AGEST Super. Straight forward. Simple. Fair

Enter the details of the person you wish to notify AGEST has passed away.

First Name *

Surname *

Member Number (if known)

Date Of Birth

Date Of Death

Address

Name of last employer (if known)

Provide the details of the deceased persons spouse if any.

First Name

Surname

Mailing Address

Contact Phone Number

Please provide as much information as this will help to reduce the amount of time it takes to manage and pay a death benefit.

First Name	Surname	Gender	DOB or Age	Contact Number	Mailing Address
		MaleFemale

Other Contacts

Use this section to note any other people that may be relevant for AGEST to contact. For example, the deceased persons parents, siblings, solicitor, employer etc.

First Name	Surname	Relationship to deceased	Contact Number	Mailing Address
		Spouse (legal or de facto) Partner Child Parent Sibling Legal Personal Representative Other

Please use this area to note any other special comments in relation to this notification.

Comments

Enter your personal details here in the event you may need to be contacted.

Your First Name *

Your Surname *

Relationship to deceased *

• Spouse (legal or de facto)
• Partner
• Child
• Parent
• Sibling
• Legal Personal Representative
• Other

Home Address *

Mailing Address *

Work Contact Number

Home Contact Number *

Mobile Contact Number

Email Address