PS Superannuants New Member Application

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Title *

Mrs

Miss

Other

Required

If you ticked Other (above) please specify

Surname *

First name *

Address Line 1 *

Address Line 2 Suburb/Location, State/Territory and Postcode *

Year of Birth *

E-mail provision will not prevent postal delivery of the Superannuant *

Telephone *

Department from which you are currently working with (If retired answer N/A)
*

Department from which you retired from (if still working answer N/A)
*

Jurisdiction of your employment *

Commonwealth

State

Paid up Partner Member's name (if any)

Membership Type *

Life Member: age under 60 = $400 ($408.80 by credit card)

Life Member: age 60 to 65 ($350 ) ($357.70 by credit card)

Life Member: age 66 - 70 ($300) ($306.60 by credit card)

Life Member aged over 70 ($250) ($ 255.50 by credit card)

Partner Life Member = $100 ($102.20 by credit card)

Annual membership ($30 p.a.) ($30.66 by credit card)

Partner annual membership ($10 p.a.) ($10.22 by credit card)

Other:

Required

Voluntary Levy (to bolster dwindling reserves): $15
*

Will be added to my payment

Will not be added to my payment

Total Due *

How do you want to receive your copy of The Superannuant *

E-mail

Post

Payment Method (Payment should be made at the time of application, no invoice will be sent) Please ensure that your surname is entered first if you are paying by bank transfer. *

Bank Transfer: Bank SA: BSB 105-900, a/c: 950313840, APSS Reference Surname and postcode

Cheque

Credit Card (this will incur a 2.2% fee)

Required

Credit Card Details

Name on Card

Credit Card Number

Card Expiry date

CVC or CVV

Amount (including fee)

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