Section B: Provider information

This section asks for details about the super provider.

A super provider can be any of the following:

  • a super fund
  • an approved deposit fund
  • a retirement savings account provider
  • a life insurance company.

Question 10

Provide the provider’s TFN. This must be the same provider TFN as shown on the assessment.

Question 11

Provide the provider’s ABN.

Question 12

Provide the date the statement was completed.

Question 13
Contact person

Provide the details of a contact person from super provider who we may contact regarding the information in this statement.


The provider contact can be the same person as the supplier contact in section A.

End of attention
Last modified: 05 Jul 2014QC 37248