Form MOD S, Separation Details Instructions
This form contains 269 fields organized into 75 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Accommodation Details | ||
| Boarding house, hostel, private hotel, hospital or disability housing | Checkbox |
Check this box if you live in a boarding house, hostel, private hotel, hospital, or disability housing.
|
| Accommodation Type Code | Text |
Provide a specific code or identifier for the type of accommodation.
|
| Private house, townhouse, unit or flat | Checkbox |
Check this box if you live in a private house, townhouse, unit, or flat.
|
| Community housing | Checkbox |
Check this box if you live in community housing.
|
| Defence housing | Checkbox |
Check this box if you live in defence housing.
|
| Caravan, cabin or mobile home | Checkbox |
Check this box if you live in a caravan, cabin, or mobile home.
|
| Boat | Checkbox |
Check this box if you live on a boat.
|
| Other | Checkbox |
Check this box if your type of accommodation is not listed above and you need to provide details.
|
| Other Accommodation Details | Text |
Provide details if your accommodation type is 'Other' or requires further explanation. Fill only if 'Other' is selected.
Depends on:
Other
|
| Accommodation Details Change Status | ||
| No | Checkbox |
Check this box if your accommodation details have not changed since you last told us.
|
| Home Address Change Date | Date |
Provide the date your home address changed.
|
| Yes | Checkbox |
Check this box if your accommodation details have changed since you last told us.
|
| Accommodation Sharing Start Date | ||
| Day | Date |
Please enter the day you started sharing accommodation with this person. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Month | Date |
Please enter the month you started sharing accommodation with this person. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Year | Date |
Please enter the year you started sharing accommodation with this person. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Accommodation Sharing With Others | ||
| No | Checkbox |
Check this box if you do not share your accommodation with anyone other than an immediate family member or the ex-partner listed at question 27.
|
| Yes | Checkbox |
Check this box if you share your accommodation with someone other than an immediate family member or the ex-partner listed at question 27.
|
| Additional Accommodation Sharer Question | ||
| No | Checkbox |
Check this box if there is no other person sharing your accommodation. Fill only if 'Yes', 'No', 'No', 'No', 'No', 'No' is 'Yes' for any.
Depends on:
Yes, No, No, No, No, No
|
| Yes | Checkbox |
Check this box if there is another person sharing your accommodation. Fill only if 'Yes', 'No', 'No', 'No', 'No', 'No' is 'Yes' for any.
Depends on:
Yes, No, No, No, No, No
|
| Arrangements Termination Details | ||
| Details for Not Sure | Text |
Please provide details if you are not sure which arrangements you would like to end. Fill only if 'Not sure' is 'Yes'.
Depends on:
Not sure
|
| Arrangements Termination Inquiry | ||
| No | Checkbox |
Check this box if you do not wish to end any of the arrangements listed above.
|
| Yes | Checkbox |
Check this box if you wish to end one or more of the arrangements listed above.
|
| Not sure | Checkbox |
Check this box if you are unsure whether you want to end any of the arrangements.
|
| Arrangements to End | ||
| All arrangements | Checkbox |
Check this box if you want to end all existing arrangements with the specified individual. Fill only if 'Yes', 'Not sure' is 'Yes' for any.
Depends on:
Yes, Not sure
|
| Person permitted to enquire | Checkbox |
Check this box if you want to end the arrangement that allows the person to ask questions on your behalf. Fill only if 'Yes', 'Not sure' is 'Yes' for any.
Depends on:
Yes, Not sure
|
| Person permitted to update | Checkbox |
Check this box if you want to end the arrangement that allows the person to ask questions and make updates to your information. Fill only if 'Yes', 'Not sure' is 'Yes' for any.
Depends on:
Yes, Not sure
|
| Payment nominee | Checkbox |
Check this box if you want to end the arrangement where the specified individual receives your payments on your behalf. Fill only if 'Yes', 'Not sure' is 'Yes' for any.
Depends on:
Yes, Not sure
|
| Correspondence nominee | Checkbox |
Check this box if you want to end the arrangement that allows the specified individual to act on your behalf regarding correspondence. Fill only if 'Yes', 'Not sure' is 'Yes' for any.
Depends on:
Yes, Not sure
|
| Board and Lodgings Cost Separation | ||
| Cannot separate board and lodgings | Checkbox |
Check this box if you cannot separate the total amount paid for board and lodgings.
|
| Can separate board and lodgings | Checkbox |
Check this box if you can separate the amount paid for board (meals) and the amount paid for lodgings (accommodation only).
|
| Board or Lodgings Payment | ||
| No | Checkbox |
Check this box if you do not pay board, lodgings, or both for your accommodation.
|
| Lodgings Payment Amount | Number |
Please provide the amount you pay for your accommodation, which is considered lodgings.
|
| Yes | Checkbox |
Check this box if you pay board, lodgings, or both for your accommodation.
|
| Charged Amount | ||
| Total Amount Charged | Number |
Provide the total monetary amount being charged. Fill only if 'Private house, townhouse, unit or flat', 'Community housing', 'Defence housing', 'Caravan, cabin or mobile home', 'Boat', 'Other' is selected, any.
Depends on:
Private house, townhouse, unit or flat, Community housing, Defence housing, Caravan, cabin or mobile home, Boat, Other
|
| Charging Period | Combobox |
Enter the period for which the amount is charged (e.g., day, week, fortnight, 4 weeks, or calendar month). Fill only if 'Private house, townhouse, unit or flat', 'Community housing', 'Defence housing', 'Caravan, cabin or mobile home', 'Boat', 'Other' is selected, any.
4 Weeks
Day
Fortnight
4 weeks
Week
Depends on:
Private house, townhouse, unit or flat, Community housing, Defence housing, Caravan, cabin or mobile home, Boat, Other
|
| Checklist for Provided Forms and Documents | ||
| Copy of documents to verify sale details | Checkbox |
Check this box if you are providing a copy of documents to verify the details of the sale (e.g., settlement statement) because you answered 'Yes' at question 13.
|
| Relationship details – Separated under one roof (SS293) form | Checkbox |
Check this box if you are providing the 'Relationship details – Separated under one roof (SS293)' form, either for both you and your ex-partner/other person (if you answered 'No' at question 30 or 'Yes' at question 35B) or for only you (if you answered 'Yes' at question 30 or 35F).
|
| Relationship details (SS284) form | Checkbox |
Check this box if you are providing the 'Relationship details (SS284)' form, either for both you and the other person (if you answered 'Yes' at question 35C, 35D, or 35E) or for only you (if you answered 'Yes' at question 35F).
|
| Details of additional person sharing accommodation | Checkbox |
Check this box if you are providing details of each additional person who shares your accommodation because you answered 'Yes' at question 35G.
|
| Child's care arrangements (FA012) form | Checkbox |
Check this box if you are providing the 'Details of your child's care arrangements (FA012)' form because you answered 'Yes' at question 39.
|
| Income and assets (Mod iA) form | Checkbox |
Check this box if you are providing the 'Income and assets (Mod iA)' form because you answered 'Yes' at question 41.
|
| Children or Students In Care Question | ||
| No | Checkbox |
Check this box if you do not have any children or students in your care younger than 20.
|
| Age Threshold for Children/Students | Text |
Please provide the age threshold for children or students in your care.
|
| Yes | Checkbox |
Check this box if you have children or students in your care younger than 20.
|
| Contact by Social Worker Preference | ||
| No | Checkbox |
Check this box if you do not want to be contacted by a social worker.
|
| Yes | Checkbox |
Check this box if you would like to be contacted by a social worker to discuss your support options.
|
| Current Accommodation Description | ||
| Private Rent Accommodation Identifier | Text |
Provide any specific identifier or reference code for your private rental accommodation, if applicable.
|
| Private Rent | Checkbox |
Check this box if you pay private rent, which includes living in a caravan park, paying site fees, or residing on a vessel with mooring fees.
|
| Own or Jointly Own Home | Checkbox |
Check this box if you own your home, either individually or jointly with another person, covering scenarios like paying off a mortgage or owning a specific type of dwelling such as a caravan or townhouse.
|
| Home Owned by Company or Trust | Checkbox |
Check this box if your home is owned by a company where you are a shareholder or director, or by a trust where you or a family member is a beneficiary or named in the trust deed.
|
| Public Housing | Checkbox |
Check this box if you reside in public housing owned by the Housing Authority, excluding situations where you pay rent to a community housing organization.
|
| Boarding House, Hostel or Similar | Checkbox |
Check this box if you live in a boarding house, guest house, hostel, hotel, campus, refuge, emergency, or similar supported accommodation.
|
| Hospital or Disability Home | Checkbox |
Check this box if your current accommodation is a hospital or a home specifically for people with disabilities.
|
| Aged Care or Nursing Home | Checkbox |
Check this box if you currently live in an aged care home or a nursing home.
|
| Retirement Village | Checkbox |
Check this box if your current accommodation is a retirement village.
|
| Accommodation with Right to Use for Life | Checkbox |
Check this box if you live in accommodation where you possess a legal right to use it for the duration of your life.
|
| Accommodation with No Rent | Checkbox |
Check this box if you are living in accommodation for which you do not pay any rent.
|
| Other Accommodation | Checkbox |
Check this box if your accommodation type is not covered by the other options, such as not having a fixed address.
|
| Other Accommodation Details | Text |
Provide a detailed description of your current accommodation if it falls under the 'Other' category, such as if you do not have a fixed address. Fill only if 'Other Accommodation' is selected.
Depends on:
Other Accommodation
|
| Customer Reference Number | ||
| Customer Reference Number Part 1 | Text |
Enter the first part of your Customer Reference Number.
|
| Customer Reference Number Part 2 | Text |
Enter the second part of your Customer Reference Number.
|
| Customer Reference Number Part 3 | Text |
Enter the third part of your Customer Reference Number.
|
| Customer Reference Number Part 4 | Text |
Enter the fourth part of your Customer Reference Number.
|
| DummyCalcQ4 | Text | |
| Date of Birth | ||
| Birth Day | Text |
Enter the day of your birth.
|
| Birth Month | Text |
Enter the month of your birth.
|
| Birth Year | Number |
Enter the year of your birth.
|
| Declaration | ||
| I have read, understood and agree to the above | Checkbox |
Check this box if you have read, understood, and agree to the declaration and privacy information provided in this form.
|
| Declaration Day | Text |
Enter the day of the date you are making this declaration. Fill only if 'I have read, understood and agree to the above' is 'Yes'.
Depends on:
I have read, understood and agree to the above
|
| Declaration Month | Text |
Enter the month of the date you are making this declaration. Fill only if 'I have read, understood and agree to the above' is 'Yes'.
Depends on:
I have read, understood and agree to the above
|
| Declaration Year | Text |
Enter the year of the date you are making this declaration. Fill only if 'I have read, understood and agree to the above' is 'Yes'.
Depends on:
I have read, understood and agree to the above
|
| Your Signature | Text |
Provide your signature to confirm the declaration. This is only required if returning the form by post or in person. Fill only if 'I have read, understood and agree to the above' is 'Yes'.
Depends on:
I have read, understood and agree to the above
|
| Ex-Partner's Current Address | ||
| Address Line 1 | Text |
Enter the first line of your ex-partner's current address.
|
| Address Line 2 | Text |
Enter the second line of your ex-partner's current address.
|
| Address Line 3 | Text |
Enter the third line of your ex-partner's current address, which may include the suburb, city, or state.
|
| Postcode | Text |
Enter the postcode for your ex-partner's current address.
|
| Ex-Partner's Full Name | ||
| Ex-Partner's Family Name | Text |
Please enter your ex-partner's family name.
|
| Ex-Partner's First Given Name | Text |
Please enter your ex-partner's first given name.
|
| Ex-Partner's Second Given Name | Text |
Please enter your ex-partner's second given name, if applicable.
|
| Ex-Partner's Other Names | ||
| DummyCalcQ28 | Text | |
| No | Checkbox |
Check this box if your ex-partner has not been known by any other names.
|
| Yes | Checkbox |
Check this box if your ex-partner has been known by other names and you will provide details.
|
| Other Names | Text |
Provide any other names your ex-partner has been known by, such as name at birth, name before marriage, previous married name, Aboriginal or skin name, alias, adoptive name, or foster name. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Expected New Home Completion Date | ||
| Expected Completion Day | Text |
Please provide the expected day of purchase or completion of your new family home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Expected Completion Month | Text |
Please provide the expected month of purchase or completion of your new family home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Expected Completion Year | Text |
Please provide the expected year of purchase or completion of your new family home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Family and Domestic Violence Experience | ||
| No | Checkbox |
Check this box if you are not experiencing family and domestic violence.
|
| Yes | Checkbox |
Check this box if you are experiencing family and domestic violence.
|
| Family and Domestic Violence in Relation to Ex-partner | ||
| No | Checkbox |
Check this box if the family and domestic violence is NOT in relation to the ex-partner you are currently separating from.
|
| Yes | Checkbox |
Check this box if the family and domestic violence IS in relation to the ex-partner you are currently separating from.
|
| Family Name | ||
| Family Name | Text |
Enter your family name.
|
| Family Tax Benefit Question | ||
| Q38_No | CheckBox | |
| Yes | Checkbox |
Check this box if you currently receive Family Tax Benefit for the child or children in your care.
|
| Fee Payment Start Date | ||
| Start Day | Text |
Enter the day the fees started being paid.
|
| Start Month | Text |
Enter the month the fees started being paid.
|
| Start Year | Text |
Enter the year the fees started being paid.
|
| First Given Name | ||
| First Given Name | Text |
Please provide your first given name.
|
| First Payment Account Details | ||
| All Payments to This Account | Checkbox |
Check this box if you want all your payments to be directed into the account specified. Fill only if 'Use a different account' is selected.
Depends on:
Use a different account
|
| Payments to Update | Text |
Enter a list of the specific payments you would like to be updated to go into this account. Fill only if 'Use a different account' is selected.
Depends on:
Use a different account
|
| Bank Name | Text |
Provide the full name of the bank, building society, or credit union where the account is held. Fill only if 'Use a different account' is selected.
Depends on:
Use a different account
|
| Branch BSB | Text |
Enter the Branch Sort Code (BSB) for the account. Fill only if 'Use a different account' is selected.
Depends on:
Use a different account
|
| Account Number | Text |
Provide the bank account number for the payment, which may not be your card number. Fill only if 'Use a different account' is selected.
Depends on:
Use a different account
|
| Account Holder Name | Text |
Enter the full name(s) in which the bank account is held. Fill only if 'Use a different account' is selected.
Depends on:
Use a different account
|
| Former Home Sale Status | ||
| No | Checkbox |
Check this box if you have not sold your former home within the last 24 months or do not intend to buy or build a new family home.
|
| DummyCalcQ13 | Text | |
| Yes | Checkbox |
Check this box if you have sold your former home within the last 24 months and intend to buy or build a new family home.
|
| General | ||
| Q4GoToQ7 | Button | |
| 10.Address1 | Text | |
| 10.Address2 | Text | |
| Q11GoToQ13 | Button | |
| Q13GoToQ14 | Button | |
| Q14GoToQ27 | Button | |
| Q15GoToQ20a | Button | |
| Q15GoToQ16 | Button | |
| Q15GoToQ27a | Button | |
| Q15GoToQ17 | Button | |
| Q15GoToQ20b | Button | |
| Q15GoToQ20c | Button | |
| Q15GoToQ27b | Button | |
| Q15GoToQ27c | Button | |
| Q15GoToQ27d | Button | |
| Q15GoToQ27e | Button | |
| Q15GoToQ20d | Button | |
| Q16GoToQ27 | Button | |
| Q16GoToQ20 | Button | |
| Q17GoToQ27 | Button | |
| Q18GoToQ20 | Button | |
| Q19GoToQ27 | Button | |
| Q20GoToQ22 | Button | |
| Q21GoToQ23a | Button | |
| Q21GoToQ23b | Button | |
| Q24GoToQ26 | Button | |
| Q29GoToQ31 | Button | |
| Q30GoToQ32a | Button | |
| Q30GoToQ32b | Button | |
| Q34GoToQ36 | Button | |
| Q35BGoToQ35C | Button | |
| Q35BGoToQ35F | Button | |
| Q35CGoToQ35D | Button | |
| Q35CGoToQ35F | Button | |
| Q35DGoToQ35E | Button | |
| Q35DGoToQ35F | Button | |
| Q35EGoToQ35G | Button | |
| Q35EGoToQ35F | Button | |
| Q35FGoToQ35Ga | Button | |
| Q35FGoToQ35Gb | Button | |
| Q37GoToQ40 | Button | |
| Clear button | Button | |
| Home Address Change Date | ||
| Home Address Change Day | Date |
Please provide the day your home address changed. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Home Address Change Month | Date |
Please provide the month your home address changed. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Home Address Change Year | Date |
Please provide the year your home address changed. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Home Address Change Status | ||
| No | Checkbox |
Check this box if your home address has not changed since you last reported it.
|
| Yes | Checkbox |
Check this box if your home address has changed since you last reported it.
|
| Home Address Change Details | Text |
Please provide details regarding the change to your home address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Immediate Family Member Clarification | ||
| Immediate Family Member Details | Text |
Please provide additional details or clarification regarding your immediate family members.
|
| Income and Assets Changes | ||
| No | Checkbox |
Check this box if there have been no other changes to your income and assets.
|
| Yes | Checkbox |
Check this box if there have been other changes to your income and assets and you need to complete an Income and assets (Mod iA) form.
|
| Intended Amount for New Home | ||
| Intended Amount for New Home | Number |
Enter the total amount you intend to use to buy or build your new family home, ensuring it does not exceed the amount of the sale proceeds. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Joint Activities as a Couple | ||
| No | Checkbox |
Check this box if you and this person do not participate in activities jointly and are not considered to be a couple. Fill only if 'Yes', 'No', 'No', 'No' is 'Yes' for any.
Depends on:
Yes, No, No, No
|
| Yes | Checkbox |
Check this box if you and this person participate in activities jointly and are considered to be a couple. Fill only if 'Yes', 'No', 'No', 'No' is 'Yes' for any.
Depends on:
Yes, No, No, No
|
| Joint Financial Commitments | ||
| No | Checkbox |
Check this box if you and the other person have never had any joint financial commitments. Fill only if 'Yes', 'No', 'No' is 'Yes' for any.
Depends on:
Yes, No, No
|
| Yes | Checkbox |
Check this box if you and the other person have had joint financial commitments, such as a joint bank account, mortgage, or other loans. Fill only if 'Yes', 'No', 'No' is 'Yes' for any.
Depends on:
Yes, No, No
|
| Lease/Tenancy Agreement | ||
| No | Checkbox |
Check this box if you do not have a formal lease or tenancy agreement.
|
| Yes | Checkbox |
Check this box if you have a formal lease or tenancy agreement.
|
| NDIS Account Acknowledgment | ||
| NDIS Exclusion Acknowledgment | Text |
Provide any required acknowledgment or details concerning the exclusion of accounts used solely for National Disability Insurance Scheme funding.
|
| Net Sale Proceeds | ||
| Net Sale Proceeds Amount | Number |
Please enter the amount received after any mortgage and costs were taken out of the sale price. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| New Home Address | ||
| Address Line 1 | Text |
Please enter the first line of your new home address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Address Line 2 | Text |
Please enter the second line of your new home address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Address Line 3 | Text |
Please enter the third line of your new home address, such as suburb or city. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Postcode | Text |
Please enter your new home postcode. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| New Postal Address | ||
| New Postal Address Details | Text |
Please enter the street number, street name, and any other relevant address details for your new postal address. Fill only if 'Yes, postal address has changed' is 'Yes'.
Depends on:
Yes, postal address has changed
|
| New Postal Address Suburb/Town | Text |
Please enter the suburb, town, or city for your new postal address. Fill only if 'Yes, postal address has changed' is 'Yes'.
Depends on:
Yes, postal address has changed
|
| New Postal Address Postcode | Text |
Please enter the postcode for your new postal address. Fill only if 'Yes, postal address has changed' is 'Yes'.
Depends on:
Yes, postal address has changed
|
| Ownership Of Property Not Lived In | ||
| No | Checkbox |
Check this box if you do not own a home that you do not live in.
|
| DummyCalcQ11 | Text | |
| Yes | Checkbox |
Check this box if you own a home that you do not live in.
|
| Payment Destination Choice | ||
| Use existing account details | Checkbox |
Check this box if you want your payment to be made to the account details you have previously provided.
|
| Use a different account | Checkbox |
Check this box if you want your payment to be made to a new or different account, for which you will provide details.
|
| Person 1 Details | ||
| Full Name | Text |
Please provide the full name of Person 1. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Sharing Start Date | Date |
Please provide the date when you started sharing accommodation with this person. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Relationship to Person 1 | Text |
Please describe your relationship to this person. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Phone Account Ownership | ||
| No | Checkbox |
Check this box if the phone account is not in your name. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if the phone account is in your name. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Phone Number | ||
| Phone Number | Text |
Please enter your phone number, including the area code. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Phone Number Change Status | ||
| No | Checkbox |
Check this box if your phone number has not changed since you last told us.
|
| Yes | Checkbox |
Check this box if your phone number has changed since you last told us and you need to provide new details.
|
| Phone Number Change Details | Text |
Please provide details about how your phone number has changed. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Postal Address Change Date | ||
| Postal Address Change Day | Text |
Enter the day the postal address changed (DD). Fill only if 'Yes, postal address has changed' is 'Yes'.
Depends on:
Yes, postal address has changed
|
| Postal Address Change Month | Text |
Enter the month the postal address changed (MM). Fill only if 'Yes, postal address has changed' is 'Yes'.
Depends on:
Yes, postal address has changed
|
| Postal Address Change Year | Text |
Enter the year the postal address changed (YYYY). Fill only if 'Yes, postal address has changed' is 'Yes'.
Depends on:
Yes, postal address has changed
|
| Postal Address Change Status | ||
| No, postal address has not changed | Checkbox |
Check this box if your postal address has not changed since you last provided it to us.
|
| Yes, postal address has changed | Checkbox |
Check this box if your postal address has changed since you last provided it to us.
|
| DummyCalcQ10 | Text |
Depends on:
Yes, postal address has changed
|
| Previous Cohabitation as a Couple | ||
| No | Checkbox |
Check this box if you and this person have not previously lived together as a couple. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| DummyCalcQ35B | Text |
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if you and this person have previously lived together as a couple (for example, married, partnered, de facto or in a registered relationship). Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Primary Tenant Rent Rate | ||
| No | Checkbox |
Check this box if the primary tenant is not paying the market rate of rent.
|
| Not sure | Checkbox |
Check this box if you are not sure whether the primary tenant is paying the market rate of rent.
|
| Yes | Checkbox |
Check this box if the primary tenant is paying the market rate of rent.
|
| Total Board and Lodgings Amount | Number |
Enter the total monetary amount charged for board and lodgings.
|
| Property Fees Amount | ||
| Property Fees Amount | Number |
Provide the total amount paid for property fees.
|
| Property Fees Payment Period | Combobox |
Provide the period for which the property fees are paid, such as day, week, fortnight, 4 weeks, or calendar month.
4 Weeks
Day
Fortnight
4 weeks
Week
|
| Public Housing Status | ||
| No | Checkbox |
Check this box if you do not live with the primary tenant or if your income has not been taken into account by the public housing authority when calculating the rent.
|
| Public Housing Calculation Item | Text |
Please provide the item or amount the public housing authority calculates when taking into account your income.
|
| Yes | Checkbox |
Check this box if you live with the primary tenant and your income has been taken into account by the public housing authority when calculating the rent.
|
| Reason for No Referee Details | ||
| Reason for No Referee Details | Text |
Provide a detailed explanation for why you are unable to provide referee details.
|
| Reason For Not Living In Home | ||
| You or your children are studying | Checkbox |
Check this box if you or your children are studying as the reason for not living in the home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Receiving medical treatment | Checkbox |
Check this box if receiving medical treatment is the reason for not living in the home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Receiving care from a person in a private home | Checkbox |
Check this box if receiving care from a person in a private home is the reason for not living in the home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Receiving care in a nursing home | Checkbox |
Check this box if receiving care in a nursing home is the reason for not living in the home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Providing care to a person in a private home | Checkbox |
Check this box if providing care to a person in a private home is the reason for not living in the home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Overseas absence | Checkbox |
Check this box if an overseas absence is the reason for not living in the home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other | Checkbox |
Check this box if your reason for not living in the home is not listed above and provide details. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Reason for Not Living in Home | Text |
Provide a brief description of the 'other' reason for not living in the home. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Detailed Explanation for Other Reason | Text |
Provide a detailed explanation for the 'other' reason you do not live in the home. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Reconciliation Details | ||
| No | Checkbox |
Check this box if you do not think you and your ex-partner will get back together.
|
| Yes | Checkbox |
Check this box if you think you and your ex-partner will get back together.
|
| Reconciliation Explanation | Text |
Explain why you believe you and your ex-partner will get back together. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Expected Reconciliation Date | Date |
Provide the date when you expect to reconcile with your ex-partner. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Referee Details | ||
| Referee Full Name | Text |
Enter the full name of the referee.
|
| Referee Address Line 1 | Text |
Provide the first line of the referee's street address.
|
| Referee Address Line 2 | Text |
Provide the second line of the referee's street address.
|
| Referee Address Line 3 | Text |
Provide the third line of the referee's street address, typically including suburb or city.
|
| Referee Postcode | Text |
Enter the postcode of the referee's address.
|
| Referee Phone Number | Text |
Enter the referee's phone number, including the area code.
|
| Referee Relationship to You | Text |
Describe the referee's relationship to you.
|
| Rental Contract Agreement | ||
| No | Checkbox |
Check this box if your name is not on the rental contract or lease agreement.
|
| Yes | Checkbox |
Check this box if your name is on the rental contract or lease agreement.
|
| Total Board and Lodgings Amount | Number |
Please enter the total amount charged for board and lodgings.
|
| Safety Concerns | ||
| No | Checkbox |
Check this box if you are not concerned about your safety if forms are issued to this person. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if you are concerned about your safety if forms are issued to this person. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Safety Concerns Regarding Ex-Partner | ||
| No Safety Concern | Checkbox |
Check this box if you are not concerned about your safety if forms are issued to your ex-partner, indicating that both you and your ex-partner will need to complete a separate 'Relationship details - Separated under one roof' form.
|
| Safety Concern Acknowledgment | Text |
Please enter your acknowledgment regarding the safety concern and the requirement for both parties to complete the 'Relationship details - Separated under one roof (SS293)' form.
|
| Yes, Safety Concern | Checkbox |
Check this box if you are concerned about your safety if forms are issued to your ex-partner, indicating that only you will need to complete a 'Relationship details - Separated under one roof' form.
|
| Second Given Name | ||
| Second Given Name | Text |
Please enter your second given name.
|
| Second Payment Account Details | ||
| Payments to Update | Text |
Enter the specific payment(s) you would like to go into this account. Fill only if 'Use a different account' is selected.
Depends on:
Use a different account
|
| Bank/Credit Union Name | Text |
Provide the full name of the bank, building society, or credit union. Fill only if 'Use a different account' is selected.
Depends on:
Use a different account
|
| Branch Number (BSB) | Text |
Enter the Branch Number (BSB) of the financial institution. Fill only if 'Use a different account' is selected.
Depends on:
Use a different account
|
| Account Number | Text |
Enter the bank account number for this account (this may not be your card number). Fill only if 'Use a different account' is selected.
Depends on:
Use a different account
|
| Account Holder Name(s) | Text |
Provide the full name(s) of the person(s) in whose name the account is held. Fill only if 'Use a different account' is selected.
Depends on:
Use a different account
|
| Separated Board Cost | ||
| Amount Paid for Board | Number |
Enter the monetary amount paid for board (meals). Fill only if 'Can separate board and lodgings' is selected.
Depends on:
Can separate board and lodgings
|
| Board Payment Frequency | Combobox |
Enter the frequency of board payment, such as day, week, fortnight, 4 weeks, or calendar month. Fill only if 'Can separate board and lodgings' is selected.
4 Weeks
Day
Fortnight
4 weeks
Week
Depends on:
Can separate board and lodgings
|
| Separated Lodgings Cost | ||
| Lodgings Cost Amount | Number |
Enter the amount paid specifically for lodgings (accommodation only). Fill only if 'Can separate board and lodgings' is selected.
Depends on:
Can separate board and lodgings
|
| Lodgings Cost Period | Combobox |
Specify the period (e.g., day, week, fortnight, 4 weeks, or calendar month) for which the lodgings cost is paid. Fill only if 'Can separate board and lodgings' is selected.
4 Weeks
Day
Fortnight
4 weeks
Week
Depends on:
Can separate board and lodgings
|
| Separation Date | ||
| Separation Day | Text |
Please provide the day of your separation from your partner.
|
| Separation Month | Text |
Please provide the month of your separation from your partner.
|
| Separation Year | Text |
Please provide the year of your separation from your partner.
|
| Separation Property Details | ||
| No | Checkbox |
Check this box if you have not received and are not expecting to receive any money or property as a result of your separation.
|
| Yes | Checkbox |
Check this box if you have received or are expecting to receive money or property as a result of your separation.
|
| Separation Details Summary | Text |
Provide a summary of the money or property received or expected as a result of your separation. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Extended Separation Details | Text |
Provide comprehensive details regarding the money or property received or expected as a result of your separation, including any additional information required. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Settlement Date | ||
| Settlement Day | Text |
Please provide the day of the settlement date. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Settlement Month | Text |
Please provide the month of the settlement date. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Settlement Year | Number |
Please provide the year of the settlement date. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Shared Accommodation at Another Address | ||
| No | Checkbox |
Check this box if you and this person have not shared accommodation at another address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if you and this person have shared accommodation at another address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Shared Care Arrangements Question | ||
| No | Checkbox |
Check this box if you will not share the care of any children, and the number of children in your care has not changed since you separated.
|
| Yes | Checkbox |
Check this box if you will share the care of any children, or if the number of children in your care has changed since you separated.
|
| Shared Home with Ex-Partner | ||
| No | Checkbox |
Check this box if you do not live in the same home as your ex-partner.
|
| DummyCalcQ29 | Text | |
| Yes | Checkbox |
Check this box if you live in the same home as your ex-partner.
|
| Shared Parenting or Guardianship | ||
| No | Checkbox |
Check this box if you and the other person do not share the parenting or guardianship of any children. Fill only if 'Yes', 'No' is 'Yes' for any.
Depends on:
Yes, No
|
| Yes | Checkbox |
Check this box if you and the other person share the parenting or guardianship of any children. Fill only if 'Yes', 'No' is 'Yes' for any.
Depends on:
Yes, No
|
| Site or Mooring Fees Payment | ||
| No | Checkbox |
Check this box if you do not pay site or mooring fees for your home (caravan, mobile home, or boat).
|
| DummyCalcQ16 | Text | |
| Yes | Checkbox |
Check this box if you do pay site or mooring fees for your home (caravan, mobile home, or boat).
|
| Unseparated Board and Lodgings Cost | ||
| Number of Payment Periods | Text |
Please provide the number of periods for which the unseparated board and lodgings cost is charged. Fill only if 'Cannot separate board and lodgings' is selected.
Depends on:
Cannot separate board and lodgings
|
| Unseparated Board and Lodgings Cost | Number |
Please enter the total unseparated amount paid for board and lodgings. Fill only if 'Cannot separate board and lodgings' is selected.
Depends on:
Cannot separate board and lodgings
|
| Payment Period Unit | Combobox |
Please enter the unit of the period (e.g., day, week, fortnight, 4 weeks, or calendar month) for which the unseparated board and lodgings cost is charged. Fill only if 'Cannot separate board and lodgings' is selected.
4 Weeks
Day
Fortnight
4 weeks
Week
Depends on:
Cannot separate board and lodgings
|