Rollover Form

Section 1. Superannuation details

1. Where do you want the amount owing transferred to?

To a nominated super fund (please answer question 2)

To my Self-Managed Super Fund (please answer question 3)

To my MLC Masterkey or MLC Navigator Super Fund (please answer question 4)

2. Please provide details of the super fund receiving the refund. We cannot process your refund if you don’t answer all the questions below. If you’re unsure about the answers, you can ask the super fund you nominated. Remember, refunds can’t be paid directly to you and must be paid directly to your chosen super fund.

*Superannuation member number:

*Unique Superannuation Identifier (USI):

*Superannuation Product Name (This field will display the relevant fund name based on the USI entered)

*Fund address:

*Australian Business Number (ABN):

3. Please provide details of the Self-Managed Super Fund receiving the refund. We cannot process your refund if you don't answer all the questions below. If you're unsure about the answers, you can ask the Self-Managed Super Fund nominated. Remember, refunds can't be paid directly to you and must be paid directly to your chosen Self-Managed Super Fund.

*SMSF Fund Name

*BSB number:

*Account number:

*Electronic Service Address (ESA):(For more information about what is an ESA, please speak to your SMSF fund manager or visit ato.gov.au for more information)

*Australian Business Number (ABN):

4. Please provide details of your nominated MLC Superannuation Account. We cannot process your refund if you do not complete all required fields outlined below. If you are unsure about the answers, you can ask your nominated fund.

*MLC Product Name (Please select your nominated MLC Super Fund from the list. If your product type is not in this list, please review your fund information.)

*Were your insurance premiums paid to MLC Life Insurance from your Navigator / Wrap Account? (MLC Masterkey Account holders, please select Yes)

*MLC Member Number