Rollouts or Member Balance Requests

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Fund Name*
PLEASE NOTE: We can only complete this request for funds we are the administrator for.
Member Name*
Request:
- Rollover Benefit Statement (rollout)
- Member Statement
Date the Rollover Benefit Statement or Member Statement is required*

Day
Month
Year
Do you require a Centrelink Schedule as at this date also?*
- Yes
- No
Receiving Fund Name*
Receiving Fund ABN*
Receiving Fund SPIN/USI*
Member Number in receiving Fund*
Receiving Fund postal address*
Full or Partial Rollover*
- Full account balance
- Partial account balance
If partial, please provide amount to be rolled over:*
Is this member ceasing as member and Trustee/ Director for the fund?*
- Yes
- No
There may be additional costs if a Change of Trustee is required.

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