Errors

errors found:

warnings found:

Save Your Form

Employer's Statement

This will end your current session but your form will be saved and may be re-opened later.

Security question

Please review your security question and answer. This question must be correctly answered to re-open the form.

Phone number *

Errors

errors found:

warnings found:

Resume Your Saved Form

Employer's Statement

To resume your form please complete the following details.

Reference Code

When you saved your form you should have been provided a reference code.

Reference Code *

Security Question

Your answer to this question must match the information you previously provided.

Phone number *

Errors

errors found:

warnings found:

Confirm Cancellation

Employer's Statement

Are you sure you want to cancel your submission? Caution: all data entered will be lost.

Having trouble with the form?

If you need any assistance completing your form, let us help you.

Why not save where you are up to?

Did you know you can securely save your progress and resume at a later time?

Feedback

We'd really appreciate you letting us know why you are cancelling your submission.

What is the main reason for your cancellation?

Comments

Errors

errors found:

warnings found:

General enquiries

Employer's Statement

Phone

1300 660 027

8.00am to 5.00pm (AEST) weekdays

super@vissf.com.au

Address

GPO Box 4974
Melbourne VIC 3001

Tracking Code:

TALGRC011 VISSF Employer Statement

Employer's Statement

Please resolve the following issues before proceeding

Click on an issue to go directly to the related section of the form.

errors found:

warnings found:

Request Received

Employer's Statement

Thank you, your submission has been received.

Next steps

You are required to complete these additional forms to finalize your request.

Your Reference Code is:

Reference code for internal use only. This is not a claim number.

For your records

Would like a copy of this submission for your personal records?

Your email address *

Check your email

We've sent a copy of your submission to your email address ().If you didn't receive it or would like another copy, just select one of the options below.

Request Saved

Employer's Statement

Your form has been saved and may be re-opened later.

Your Reference Code is:

Please note that your form will expire on .

Send yourself a reminder email

Enter your email address and we'll send you you instructions on how to return to your form.

Your email address *

Check your email

We've sent instructions to your email address () on how to return to the application when you are ready. If you didn't receive it or would like a reminder sent to a different email address, just click the link below and follow the instructions.

Request Cancelled

Employer's Statement

Your application has been cancelled and will not be processed.

Starting the claim

Employer's Statement

Fields marked with * are required

This form is to be completed by the Employer (where possible the Employee’s direct manager) and relates to a claim for:

•Total and Permanent Disablement (TPD)•Income Protection (IP)•Both TPD and IP
It will take approximately 20-30 minutes to complete and you may be required to upload scanned copies of:
•Job description•Rehabilitation reports and incident reports•Sick leave payslips•Proof of earnings (payslips) for the 12 months prior to the employee's last physical day at work•Leave reports (annual leave, sick leave)•Termination documents•Any other information that will assist in the assessment of the claim
You can save the form at any time, should you not have these documents readily available.

Please ensure you complete this form in full, as assessment of this claim may be delayed if the information provided is incomplete.

Employer details

Employer's Statement

Fields marked with * are required

Name of company *

Address of company

Address Line 1 *

Address Line 2

Level Number

Unit Number

Street Number

Street Name

Street Type

Suburb

State

Postcode

Selected Address Field

Phone number *

Fax number

Email address

Employee details

Employer's Statement

Fields marked with * are required

Title *

Please specify

Given name(s) *

Surname *

Date of birth

Day *

Month *

Year *

Employment details

Employer's Statement

Fields marked with * are required

Employment details

What date did the employee join the company? *

What is the employee's job title? *

What date did the employee cease all duties? *

What was the reason for the employee ceasing work? *

What was the employee's gross base monthly salary + super prior to ceasing work? *

What was the employee's gross monthly salary prior to ceasing work?

Please provide the components of the salary package

Was the employee employed full-time, part-time, contractor or casual basis? *

Please indicate the current employment status *

Please specify *

Prior to the date the employee ceased all duties was he/she working in a reduced capacity or on alternative or restricted duties? *

Yes

Please provide details including start/end date and title *

Are there alternative duties the employee would be able to perform if they are unable to return to their normal duties? *

Yes

Please provide details *

Would you support a return to work program? *

Yes

Is there a return to work co-ordinator to assist the employee with a return to work program? *

Yes

Please provide details *

Are you aware of any other claims being lodged by the employee?

Yes

Please provide details *

Additional Information

Employer's Statement

Fields marked with * are required

Additional information

We welcome any additional information or comments which may assist with the assessment of the claim

Document upload

Employer's Statement

Fields marked with * are required

Job Description

File:

Rehabilitation and Incident Reports

File:

Proof of earnings (payslips for the 12 months prior to ceasing work)

File:

Leave reports (annual leave, sick leave)

File:

Termination documents

File:

Other

File:

Please note maximum upload size is 25MB.

Declaration

Employer's Statement

Fields marked with * are required

Privacy statement

TAL is bound by obligations imposed by current privacy legislation. Information received or requested from you is handled in accordance with these obligations. TAL requires that all entities adhere to relevant privacy obligations when dealing with personal and sensitive information about our customers.

Print name *

Job title *

Phone number *

Email address *

Please provide a signature

Draw signature

Type signature

Signature

ROTATE YOUR
DEVICE FOR
BEST RESULTS

Please type signature *

Date *

Call

Reference Code

Been here before?

Change of mind?

Fields marked with * are required

Insurance is provided by TAL Life Limited ABN 70 050 109 450 AFSL 237848 to VIS Nominees Pty Ltd ABN 11 006 586 367 AFSL 235097 as trustee of The Victorian Independent Schools Superannuation Fund ABN 37 024 873 660

error(s) Found

Please touch here to resolve the first error.