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  • Super member contributions statement for 2012-13 and later financial years

    Instructions and form for super providers and suppliers with no more than 20 members. Only use this version of the Super member contributions statement (NAT 74656) to report member information for the 2012–13 and subsequent financial years.

    You can download this form in Portable Document Format (PDF) – Super members contribution statement for 2012–13 and later financial years (NAT 74656 PDF 404KB).

    See also:

    Instructions

    You can complete this form by hand or online. It's easier to complete it online and print it because you will need two completed and signed copies (one for your records and one to mail to us).

    The statement is made up of the following sections:

    Section A: Supplier details

    Give your details as the person or entity supplying information and completing this statement. You may be:

    • a tax agent, accountant, administrator or other authorised person completing this statement on behalf of the provider
    • the provider themselves, completing the statement on your own behalf.

    1 Tax file number (TFN)

    Provide your TFN.

    2 Australian business number (ABN)

    Provide your ABN.

    3 Tax agent number (TAN)

    Provide your TAN if you are a tax agent reporting the contributions information on behalf of the provider.

    4 Organisation name

    Provide the full name of your organisation.

    5 Street address

    Provide your street address, not a post office box.

    6 Postal address

    Provide your postal address.

    7 Contact person

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

    8 Reference

    Provide a reference that you will find useful in identifying the statement if we need to contact you about the information on this MCS.

    9 Number of member records reported

    Provide the number of members reported. You must report all members each financial year.

    Note:

    • You can only report a maximum of 20 members using this statement.
    Last modified: 16 Jan 2017QC 35483