Combine my super (rollover) form
Complete this form to arrange the rollover of your super from another fund to your UniSuper account.

Important information
One form is required for each rollover into UniSuper from another previous fund. You can photocopy this form or download another form from www.unisuper.com.au.
You should check whether your other fund will charge you any exit fees. You should also check whether any benefits such as insurance cover might cease once you have combined your super.

Further information
If you need further information or help to complete this form: contact your employer’s Superannuation Officer call us on 1800 331 685, or visit our website at www.unisuper.com.au

Privacy information
UniSuper recognises the importance of protecting your personal information and is committed to complying with its privacy law obligations. For more information on how we collect and manage your information please refer to the Privacy statement at the end of this form.

SECTION 1 — Member details Please use BLACK or BLUE BALL POINT PEN and print in CAPITAL LETTERS. Cross where required
Please note all fields are mandatory apart from your tax file number.
UniSuper member number

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If you are unsure of your member number, refer to your most recent UniSuper correspondence or call us on 1800 331 685

Providing your Tax File Number (TFN)

Title

The Trustee is authorised and required to ask you for your TFN by tax law and in accordance with the
Superannuation Industry (Supervision) Act 1993.

■ Mrs ■ Ms ■ Dr ■ Professor ■

Other

Your TFN will only be used for lawful purposes, which include: finding and combining your superannuation benefits where insufficient information is available; providing information to the Australian
Taxation Office, for example when you receive a benefit, if you are a lost member or have unclaimed benefits; verifying you are the person to whom the super entitlements belong prior to transferring your benefit to another super fund; and providing information to the Trustee of another super fund when your benefits are being transferred, unless you advise us in writing that you do not wish your TFN to be passed on.
It is not an offence not to quote your TFN, however, providing your TFN will have the following advantages (which may not otherwise apply): we will generally be able to accept all types of contributions to your accounts; the tax on contributions to your super accounts will not increase; other than the tax that may ordinarily apply, no additional tax will be deducted when you start drawing down your super benefits; and it will make it much easier to identify you as the person to whom the super benefits belong and to trace different super accounts in your name so that you receive all your super benefits when you retire.

Fund:
Trustee:

Administrator:

Mr

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Given name
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Surname

Date of birth (DDMMYYYY)

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Gender
Male

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Female

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What phone number do you want us to call you on if there is a question we need to ask you regarding this form?*
Contact number (during business hours)

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Email address*

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@ ■■■■■■■■■■■■■■■■
Your tax file number
■■■ – ■■■ – ■■■ being ■ I consent to my TFNfor lostused by UniSuper to search the ATO’s databases or unclaimed benefits in my

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name and any active super accounts (where contributions have been received in the previous two financial years) I do not wish to quote my TFN

* Mandatory

UNISF00003 0314
UniSuper ABN 91 385 943 850
March 2014
UniSuper Limited ABN 54 006 027 121
Level 35, 385 Bourke Street, Melbourne Vic 3000
UniSuper Management Pty Ltd ABN 91 006 961 799 AFSL 235907

ÊF00003À0314DŠ

SECTION 1 — Continued

SECTION 2 — Other fund details Refer to the latest