Section D: Member details


If multiple members need to be reported, you must complete sections D, E and F for each member.

Three member details, member account details and employer details sections have been included with this LMS. If you require more copies of sections D, E and F, contact us or visit our website.

End of attention

Question 26*

Provider’s TFN

Provide your TFN.

Question 27*

Member’s TFN

Provide your member’s TFN. If you do not know your member’s

TFN, complete this question by writing ‘000 000 000’.

Question 28


Provide your member’s full name.

Question 29

Previous name

If your member’s name has changed, provide details of their previous name and the date that your records show the member changed part or all of their name.

Question 30


Provide your member’s residential address.

Question 31

Previous address

If your member has changed their residential address, provide details of the previous address and the date that your records show that their address changed.

Question 32*


Place an X in the applicable box.

Question 33*

Date of birth

Provide your member’s date of birth. This should be in the format DD/MM /YYYY.


If only a year of birth is known (for example 1956) report the date of birth in the format 00/00/1956.

End of attention

Question 34*

Has the date of birth been deemed?

Place an X in the applicable box.

Last modified: 06 Feb 2015QC 21218