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OFFICIAL: Sensitive (when completed)
ABN
Business name
6 Your details
Signature
Day Month Year
Date
Section B: Employer to complete
You must complete this section before giving the form to an employee who is eligible to choose the super fund into which you
pay their super contributions.
7 Your nominated super fund
If an employee does not choose their own super fund, and the ATO has advised the employee does not have a stapled super
fund (for new employees from 1 November 2021), you can meet your SG obligations by paying super guarantee contributions
on their behalf to the fund you have nominated below or another fund that meets the choice requirements:
Sign and date the form when you give it to your employee.
Section C: Employer to complete
8 Record of choice acceptance
In the two months after you receive the form from an existing employee you can continue to make super contributions to their
current fund or you can contribute to the new fund the employee nominated. After the two‑month period you must make
payments to the new fund chosen by the employee.
For new employees commencing employment from 1 November 2021, within the two month period, super contributions
should be made to the employee’s chosen fund or the stapled super fund if the employee has not made a choice . You can
only make contributions to your nominated fund if the ATO advises you the employee does not have a stapled super fund.
Super fund website address
Phone (for the product disclosure statement for this fund)
Super fund name
Unique superannuation identifier (USI)
PRIVACY STATEMENT
The ATO does not collect this information; we provide this form as a means for employees to identify and provide necessary
information to their employer. An employer is authorised to collect an employee’s TFN under the Superannuation Industry
(Supervision) Act 1993. It is not an offence for an employee not to quote their TFN. However, quoting a TFN reduces the risk
ofadministrative errors and if the employee does not quote their TFN their contributions may be taxed at a higher rate.
An employee can get more details regarding their privacy rights by contacting their superannuation fund.
Date you act on your
employee’s choice
Day Month Year
Date employee’s choice
isreceived
Day Month Year
Employers must keep the completed form for their own record for five years. Do not send it to the Australian
Taxation Office, the employer’s nominated fund or the employee’s nominated fund.
If you don’t meet your obligations, including paying your employee superannuation guarantee contributions to the
correct fund, you may face penalties.
Complete this section when your employee returns the form to you with section A completed.