Fillable and unclaimed super Searching for lost OFFICE USE (Australian Taxation Office)

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and unclaimed super Searching for lost OFFICE USE (Australian Taxation Office)

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Country of origin: AUSTRALIA
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Page 1
Sensitive (when completed)
NAT 2476-03.2017
Searching for lost
and unclaimed super
WHEN COMPLETING THIS FORM
You can complete this form electronically or with a pen. If you
choose to use a pen:
■ print clearly in BLOCK LETTERS using a black or dark blue
pen only
■ place X in all applicable boxes
■ do not use correction fluid or covering stickers
■ do not use pins or staples to attach additional details.
7 Email address (if applicable)
6 Daytime phone number
5 Current postal address
Section B: Your contact details
OFFICE USE ONLY
LMR reference number
Enquiry number
Form keyed by:
Name (please print)
Day Month Year
Date
USM reference number
2 Name
Day Month Year
3 Date of birth
Section A: Your personal details
1 Taxlenumber(TFN)
You do not have to provide us with your TFN but doing so will help us process your enquiry.
The ATO is a government agency bound by the Privacy Act 1988 in terms of collection and handling ofpersonal
information and tax file numbers (TFNs). For further information about privacy law notices pleasegotoato.gov.au/privacy
YesNo
4 Residency
Are you, or were you ever a temporary resident visa holder?
Title: Mr Mrs Miss Ms Other
Family name
First given name Other given name
Suburb/town/locality
State/territory
(Australia only)
Country if outside Australia
Postcode
(Australia only)
Street number and name
Page 2
Sensitive (when completed)
8 Super fund details Provide details of any super fund where contributions may have been made on your behalf.
Superannuation fund name Beneciaries Period of contributionsAccount number
Section C: Your super fund details
Address State Postcode Period of residence
10 Previous address details Provide details of all previous addresses you lived at in Australia.
11 Previous employment details Provide details of all your previous employers.
Employer name Occupation Period of employmentEmployer address
9 Previous name details Provide details of all previous names and any names you are commonly known by.
Family name Given name Other given names Date of change
Section D: Your previous details
If you have additional information for the following questions, attach it to this form. If you can't provide responses to any of
these questions we will still search for your lost and unclaimed super.
Signature
Date
Day Month Year
12 Declaration Either you or a person authorised to act on your behalf must complete this declaration.
I declare that the information given on this form is complete and correct.
Name of signatory
Section E: Declaration
After completing this form
After completing this form send it to us at:
Australian Taxation Office
PO Box 3578
ALBURY NSW 2640
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and unclaimed super Searching for lost OFFICE USE (Australian Taxation Office)

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Completed 7 January 2022

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