Section B: Provider details

The provider can be:

  • the trustee of a regulated super fund
  • the trustee of an approved deposit fund
  • a retirement savings account provider.

The information you provide in questions 12 to 14 may be supplied to other superannuation funds in a SuperMatch report.

End of attention

Question 7*


Provide your TFN.

Question 8


Provide your ABN.

Question 9*


Provide your full business name.

Question 10

Previous name

Provide your previous business name, if it has changed since you last lodged an LMS.


If your name has changed since the last tax return was lodged with us, show the name that appeared on the assessment.

End of attention

Question 11*

Phone number

Provide the current phone number that a member would call to enquire about their lost super. Include the area code followed by the phone number (for example, 02 1234 5678) or the national phone number (for example, 13 00 00).

Question 12*

Street address

Provide your street address, not a post office box.

Question 13

Postal address

Provide your postal address details.

Question 14

Address for service of notices

Place an X in the applicable box.

Question 15

Your preferred correspondence method

Place an X in the applicable box.


Only complete this question if you have chosen ‘Provider address’ in question 14.

If you chose ‘Email’, you must provide a valid email address at question 16.

End of attention

Question 16*

Contact person

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

Question 17*

Type of superannuation provider

Place an X in the box that best indicates the type of super provider you are. Only one selection can be made.

Last modified: 06 Feb 2015QC 21218