Employer contributions

and remittance advice

This form should
be completed by 1. Employer details
employers who wish
to make contributions Employer name
to First State Super on
behalf of employees.
If further space is required Employer code ABN
for your contribution
details, attach additional
copies of the page
overleaf. Alternatively, First contact name Daytime contact number
attach your own payroll
system report.
Please use a dark pen Address
and CAPITAL letters.
Insert (✗) when you have
to choose an option.

Unique Superannuation Suburb State Postcode

Identifier (USI)
53 226 460 365 001
Postal address (If different from street address)
MySuper Authorisation
Number
53 226 460 365 073
Suburb State Postcode

Email

Return the completed Second contact name Daytime contact number

form to:
First State Super
PO Box 1229 Email
WOLLONGONG
NSW 2500.
For more information
and to make online
enquiries visit 2. Payment details
firststatesuper.com.au
or call us on
1300 650 873 Total amount of contributions* Contribution period ended (DD-MM-YYYY)
Monday to Friday
$
8.30am to 6.00pm , , .
AEST. * must equal Total contributions payable as shown in Section 3. Member contribution details overleaf

Payment method
You have a choice
of four payment
options. Place ✗
next to the option
you wish to use and
fill in the payment
details.
EFT Account name: First State Super – Application account Date deposited (DD-MM-YYYY)
BSB No: 062000 Account number: 1022 6245
Payment reference: your employer code
Date deposited (DD-MM-YYYY)
Direct
deposit Deposit no.
Account name: First State Super – Application account
BSB No: 062000 Account number: 1022 6245
Payment reference: your employer code

BPAY® Your Biller Code and Reference Number are available Date transferred (DD-MM-YYYY)
by sending an email to employers@firststatesuper.com.au
or calling us on 1300 650 873.
Payment reference: your employer code
Cheque dated (DD-MM-YYYY)
Cheque Cheque no.
Write your employer code on the back of your cheque.

page 1 of 2
FSS Trustee Corporation (Trustee) ABN 11 118 202 672 AFSL 293340 First State Superannuation Scheme (Fund) ABN 53 226 460 365 E FSS023  05/16
 3. Member contribution details
Employer Optional employee Optional employer
Super guarantee additional contribution (OEE) contribution (OER)
Member number Member full name Date of birth TFN* (SG) contributions contributions (after tax) (before tax)

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

Total contributions payable (must equal ‘Total amount of contributions' shown in section 2. Payment details) $ $ $ $

* Tax file number is only required the first time you complete this form. When a new employee provides their tax file number (TFN) on the Tax file number declaration (NAT 3092) form it is also deemed to have been provided
for superannuation purposes. If you don’t pass on your employee’s TFN, they may pay extra tax on contributions and may not be able to make some types of contributions.

page 2 of 2
Return the completed form to First State Super, PO Box 1229 WOLLONGONG NSW 2500. E FSS023  05/16
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