The information provided in this form 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 relevant 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

Commonwealth Superannuation SchemeABN: 19 415 776 361 RSE: R1004649

Military Superannuation and Benefits SchemeABN: 50 925 523 120 RSE: R1000306

Public Sector Superannuation SchemeABN: 74 172 177 893 RSE: R1004595

Defence Force Retirement and Death Benefits SchemeABN: 39 798 362 763

Public Sector Superannuation SchemeABN: 74 172 177 893 RSE: R1004595

Commonwealth Superannuation Corporation retirement income

Australian Defence Force SuperannuationABN: 90 302 247 344 RSE: R1077063

Important information about this form Use this form if you wish to give a third party the right to access your personal super entitlement information or act on your behalf.

How long is an authority valid?Your authorisation will be valid indefinitely or until you revoke it by advising us verbally or in writing. Alternatively you can supply us with another form and your authorisation details will be updated.

How to use this formPlease use CAPITAL LETTERS and a black or blue pen.Mark boxes like this with a or then fill out the next question or section.

A Authority to release information to a third partyAGS or service number

Scheme CSS PSS Military Super

DFRDB ADF Super

PSSap CSCri ADF Cover

Please note: You should select each scheme this authority applies for.

Title Mr Mrs Ms Miss Other

Your nameGIVEN NAME(S)

SURNAME

Date of birthD D M M Y Y Y Y

/ /

Your postal address

SUBURB STATE POSTCODE

Residential address

SUBURB STATE POSTCODE

AUTH09/19

Third party authority

Section A continued on next page

AUTH 1 of 3

Phone numbersBUSINESS HOURS

MOBILE NUMBER

AFTER HOURS

Please update my contact details

B Personal representativeI authorise the Commonwealth Superannuation Corporation (CSC) or its administrator, Mercer, to release information about my super entitlements to:

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

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)

AUTH 2 of 3

C ConsentSIGNATURE

Date signedD D M M Y Y Y Y

/ /

PrivacyYour privacy is important to us. We are collecting information on this form to administer your super. If you’d like to read CSC’s privacy and security statement, visit csc.gov.au

Sign

D Submit your formWe can accept your completed form by email or post.

by email to:

CSS, PSS, DFRDB, MilitarySuper and ADF Cover please email your form to: formsandapplications@csc.gov.au

PSSap please email your form to: formsandapplications@pssap.com.au

ADF Super please email your form to: formsandapplications@adfsuper.gov.au

CSCri please email your form to: formsandapplications@cscri.com.au

by post to:

CSS, PSS, DFRDB, MilitarySuper and ADF Cover please post your form to: GPO Box 2252, Canberra, ACT 2601

PSSap please post your form to: Locked Bag 9300, Wollongong, NSW 2500

ADF Super please post your form to: Locked Bag 9400, Wollongong DC, NSW 2500

CSCri please post your form to: Locked Bag 8840, Wollongong, NSW 2500

End form

AUTH 3 of 3

http://csc.gov.aumailto:formsandapplications%40csc.gov.au?subject=mailto:formsandapplications%40pssap.com.au?subject=mailto:formsandapplications%40adfsuper.gov.au?subject=mailto:formsandapplications%40cscri.com.au%0D?subject=

to a third party: CSS: OffPSS: OffMilitary: OffDFRDB: OffADF: OffPSSap: OffCSCri: OffADF_2: Offsalutation: Offundefined_3: GIVEN NAMES: undefined_4: SURNAME: D: M: Y: undefined_5: undefined_6: SUBURB: STATE: POSTCODE: undefined_7: undefined_8: SUBURB_2: STATE_2: POSTCODE_2: BUSINESS HOURS: undefined_9: AFTER HOURS: undefined_10: MOBILE NUMBER: undefined_11: Please update my contact details: OffPersonal representative: OffFinancial Advisor: OffPower of Attorney: OffFinancial representative: OffSolicitor: OffAdministrationFinancial: OffAccountanttax adviser: OffPublic Trustee: OffOther please specify: OffTrustee requests must accompany this authority form in order for information: Receivingaccessing: OffActing on my behalf: OffBoth: OffGIVEN NAMES_2: SURNAME_2: D_2: M_2: Y_2: undefined_12: any representative of the organisation: Offonly the named individual: OffOR: undefined_13: SUBURB_3: STATE_3: POSTCODE_3: HOME PHONE: undefined_14: MOBILE NUMBER_2: undefined_15: undefined_16: undefined_17: undefined_18: ABN: D_3: M_3: Y_3: D_4: M_4: Y_4: D_5: M_5: Y_5: