• How do you complete this statement?

    Attention

    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.
    Attention

    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

    Reference

    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