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

Postcode

Contribution Method

Contribution Frequency

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

Daytime Contact Number Enter landline or mobile number without spaces

Comments

LGIAsuper (the issuer of the Energy Super products) respects your privacy. All personal information collected via this form is protected in line with LGIAsuper’s Privacy policy. To find out more about how we collect and manage your personal information, please refer to our privacy policy

Employer Application Form

Employer Details

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