Employer Application Form

Employer Details

Please complete the details below to register your business with Energy Super and optionally choose to use the Energy Super Clearing House as your preferred method of payment.

Company

ABN Please ensure you enter an 11 or 14 digit number for the ABN

Address

City/Suburb

State ACT NSW NT QLD SA TAS WA VIC

Postcode

Contribution Method Energy Super Clearing House Own Clearing House

Contribution Frequency Quarterly Monthly Fortnightly Weekly

Facility Type Single employer facilityMultiple employer facility For a single employer facility – The employer will make contributions on behalf of their own employees. For a multiple employer facility – The employer will facilitate contributions on behalf of multiple businesses.

Number of staff

Financial Institution

Account Name

BSB Number

Account Number

First Name

Last Name

Job Title

Email

Daytime Contact Number Enter landline or mobile number without spaces

Comments

This Privacy Statement provides you with details about the personal information we have collected from you, how we will manage that information and how to contact us if you have any privacy concerns, including if you want to make a complaint.

Energy Super* collects your personal information and that of your employees in order to answer your queries, process your application and for the purposes of managing our ongoing relationship with you and your employees as further described in this statement. We may disclose your personal information to our authorised personnel, third parties and our service providers, including administration services provider Independent Fund Administrators & Advisers Pty Ltd, insurers MLC and Beazley, and ESI Financial Services Pty Ltd (a wholly owned subsidiary of Energy Super). We collect and may use and disclose your personal information in order to:

• administer your account, provide your employee(s) with insurance cover and provide services complementary to your account such as seminars, newsletters and educational offerings;
• conduct market research and analysis, develop and improve our products and services, and inform you about additional products and services that may be of interest to you; and
• meet legislative and regulatory obligations.

If we ask for your personal information and you don’t give it to us, we may not be able to provide you with any, some, or all of the features of our products or services available to you.

We generally collect your personal information directly from you but may also collect it from other organisations, your representatives, organisations who provide products or services to you jointly with us, and from publicly available sources. We may also be required to collect your personal information under anti-money laundering, corporations, family, insurance, superannuation, and taxation legislation, or under court/tribunal orders.

We are likely to disclose your personal information to organisations and persons located overseas. These countries include New Zealand, the United Kingdom, Ireland, France and the United States of America, depending on the details of the
transaction or other act you ask us, or we are required, to carry out.

Energy Super and the ESI Group* have a Privacy Policy which is available for download from our website at energysuper.com.au or by contacting us on 1300 4 ENERGY (1300 436 374) or info@energysuper.com.au. The Privacy Policy also contains information on how you may access and seek correction of your personal information held by Energy Super, and also how to complain about a breach of your privacy and how we will deal with that complaint.

* Energy Super is a reference to Electricity Supply Industry Superannuation (Qld) Ltd (ABN 30 069 634 439; AFSL 336567) (the Trustee), as Trustee for Energy Super (ABN 33 761 363 685) (the Fund). Energy Super is a member of the ESI Group.