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Deceased member's details

*Required information

First name*

Last name*

Date of birth*

Date of death*

Last known residential address

Member number*

Does the deceased member have more than one account with us?*

Yes

No

Provide additional member number

Are you aware of any other membership from any of the following funds?

VicSuper (now Aware Super)

VicSuper member number

State Plus

Stateplus member number

WA Super

WA Super member number

Not known

Has a death certificate been issued?

Yes

No

Notifier's details

First name*

Last name*

Phone number*

Email address*

Residential address

Postal address - same as residential address

Yes

No

Postal address

Which address do you prefer communication to be sent to?

What is your relationship to the deceased person?*

Are you a Solicitor / Third Party acting on behalf of the Estate or the Executors of the Estate?

Yes

No

Name of organisation/firm

Are there any children of the deceased member?

Yes

No

Unsure

Provide the number of children (regardless of age, includes step-children and adopted children)

Adult children

Minor children

Would you like a Case Manager to contact you by phone?*

Yes

No