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.
How to obtain this form
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)
How to complete the statement
You can complete this form by hand or online. We recommend completing it online and printing it because you will need two completed and signed copies ( one for your records and one to mail to us).
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The statement is made up of the following sections:
Section A: Supplier details
Complete this section to 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.
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.
Last modified: 26 Aug 2014QC 35483
If you are using this statement, you may report a maximum of 20 members.
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