CSS Estimate Request Form by lindayy

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									 CSS            Commonwealth Superannuation Scheme




                CSS Estimate Request Form
                (Member use only)
Please fill in this form if you will be exiting in the next 12 months and would like a benefit estimate.
AGS number

First name

Surname

Date of birth                        DAY     MONTH           YEAR




Exit date                            DAY     MONTH           YEAR




Exit salary
                                 $
Phone number

Exit type (please tick one)
       Involuntary retirement
               (Retrenchment)
    Resignation and dismissal

                  Age retirement

                            Death

            Invalidity retirement           Sick leave start date                 DAY           MONTH       YEAR




Estimate to be returned by (please tick one)
                            Email           Email address




                              Post          Postal address




                                                                                        STATE           POSTCODE

                               Fax          Fax Number

SIGNATURE                                                                      DATE


                                                                                  DAY           MONTH        YEAR




Privacy
Your privacy is important to us. We are collecting information on this form to administer your super.
If you’d like to read ARIA’s privacy and security statement, visit http://www.aria.gov.au/privacy.shtml.

 Mail:      CSS, PO Box 22, Belconnen ACT 2616    Phone: 1300 000 277                                               ESTI-CSS
 Web:       www.css.gov.au                        Fax:   02 6272 9612                                                  01/10
 Email:     members@css.gov.au                    TTY:   02 6272 9827

								
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