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I would like to salary package

my super - additional information

Things to know
Under the Superannuation Legislation Amendment (Stronger Super) Act 2012, Maxxia is required to provide your Tax File Number
(TFN) and your super fund’s Unique Superannuation Identifier (USI) or an Electronic Service Address (ESA) should you have a self
managed superannuation fund, when making payments to your superannuation account, so that your account can be identified.
This means that if you wish to salary package additional superannuation, you need to provide us with this information to ensure
there is no interruption to your superannuation payments. Not providing this information will mean we are unable to continue
making payments to your superannuation account.
Please complete this form and submit if you wish to continue salary packaging additional superannuation.

1 My details

Full name

Tax File Number Payroll ID

Email Contact number

Address

2 My superannuation details

Please contact your superannuation fund if you are unsure of any of these details. Your superannuation fund may
CHECKPOINT have either a USI or an ESA - you need to complete at least one of these fields.

Name of superannuation fund

Superannuation fund ABN Policy/member number

Unique Superannuation Identifier (USI)

Electronic Service Address (ESA)


for Self Managed Super Funds only

Payment frequency and amount o Weekly o Fortnightly o Quarterly o Other


Please choose one option $ $ $ $

Please complete the details below if you have a self managed super fund.

Super fund BSB Super fund account number

Sign here Date / /

3 How to submit this form


MAXMKG_SP_PackageSuperAdditionalInfo_0117

Please submit your completed form by post to Maxxia, Locked Bag 18, Collins Street East, Melbourne, Victoria 8003

Privacy statement: Maxxia is committed to protecting the privacy and rights of its customers. Our Privacy Policy contains important information about how we collect, hold, use
and disclose personal information. It explains what happens if we cannot collect your personal information, as well as how you can access and correct the personal information
we hold about you or make a complaint. If you do not wish to receive promotional material from us, or would like a copy of our Privacy Policy, please contact us on 1300 123 123.
Important information: This general information doesn’t take your personal circumstances into account. Please consider whether this information is right for you before making
a decision and seek professional independent tax or financial advice. Conditions and fees apply, along with credit assessment criteria for lease and loan products. The availability
of benefits is subject to your employer’s approval. Maxxia may receive commissions in connection with its services.
Maxxia Pty Ltd | ABN 39 082 449 036 | Authorised Representative (278683) of McMillan Shakespeare Limited (AFSL 299054), Reliance Insurance Brokers Pty Ltd (AFSL 345986)
issuer of lease protection and gap cover, Swann Insurance (Aust) Pty Ltd (AFSL 238292), Allianz Australia Insurance Limited (AFSL 234708) ABN 15 000 122 850 issuer of
comprehensive insurance, and AVEA Insurance Limited (AFSL 238279) issuer of extended warranty insurance. Read the product disclosure statement available from us or the
product issuer before making a decision about insurance.
Maxxia Pty Ltd ABN 39 082 449 036 Authorised Representative (No. 278683) of McMillan Shakespeare Limited (AFSL No. 299054) Page 1
Phone 1300 123 123 | Email info@maxxia.com.au | Fax 1300 733 444