How do you complete this statement?


You must complete all questions with an ‘*’ as these are mandatory questions.

End of attention

Section A: Supplier details

Complete this section if you are the supplier of the lost member information and are authorised to act on behalf of the super provider – for example, you are:

  • a tax agent
  • an accountant
  • a super administrator.

If you are the provider and you are reporting the LMS details, you must complete this section and section B.

End of attention

Question 1*

Supplier Number

Provide either your:

  • Australian business number (ABN)
  • tax file number (TFN)
  • tax agent number (TAN).

Question 2*

Organisation name

Provide the full name of your organisation.

Question 3*

Street address

Provide your street address, not a post office box.

Question 4

Postal address

Provide your postal address details. This will be used for the service of notices.

Question 5*

Contact person

Provide details of the person who may be contacted if we have any questions about the information in this statement.

Question 6


Provide a reference that may be useful to help you identify this LMS if we need to contact you about information in it.

Last modified: 06 Feb 2015QC 21218