How to complete this statement

Section A: Supplier details

Complete this section if you are the supplier of the information and authorised to act on behalf of the super provider – for example, if you are:

  • a tax agent
  • an accountant
  • a super administrator
  • the provider, including  
    • a super fund
    • an approved deposit fund
    • a retirement savings account provider. 

Find Out More

If you are the provider and don't have a separate supplier to provide details on your behalf, you must complete section A and B, even if the details are the same.

Question 1
Australian business number (ABN)  

Provide your ABN.

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.

If this is the same as the street address, write ‘as above’.

Question 5
Contact details  

Provide the name, phone number and email for the nominated supplier contact person who may be contacted on behalf of the provider if we have any questions about the information in this USM statement.

Question 6
Your reference  

Provide a reference that you will find useful in identifying this USM statement if we need to contact you about information supplied in it.

Last modified: 21 Oct 2016QC 21679