with the documents listed in Section D to claims@pssap.com.au
Sign
Where can I get more information?
EMAIL employer.service@csc.gov.au
PHONE 1300 338 240
MAIL PSSap
Locked Bag 9300
Wollongong NSW 2500
WEB csc.gov.au
3 of 3
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SPC-PSSap-Application-for-issue-of-invalidity-retirement-certificate PSSap Application for issue of invalidity retirement certificate

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Completed 3 July 2020

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