Any financial product advice in this document is general advice only and has been prepared without taking account of your personal objectives, financial situation or needs. Before acting on any such general advice, you should consider the appropriateness of the advice, having regard to your own objectives, financial situation and needs. You may wish to consult a licensed financial advisor. You should obtain a copy of the PSSap Product Disclosure Statement (PDS) and consider its contents before making any decision regarding your super.Commonwealth Superannuation Corporation (CSC) ABN: 48 882 817 243 AFSL: 238069 RSEL: L0001397 Trustee of the Public Sector Superannuation accumulation plan (PSSap) ABN: 65 127 917 725 RSE: R1004601

Join PSSap as an Ancillary member

Did you know – you can invest your

retirement amounts in PSSap even if you have exceeded your transfer

balance cap and/or if you have not met your preservation age

For PSS and CSS membersBefore making any decisions you should read the PSSap Financial Services Guide (FSG), PSSap Product Disclosure Statement (PDS) and the PSSap Target Market Determination issued by Commonwealth Superannuation Corporation (CSC). These documents are available to view and download at csc.gov.au

Why join PSSap Ancillary:PSSap Ancillary allows you to stay with CSC for all your superannuation needs:• Grow your super with additional contributions or salary sacrifice• Access four investment options for your transfer amounts• Access lifePLUS cover for your additional insurance needs

(subject to eligibility)• Invest money at retirement in a superannuation environment

Eligibility for PSSap Ancillary To join PSSap as an Ancillary member you must have been employed by an eligible employer for a minimum of 12 continuous months, and:• be a Contributing or Preserved PSS or CSS member, or• had been a Contributing PSS or CSS member at any time on or

after 7 March 2021.

Note: former PSS/CSS members in receipt of a pension are not classed as preserved members and are ineligible for PSSap Ancillary membership unless they were a Contributing member at any time on or after 7 March 2021.

PSSap Ancillary membership will be in addition to your CSS or PSS membership.

Here to help

Call us on 1300 725 171 if you have questions

PSSapF1711/21

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A Your personal detailsCSC Scheme PSS CSS

AGS number/s

Salutation Mr Mrs Ms Miss Other

Surname

Given name(s)

Date of birthD D M M Y Y Y Y

/ /

Residential address

SUBURB STATE POSTCODE

Postal address

SUBURB STATE POSTCODE

PhoneBUSINESS HOURS AFTER HOURS

MOBILE NUMBER

Email

@

Communication preference Post EmailBy nominating email you agree to receive the following via email:• notification of the availability of secure information (including your

Member Statement) electronically via PSSap Member Services Online at csc.gov.au

• information about products and servicesand• notification to participate in member research

In addition to the PSSap PDS and the PSSap FSG, you can view and download notices of significant changes and events relating to PSSap at csc.gov.au

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B Choose your investment option ormix of optionsNote: you must choose one or a mix of up to four investment options to invest your contributions. You must make a choice because there is no default option.

Please invest my contributions, and any other amounts, in the following option or mix of options:

Cash %Income Focused %Balanced %Aggressive %

TOTAL 1 0 0 %

Note: you can change your investment options at any time using your secure PSSap Member Online account or by sending us your completed Investment Choice form available at csc.gov.au. A fee may apply. For more information, please refer to the PSSap PDS which is available at csc.gov.au

C Provide your Tax File NumberUnder the Superannuation Industry (Supervision) Act 1993, CSC is authorised to collect, use and disclose your tax file number. We may disclose your tax file number to another superannuation provider when your benefits are being transferred, unless you request to us in writing that your tax file number not be disclosed to any other superannuation provider. Declining to quote your tax file number is not an offence, however giving your tax file number to us will have the following advantages: • we will be able to accept all permitted types of contributions to your account/s;• other than the tax that may ordinarily apply, you will not pay more tax than you need to – this affects

both contributions to your superannuation and benefit payments when you start drawing down your superannuation benefits; and

• it will make it much easier to find different superannuation accounts in your name so that youreceive all your superannuation benefits when you retire.

Tax File Number

D Nominate a third partyI nominate the following financial planner/third party representative(s) to enquire on my behalf in respect of my PSSap Ancillary member account:

Representative Personal representative Financial representative

Relationship Financial Advisor Solicitor Accountant/tax adviser

Power of Attorney Administration/Financial Management Order

Public Trustee

Note: Powers of Attorney, Administration or Financial Management Order or Public Trustee requests must accompany this authority form in order for information to be released.

Other (please specify)

For the purposes of Receiving/accessing information only

Acting on my behalf Both

NameGIVEN NAME(S)

SURNAME

Important:Make sureyou usewhole numbers

Section D continued on next page

Ensure your total percentage

equals 100% and your selection is in whole

percentages only.

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Date of birthD D M M Y Y Y Y

/ /

Organisation (if applicable)

You authorise access to your account details to

any representative of the organisation OR only the named individual

Postal address

SUBURB STATE POSTCODE

PhoneHOME PHONE MOBILE NUMBER

Email address

@

Financial Services Licence Number (Financial representative)

ABN

Allow access fromD D M M Y Y Y Y D D M M Y Y Y Y

/ / to / /

(only specify an end date if applicable)

Company name (if applicable)

If you wish to nominate more than one third party authority, please provide their details on a separate sheet and enclose it with your completed application form.

Name of representative

Date of birthD D M M Y Y Y Y

/ /

Email

@

PhoneBUSINESS HOURS AFTER HOURS

MOBILE NUMBER

Postal address

SUBURB STATE POSTCODE

PrivacyWe’re committed to protecting your privacy. We collect your personal information for the purposes of providing superannuation services to you, improve our products and to keep you informed. We will only share your personal information where necessary for providing superannuation services to you. This may include disclosing your personal information to our scheme administrator, service providers or government or regulatory bodies. Your personal information may be accessed overseas by our service providers. Please see our privacy policy for full details. Your personal information will not be otherwise used or disclosed unless required or permitted under law. A full copy of our privacy policy as well as the privacy complaint process is available at csc.gov.au/Members/Privacy-privacy/

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Emailmembers@pssap.com.au

Phone1300 725 171

Financial Advice1300 277 777

PostPSSapLocked Bag 9300 Wollongong NSW 2500Web

csc.gov.auOverseas Callers+61 2 4209 5403

Fax1300 364 144

E DeclarationI declare that: • the information shown on this application is true and correct • I have read the PSSap PDS, PSSap FSG, and CSC Privacy Policy, and this application is made subject to

the terms and conditions of that information • I have read the PSSap Target Market Determination so I understand the class of customers for

which this product has been designed, taking into account the objectives, financial situation and needs of the target market.

• I am applying to become a Public Sector Superannuation accumulation plan (PSSap) Ancillary Member (in addition to my CSS or PSS membership) and if accepted as a member, I agree to be bound by the Trust Deed that governs the Fund

• I understand and accept that no party associated with PSSap guarantees the performance of the investment options in PSSap

• I understand that the investment option or mix of options I have selected will remain in place until I make a subsequent investment choice and it is processed

• I authorise the third party listed in Section F (if completed) to make enquiries about my PSSap account

• I understand my account will be closed if no monies are received within the first 60 days • I acknowledge Commonwealth Superannuation Corporation has recommended that I obtain

financial advice.

Your name FULL NAME

SIGNATUREDate signed

D D M M Y Y Y Y

/ /

Please send this form by email to members@pssap.com.au or post toPSSapLocked Bag 9300Wollongong NSW 2500

What next?Once we have established your PSSap account, we will email or post to you a welcome letter advising of your membership number and instructions to set up your online account. You can then:• Provide your membership number to your employer to make contributions • Use our online Super Finder tool to search for and consolidate amounts held with other funds

(excluding your PSS and CSS amounts)• Make additional contributions via BPay including spouse or personal contributions• Apply for lifePLUS cover using our online lifeAPP tool (or use the Application and Variation

form at csc.gov.au)• Complete a beneficiary nomination form available at csc.gov.au

Sign

How do I get more information?EMAIL members@pssap.com.au PHONE 1300 725 171 FAX 1300 364 144 MAIL PSSap Locked Bag 9300 Wollongong NSW 2500 WEB csc.gov.au

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