Application to transfer to another division
within AustralianSuper
How to apply
Use this form if you’re an existing member of AustralianSuper and you wish to transfer your super account to
AustralianSuper plan or Personal Plan.
If you have insurance cover1, you must transfer the whole amount of your existing cover. Your cover will have the same
conditions and exclusions that applied previously and it may be limited cover. See the Insurance in your super guide for more
details. Download a copy at australiansuper.com/InsuranceGuide
Please see the Product Disclosure Statement (PDS) for more information about the division you’re transferring to. You can find
the relevant PDS at australiansuper.com/PDS Please refer to the Target Market Determinations (TMDs) to ensure your new
division is right for you. A TMD is a document that outlines the target market a product has been designed for. Find the TMDs
at australiansuper.com/TMD
Don't use this form if you're a member of AustralianSuper Select, or want to transfer your super account to
AustralianSuper Select. Contact us for the relevant form on 1300 300 273.
Please complete in pen using CAPITAL letters. Print (✗) to mark boxes where applicable. Read the Privacy Collection
Statement on page 2 of this form to see how AustralianSuper uses your personal information.
1 Your personal details
Last name Mr Mrs Ms Miss Dr
X X X X X
First name/s
Date of birth Member number Male Female
D D M M Y Y Y Y X X
Street address
Suburb State Postcode
Telephone (business hours) Telephone (after hours) Mobile
2 Your new division
Your super account and any existing insurance cover you have will be moved to your new division (if eligible). Your insurance
cover amount(s) and the cost of your cover will stay the same. Your Income Protection waiting period and benefit payment
period will remain unchanged (if applicable).
Print (✗) next to the division you wish to transfer to:
X AustralianSuper plan X Personal Plan
Don't have insurance cover?
If you don't have insurance cover, you won't automatically get cover when you transfer to another division
using this form. Learn more about insurance and how to apply for it in the Insurance in your super guide at
australiansuper.com/InsuranceGuide
1
AustralianSuper insurance is provided by TAL Life Limited (the Insurer), ABN 70 050 109 450, AFSL 237848.
Issued by AustralianSuper Pty Ltd ABN 94 006 457 987 AFSL 233788 Trustee of AustralianSuper ABN 65 714 394 898.
A Target Market Determination (TMD) is a document that outlines the target market a product has been designed for.
Find the TMDs at australiansuper.com/tmd 21373 09/24 page 1 of 2
3 Declaration and acknowledgement
This section must be completed in all circumstances.
I declare that:
• I’ve read and understood the Product Disclosure Statement at australiansuper.com/pds and the Insurance in your super
guide at australiansuper.com/InsuranceGuide for the division I’m transferring to and understand that the additional
information referred to in the guide is also part of the Product Disclosure Statement.
• I’ve read the Privacy Collection Statement below and I understand how AustralianSuper will use my personal information.
I acknowledge that:
• My eligibility to claim for benefits will be determined in line with AustralianSuper’s insurance policy terms and conditions.
• Insurance cover will only be provided in line with the insurance policy terms and conditions as agreed between
AustralianSuper and the Insurer. Those terms and conditions may change from time to time and AustralianSuper will notify
me of those changes where required by law.
• If I don’t fully complete, sign and date this application, I won’t be eligible to transfer my existing cover to a different division
within AustralianSuper.
• My existing cover and any election to keep or extend cover (as at the transfer date) will continue in my new division.
• If I have active cover, my cover will transfer to my new division.
• If I’m transferring to Personal Plan, and my basic cover in AustralianSuper plan hasn’t started yet, I won’t receive basic cover
in Personal Plan.
• If accepted, all my cover will be subject to the terms and conditions of AustralianSuper’s insurance arrangements within my
new division.
• If my cover under the former division is subject to any exclusions, including but not limited to pre-existing condition
exclusions or restrictions, these special conditions will be transferred with my cover to the new division.
• For cover that's been accepted by the Insurer, AustralianSuper will confirm when it will start (if applicable).
• A photocopy of this authorisation is as valid as the original.
Sign here
Date
D D M M Y Y Y Y
Print full name
A summary of AustralianSuper’s Privacy Collection Statement is below. Our Privacy Collection Statement and
Privacy Policy may change from time to time. The latest versions will be available online at
australiansuper.com/CollectionStatement and australiansuper.com/privacy-policy
For information on the Insurer’s privacy and information handling practices, read their Privacy Policy Statement
at tal.com.au or call 1300 302 961 for a copy.
Privacy Collection Statement
AustralianSuper Pty Ltd (ABN 94 006 457 987) of GPO Box 1901, Melbourne, Victoria 3001, collects your personal information (PI), including
health information (if applicable) to assess, administer, manage and keep you updated on your insurance cover application or insurance claim
and improve our products and services. If we can't collect your PI we may not be able to provide these services. PI is collected from you but
sometimes from third parties like your employer. Health information is collected (if applicable) from you or your employer, adviser, other insurer
or reinsurer, or other representative authorised by you and is provided to us, our administrator or to our insurers. If required, we or the Insurer
will obtain independent medical reports directly from your medical practitioner(s). We will only share your PI where necessary to perform the
above listed activities with the Insurer (TAL Life Limited ABN 70 050 109 450, AFSL 237848) or other relevant insurer for certain insurance
claims, our administrator (Australian Administration Services Pty Ltd, being a part of MUFG Pension & Market Services Holdings Ltd), service
providers, as required by law or court/tribunal order, or with your permission. Our Privacy Policy details how to access and change your PI, as
well as the privacy complaints process. For complete details go to australiansuper.com/privacy-policy or call us on 1300 300 273.
Please upload a scanned copy of your completed form to us
via our website at australiansuper.com/email
or post it to AustralianSuper, GPO Box 1901, MELBOURNE VIC 3001
Questions? Call 1300 300 273 or visit australiansuper.com 21373 09/24 page 2 of 2
