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CONSOLIDATE YOUR SUPER INTO RAIZ INVEST SUPER

Phone: 1300 754 748

Instructions: Please complete this form on your device and save a copy. Please send the saved copy to support@raizinvest.com.au

Member number

Personal email address Mobile phone number*

Street Address/PO Box*

Street

First name* Middle nameTitle

Date of birth (DD/MM/YYYY)* Gender*Last name*

1. PERSONAL DETAILS

2. PREVIOUS DETAILS

If yes, please provide name

Have you ever been known by another name? Yes No

If yes, please provide your previous address

Have you recently changed address and not updated your other super fund? Yes No

If the details you have provided do not match the records of your other fund there may be delays in combining your super.

Home phone numberSuburb/Town* State* Postcode*

State* Postcode*

Suburb/Town

Member Number Unique Superannuation Identifier Fund Name

3. SUPER FUND DETAILS

Transfer Whole Balance? Yes If No, Partial Amount of $No

Member Number Unique Superannuation Identifier Fund Name

Transfer Whole Balance? Yes If No, Partial Amount of $No

Member Number Unique Superannuation Identifier Fund Name

Transfer Whole Balance? Yes If No, Partial Amount of $No

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Diversa Trustees LimitedABN: 49 006 421 638, AFSL No: 235153, RSE License No: L0000635

Important information

Instructions – Fully complete all sections and return this form to the above address• Please ensure all sections are fully completed.• You may have insurance cover as part of your other super fund. If you transfer your entire balance to RAIZ Invest Super your other fund will

close and your cover there will likely cease.• If your employer has previously paid contributions to your other fund please ensure you update them with details of your RAIZ Invest Super.• When you email your completed form to support@raizinvest.com.au please ensure this is from the email address associated with your RAIZ

Invest Super account

Please return the form to support@raizinvest.com.au