Breach Notification
Online Breach Notification Form Please complete the following information to verify your details Enter your ABN: Instructions - How to use the online system and complete the form. If you are unable to use the online system, word versions of the form are available (ADI, GI, Life, Super) Technical Notes: Please contact your IT department or the APRA Contact Centre on 1300 13 10 60 if you have any issues with using the form. This form requires verification via a HTML formatted email (i.e. you must be able to send AND receive HTML formatted emails) If using Microsoft Outlook 2007, select Other Actions/View in Browser from the Quick Access Toolbar to process the form. If using Lotus Notes or GroupWise, liaise with your internal IT area or software provider to adjust your settings to use the HTML format. Conditions of Use By completing this on-line form you are lodging a breach notification by e-mail with the Australian Prudential Regulation Authority (APRA) under one of the following Acts (as applicable): s. 29JA of the Superannuation Industry (Supervision) Act 1993 s. 132A of the Life Insurance Act 1995 s. 38AA of the Insurance Act 1973 s. 62A of the Banking Act 1959 If your breach of APRA-administered legislation also breaches ASIC-administered legislation, you may choose to use this form to notify ASIC as well as APRA. APRA will be acting as ASIC’s agent for the purpose of collecting these dual breach reports for ASIC and forwarding them to ASIC. If you are required to only report the breach to ASIC you must report it directly to ASIC (and may not use this form).

Australian Prudential Regulation Authority