Important: Please download this PDF to your computer. You can fill it in using Adobe Reader as it may not save if you attempt to fill it in using your web browser.
Published:18 Oct 2021
File type:PDF
File size:116.48 kB
Length:2 pages
Reading level:Medium
What it contains
Fill in this form so your authorised agent can start making superannuation payments into your fund.
You will need to fill in parts 1, 2, 3 and 5, or if nominating a self-managed super fund - parts 1, 2, 4 and 5.
Ensure you sign the consent and declaration. You can digitally sign using an Adobe ID or by inserting a photograph of your signature. Use the 'Fill and sign' function in Adobe Reader to do this.
Return the completed form to your WorkSafe agent.
WorkSafe Victoria
WorkSafe Victoria
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