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AUTH 12/10 Authority to release information to a third party Use this form if you re a PSS member wishing to give a third party the right to access your personal super entitlement information. How long is an authority valid Unless you indicate otherwise your authorisation will be valid for 12 months. What do I have to do Simply complete this authority and fax it to us on 02 6272 9613 or post it to PSS GPO Box 2252 Canberra City ACT 2601 SECTION A Authority to release information to a third party Reference number AGS Your name GIVEN NAME S SURNAME Date of birth D M / Y I authorise the Commonwealth Superannuation Corporation CSC and its administrator ComSuper to release information about my PSS super entitlements to Name of person Name of company or firm Allow access from Your signature to SIGNATURE Date signed Privacy Your privacy is important to us. This means we will give information about your super to the person or persons nominated for up to 12 months. We are collecting information on this form to administer your super. If you d like to read CSC s privacy and security statement visit www. csc*gov*au/privacy. If you d like a benefit estimate just complete a separate Estimate request form* 1 of 1 Your Government Super at Work Any financial product advice in this document is general advice only and has been prepared without taking account of your personal objectives financial situation or needs. Before acting on any such general advice you should consider the appropriateness of the advice having regard to your own objectives financial situation or needs. You may wish to consult a licensed financial advisor. You should obtain a copy of the PSS Product Disclosure Statement and consider its contents before making any decision regarding your super. Commonwealth Superannuation Corporation CSC ABN 48 882 817 243 AFSL 238069 RSEL L0001397 Trustee of the Public Sector Superannuation Scheme PSS ABN 74 172 177 893 RSE R1004595 email tty members pss. gov*au 02 6272 9827 web fax www. pss. gov*au 02 6272 9613 phone post 1300 000 377 overseas callers 61 2 6272 9622. We are collecting information on this form to administer your super. If you d like to read CSC s privacy and security statement visit www. csc*gov*au/privacy. If you d like a benefit estimate just complete a separate Estimate request form* 1 of 1 Your Government Super at Work Any financial product advice in this document is general advice only and has been prepared without taking account of your personal objectives financial situation or needs. csc*gov*au/privacy. If you d like a benefit estimate just complete a separate Estimate request form* 1 of 1 Your Government Super at Work Any financial product advice in this document is general advice only and has been prepared without taking account of your personal objectives financial situation or needs. Before acting on any such general advice you should consider the appropriateness of the advice having regard to your own objectives financial situation or needs.

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