Instructions

This form should be completed by a superannuation fund or retirement savings account provider when claiming:

• super co-contribution entitlements for an individual using the contributions reference number
• individual account balances held in the superannuation holding accounts (SHA) special account
• superannuation guarantee (SG) for an individual using the reference number
• low income superannuation contribution (LISC)

This form may be used to claim the account balances of more than one member or account holder.

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