Equity Trustees Superannuation Limited ABN 50 055 641 757 AFSL 229757 (ETSL)
The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809 AFSL 235035 (CMLA)
Additional Contribution Form
You may lodge this form by posting to:
Commonwealth Financial Services
GPO Box 3306
Sydney NSW 2001
You can also email a scanned copy to email@example.com
Please note: Contributions will be made effective the date your completed documentation is received at our principal
ofﬁce of administration.
If you would like further information about this form, simply call our Customer Contact Centre on 13 2015 between
8:30am and 6pm (Sydney time), Monday to Friday.
Section 1 – Personal (to be completed in all cases together with Section 5)
SuperSelect Account number
Given name(s) Surname
Evening telephone Mobile number
Title Mr Mrs Miss
Section 3 – Additional contribution type (minimum $100)
Please attach Rollover Benefit Statement
Section 2 – Eligibility to contribute – complete this if you are aged 67 or above
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
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‘Commonwealth Financial Services’ is used under licence by CMLA.