Form SA296, Claim for a Commonwealth Seniors Health Card Instructions
This form contains 508 fields organized into 139 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Aboriginal or Torres Strait Islander Descent | ||
| Torres Strait Islander Australian Descent | Text |
Please indicate if you are of Torres Strait Islander Australian descent.
|
| No | Checkbox |
Check this box if you are not of Aboriginal or Torres Strait Islander Australian descent.
|
| Yes - Aboriginal Australian | Checkbox |
Check this box if you are of Aboriginal Australian descent.
|
| Yes - Torres Strait Islander Australian | Checkbox |
Check this box if you are of Torres Strait Islander Australian descent.
|
| Partner Aboriginal Australian Descent Confirmation | Text |
Please confirm your partner's Aboriginal Australian descent. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| No | Checkbox |
Check this box if your partner is not of Aboriginal or Torres Strait Islander Australian descent. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Yes - Aboriginal Australian | Checkbox |
Check this box if your partner is of Aboriginal Australian descent. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Yes - Torres Strait Islander Australian | Checkbox |
Check this box if your partner is of Torres Strait Islander Australian descent. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Account-Based Income Stream Status | ||
| No | Checkbox |
Check this box if neither you nor your partner receive income from an account-based income stream.
|
| Yes | Checkbox |
Check this box if you or your partner receive income from an account-based income stream.
|
| Account-Based Income Stream Details | Text |
Please provide details regarding the account-based income stream, such as a Centrelink/DVA schedule or similar information.
|
| Additional Child Inquiry After Child 1 | ||
| No | Checkbox |
Check this box if you do not have another dependent child after Child 1. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| DummyCalcQ65 | Text | |
| Yes | Checkbox |
Check this box if you have another dependent child after Child 1 and need to provide their details. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Additional Child Inquiry After Child 2 | ||
| No, no additional dependent children | Checkbox |
Check this box if you do not have any more dependent children after Child 2. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes, I have another dependent child | Checkbox |
Check this box if you have one or more additional dependent children after Child 2. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Australian Citizenship Details | ||
| Australia | Checkbox |
Check this box if Australia is your country of citizenship. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Year Century Code | Text |
Please provide the century code for the year your Australian citizenship was granted (e.g., '1' for 19xx, '2' for 20xx). Fill only if 'Australia' is 'Yes'.
Depends on:
Australia
|
| Day of Grant | Text |
Please provide the day your Australian citizenship was granted. Fill only if 'Australia' is 'Yes'.
Depends on:
Australia
|
| Month of Grant | Text |
Please provide the month your Australian citizenship was granted. Fill only if 'Australia' is 'Yes'.
Depends on:
Australia
|
| Year of Grant (Last Two Digits) | Text |
Please provide the last two digits of the year your Australian citizenship was granted. Fill only if 'Australia' is 'Yes'.
Depends on:
Australia
|
| Australian Citizenship Status | ||
| No | Checkbox |
Check this box if you are an Australian citizen but were not born in Australia.
|
| Yes | Checkbox |
Check this box if you are an Australian citizen and were born in Australia.
|
| DummyCalcQ23 | Text | |
| Australian South Sea Islander Descent | ||
| No | Checkbox |
Check this box if you are not of Australian South Sea Islander descent.
|
| Yes | Checkbox |
Check this box if you are of Australian South Sea Islander descent.
|
| Authorisation for a Representative | ||
| No | Checkbox |
Check this box if your partner does not want to authorise a person or organisation to make enquiries, updates, or payments on their behalf.
|
| Yes | Checkbox |
Check this box if your partner wants to authorise a person or organisation to make enquiries, updates, or payments on their behalf.
|
| Authorisation to Act on Behalf | ||
| No | Checkbox |
Check this box if you do not want to authorise a person or organisation to make enquiries, make updates, act, or get payments on your behalf.
|
| Yes | Checkbox |
Check this box if you want to authorise a person or organisation to make enquiries, make updates, act, or get payments on your behalf and will provide the required details.
|
| Authorising a person or organisation to enquire or act on your behalf (SS313) form | ||
| You - Authorising a person or organisation to enquire or act on your behalf (SS313) form | Checkbox |
Check this box if you are providing the SS313 form to authorise a person or organisation to enquire or act on your behalf, and you answered Yes at question 20 or 46. Fill only if you answered 'Yes' at question 20 or 46.
|
| Your partner - Authorising a person or organisation to enquire or act on your behalf (SS313) form | Checkbox |
Check this box if your partner is providing the SS313 form to authorise a person or organisation to enquire or act on their behalf, and you answered Yes at question 20 or 46. Fill only if you answered 'Yes' at question 20 or 46.
|
| Centrelink Customer Reference Number | ||
| Centrelink Customer Reference Number - Part 1 | Text |
Provide the first part of your Centrelink Customer Reference Number.
|
| Centrelink Customer Reference Number - Part 2 | Text |
Provide the second part of your Centrelink Customer Reference Number.
|
| Centrelink Customer Reference Number - Part 3 | Text |
Provide the third part of your Centrelink Customer Reference Number.
|
| Centrelink Customer Reference Number - Part 4 | Text |
Provide the fourth part of your Centrelink Customer Reference Number.
|
| Centrelink Pension or Benefit Recipient | ||
| No | Checkbox |
Check this box if you do not currently receive a Centrelink pension or benefit.
|
| Yes | Checkbox |
Check this box if you currently receive a Centrelink pension or benefit, understanding that you cannot get a Commonwealth Seniors Health Card unless your current pension or benefit is cancelled.
|
| Child 1 Date of Birth | ||
| Day of Birth | Number |
Enter the day of the child's birth. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Month of Birth | Number |
Enter the month of the child's birth. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Year of Birth | Number |
Enter the four-digit year of the child's birth. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 1 Family Tax Benefit Status | ||
| No | Checkbox |
Check this box if you do not receive Family Tax Benefit for Child 1. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if you do receive Family Tax Benefit for Child 1. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Proof of Birth Reference | Text |
Please provide any reference number or details for the proof of birth document submitted for this child.
|
| Child 1 Full Name | ||
| Child 1 Family Name | Text |
Enter the family name of Child 1. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 1 First Given Name | Text |
Enter the first given name of Child 1. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 1 Second Given Name | Text |
Enter the second given name of Child 1. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 1 Gender | ||
| Male | Checkbox |
Check this box if Child 1 identifies as male. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Female | Checkbox |
Check this box if Child 1 identifies as female. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Non-binary | Checkbox |
Check this box if Child 1 identifies as non-binary. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 1 Other Known Names | ||
| No | Checkbox |
Check this box if Child 1 has never been known by any other names. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if Child 1 has been known by other names. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Name 1 | Text |
Please provide the child's first other known name. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Additional Other Names | Text |
Please list any additional names by which the child has been known. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 2 Date of Birth | ||
| Child 2 Birth Day | Text |
Provide the day of birth for child 2. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 2 Birth Month | Text |
Provide the month of birth for child 2. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 2 Birth Year | Text |
Provide the year of birth for child 2. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 2 Family Tax Benefit Status | ||
| No | Checkbox |
Check this box if you do not receive Family Tax Benefit for Child 2. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if you receive Family Tax Benefit for Child 2. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 2 Full Name | ||
| Child 2 Family Name | Text |
Please enter the family name for Child 2. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 2 First Given Name | Text |
Please enter the first given name for Child 2. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 2 Second Given Name | Text |
Please enter any second given name for Child 2. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 2 Gender | ||
| Male | Checkbox |
Select this box if Child 2's gender is male. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Female | Checkbox |
Select this box if Child 2's gender is female. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Non-binary | Checkbox |
Select this box if Child 2's gender is non-binary. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child 2 Other Known Names | ||
| No | Checkbox |
Check this box if Child 2 has never been known by any other names. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if Child 2 has been known by other names and you need to list them. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Known Names | Text |
Please list any other names this child has been known by. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Claim for a Health Care Card (SS050) form | ||
| Claim for a Health Care Card (SS050) form | Checkbox |
Check this box if you are providing the 'Claim for a Health Care Card (SS050)' form, as indicated by answering 'Yes' to question 68. Fill only if you answered 'Yes' at question 68.
Depends on:
Yes
|
| Combined Income Status | ||
| The same | Checkbox |
Check this box if your combined income in the current financial year is the same as it was in the financial year indicated at question 69. Fill only if 'Above the income limit' is 'Yes'.
Depends on:
Above the income limit
|
| Higher | Checkbox |
Check this box if your combined income in the current financial year is higher than it was in the financial year indicated at question 69. Fill only if 'Above the income limit' is 'Yes'.
Depends on:
Above the income limit
|
| Lower | Checkbox |
Check this box if your combined income in the current financial year is lower than it was in the financial year indicated at question 69. Fill only if 'Above the income limit' is 'Yes'.
Depends on:
Above the income limit
|
| Combined Total Adjusted Taxable Income | ||
| Combined Total Adjusted Taxable Income | Number |
Provide the combined total adjusted taxable income for you and your partner. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Combined Total Adjusted Taxable Income | Number |
Enter the combined total adjusted taxable income for you and your partner, including any deemed income from account-based income streams. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Confirmation of identity | ||
| Confirmation of identity - You | Checkbox |
Check this box if you are providing documents to confirm your identity.
|
| Confirmation of identity - Your partner | Checkbox |
Check this box if your partner is providing documents to confirm their identity, and they are also making a claim. Fill only if 'Is your partner also claiming the Commonwealth Seniors Health Card?' is 'Yes'.
Depends on:
Yes
|
| Contact Details | ||
| Home Phone Number | Text |
Please provide your home phone number, including the area code.
|
| Mobile Phone Number | Text |
Please provide your mobile phone number.
|
| Work Phone Number | Text |
Please provide your work phone number, including the area code.
|
| Alternative Phone Number | Text |
Please provide an alternative phone number, including the area code.
|
| Email Address | Text |
Please provide your email address.
|
| Country of Birth | ||
| Country of Birth | Text |
Please enter the country where you were born. Fill only if 'No' is 'No'.
Depends on:
No
|
| Current Country of Residence | ||
| Australia | Checkbox |
Check this box if Australia is the country where you currently live on a long-term basis.
|
| Other Country | Checkbox |
Check this box if you currently live on a long-term basis in a country other than Australia.
|
| Other Country of Residence (Part 1) | Text |
Please provide the first part of the country where you currently reside if it is not Australia.
|
| Other Country of Residence (Part 2) | Text |
Please provide the second part of the country where you currently reside if the first field is insufficient. Fill only if 'Other Country' is 'Other'.
Depends on:
Other Country
|
| Date Married or Reconciled | ||
| Married Date Day | Date |
Enter the day of the date you were married or last reconciled with your partner. Fill only if 'Married' is 'Yes'.
Depends on:
Married
|
| Married Date Month | Date |
Enter the month of the date you were married or last reconciled with your partner. Fill only if 'Married' is 'Yes'.
Depends on:
Married
|
| Married Date Year | Date |
Enter the year of the date you were married or last reconciled with your partner. Fill only if 'Married' is 'Yes'.
Depends on:
Married
|
| Date of Birth | ||
| Day of Birth | Date |
Please enter the day of your birth.
|
| Month of Birth | Date |
Please enter the month of your birth.
|
| Year of Birth | Date |
Please enter the year of your birth.
|
| Date of Divorce | ||
| Divorce Day | Text |
Provide the day of your divorce. Fill only if 'Divorced' is 'Yes'.
Depends on:
Divorced
|
| Divorce Month | Text |
Provide the month of your divorce. Fill only if 'Divorced' is 'Yes'.
Depends on:
Divorced
|
| Divorce Year | Text |
Provide the year of your divorce. Fill only if 'Divorced' is 'Yes'.
Depends on:
Divorced
|
| Date of Last Separation | ||
| Day of Separation | Text |
Please provide the day your last separation occurred. Fill only if 'Separated' is 'Yes'.
Depends on:
Separated
|
| Month of Separation | Text |
Please provide the month your last separation occurred. Fill only if 'Separated' is 'Yes'.
Depends on:
Separated
|
| Year of Separation | Text |
Please provide the year your last separation occurred. Fill only if 'Separated' is 'Yes'.
Depends on:
Separated
|
| Date of Partner's Death | ||
| Day of Partner's Death | Date |
Enter the day your partner passed away. Fill only if 'Widowed' is 'Yes'.
Depends on:
Widowed
|
| Month of Partner's Death | Date |
Enter the month your partner passed away. Fill only if 'Widowed' is 'Yes'.
Depends on:
Widowed
|
| Year of Partner's Death | Date |
Enter the year your partner passed away. Fill only if 'Widowed' is 'Yes'.
Depends on:
Widowed
|
| Date Registered or Reconciled | ||
| Registered Relationship Date Day | Text |
Enter the day your registered relationship was registered or last reconciled. Fill only if 'Registered relationship' is 'Yes'.
Depends on:
Registered relationship
|
| Registered Relationship Date Month | Text |
Enter the month your registered relationship was registered or last reconciled. Fill only if 'Registered relationship' is 'Yes'.
Depends on:
Registered relationship
|
| Registered Relationship Date Year | Text |
Enter the year your registered relationship was registered or last reconciled. Fill only if 'Registered relationship' is 'Yes'.
Depends on:
Registered relationship
|
| Date Started De Facto Relationship or Reconciled | ||
| De Facto Relationship Start Day | Date |
Please provide the day you started your de facto relationship or last reconciled with your partner. Fill only if 'De facto' is 'Yes'.
Depends on:
De facto
|
| De Facto Relationship Start Month | Date |
Please provide the month you started your de facto relationship or last reconciled with your partner. Fill only if 'De facto' is 'Yes'.
Depends on:
De facto
|
| De Facto Relationship Start Year | Date |
Please provide the year you started your de facto relationship or last reconciled with your partner. Fill only if 'De facto' is 'Yes'.
Depends on:
De facto
|
| Department of Veterans' Affairs Benefits Status | ||
| No | Checkbox |
Check this box if you do not receive or have any of the listed benefits from the Department of Veterans' Affairs.
|
| Yes | Checkbox |
Check this box if you receive or have one or more of the listed benefits from the Department of Veterans' Affairs.
|
| Dependent Children Inquiry | ||
| No | Checkbox |
Check this box if you and your partner do not have any dependent children.
|
| Yes | Checkbox |
Check this box if you or your partner have one or more dependent children and you need to provide their details.
|
| Number of Dependent Children | Number |
Please enter the total number of dependent children you and/or your partner have. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Dependent children proof of birth | ||
| Dependent children proof of birth (You) | Checkbox |
Check this box if you are providing proof of birth for your dependent children, as required at question 61. Fill only if you answered No at question 61.
Depends on:
No
|
| Details of each additional child | ||
| Details of each additional child (You) | Checkbox |
Check this box if you are providing details of each additional child, as required at question 65. Fill only if you answered 'Yes' at question 65.
Depends on:
Yes, I have another dependent child
|
| Details of income stream product (SA330) form | ||
| You are providing Details of income stream product (SA330) form | Checkbox |
Check this box if you are providing a Centrelink/DVA schedule, a similar schedule, or the Details of income stream product (SA330) form, and you answered Yes to question 73. Fill only if you answered 'Yes' at question 73.
Depends on:
Yes
|
| Your partner is providing Details of income stream product (SA330) form | Checkbox |
Check this box if your partner is providing a Centrelink/DVA schedule, a similar schedule, or the Details of income stream product (SA330) form, and you answered Yes to question 73. Fill only if you answered 'Yes' at question 73.
Depends on:
Yes
|
| Documents to support the reason your income will be lower | ||
| You | Checkbox |
Check this box if you are providing documents to support the reason your income will be lower. Fill only if you answered 'Lower' at question 75.
Depends on:
Lower
|
| Your partner | Checkbox |
Check this box if your partner is providing documents to support the reason their income will be lower. Fill only if you answered 'Lower' at question 75.
Depends on:
Lower
|
| Documents to verify amount (Question 72A) | ||
| Original Notice of Assessment (You) | Checkbox |
Check this box if you are providing an Original Notice of Assessment or other documents to verify the amount, as specified in question 72A, especially if you are not required to lodge an income tax return.
|
| Original Notice of Assessment (Your partner) | Checkbox |
Check this box if your partner is providing an Original Notice of Assessment or other documents to verify the amount, as specified in question 72A, especially if they are not required to lodge an income tax return. Fill only if 'Is your partner also claiming the Commonwealth Seniors Health Card?' is 'Yes'.
Depends on:
Yes
|
| Documents to verify amount (Question 72B) | ||
| Your Income Tax Return/Other Documents | Checkbox |
Check this box if you are providing your income tax return or other documents to verify the amount for yourself, as specified in question 72B.
|
| Partner's Income Tax Return/Other Documents | Checkbox |
Check this box if you are providing your partner's income tax return or other documents to verify the amount for your partner, as specified in question 72B. Fill only if 'Is your partner also claiming the Commonwealth Seniors Health Card?' is 'Yes'.
Depends on:
Yes
|
| Documents to verify amount (Question 72C) | ||
| Your 72C Income Tax Documents | Checkbox |
Check this box if you are providing an income tax return or other documents to verify your amount, as specified in Question 72C.
|
| Partner's 72C Income Tax Documents | Checkbox |
Check this box if your partner is providing an income tax return or other documents to verify their amount, as specified in Question 72C. Fill only if 'Is your partner also claiming the Commonwealth Seniors Health Card?' is 'Yes'.
Depends on:
Yes
|
| Documents to verify amount (Question 72E) | ||
| Payment Summary and/or Income Tax Return (You) | Checkbox |
Check this box if you are providing a payment summary and/or income tax return, or other documents, to verify your amount as per question 72E.
|
| Payment Summary and/or Income Tax Return (Your Partner) | Checkbox |
Check this box if your partner is providing a payment summary and/or income tax return, or other documents, to verify their amount as per question 72E. Fill only if 'Is your partner also claiming the Commonwealth Seniors Health Card?' is 'Yes'.
Depends on:
Yes
|
| Financial Year for Income Details | ||
| Financial Year Start | Text |
Please provide the starting year of the financial year for which you are providing income details.
|
| Financial Year End | Text |
Please provide the ending year of the financial year for which you are providing income details.
|
| First Account-Based Income Stream Details | ||
| Name of Product Provider | Text |
Enter the full name of the product provider, SMSF, or SAF for the first account-based income stream. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Product Reference Number | Text |
Provide the reference number for the first account-based income stream product. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Commencement Day | Text |
Enter the day the first account-based income stream commenced. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Commencement Month | Text |
Enter the month the first account-based income stream commenced. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Commencement Year | Text |
Enter the year the first account-based income stream commenced. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Q73Details.Owner.0_Y | CheckBox |
Depends on:
Yes
|
| Q73Details.Owner.0_YP | CheckBox |
Depends on:
Yes
|
| First Country Lived In | ||
| Country | Text |
Enter the name of the first country where you lived for a long period, making it your home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Date From Day | Text |
Enter the day you started living in the country entered in the 'Country' field. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Date From Month | Text |
Enter the month you started living in the country entered in the 'Country' field. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Date From Year | Number |
Enter the year you started living in the country entered in the 'Country' field. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| First Country Lived In Details | ||
| Country | Text |
Please provide the name of the first country your partner lived in outside of Australia. Fill only if 'Yes, lived outside Australia' is 'Yes'.
Depends on:
Yes, lived outside Australia
|
| Date From Day | Text |
Please provide the day (DD) your partner started living in this country. Fill only if 'Yes, lived outside Australia' is 'Yes'.
Depends on:
Yes, lived outside Australia
|
| Date From Month | Text |
Please provide the month (MM) your partner started living in this country. Fill only if 'Yes, lived outside Australia' is 'Yes'.
Depends on:
Yes, lived outside Australia
|
| Date From Year | Text |
Please provide the year (YYYY) your partner started living in this country. Fill only if 'Yes, lived outside Australia' is 'Yes'.
Depends on:
Yes, lived outside Australia
|
| First Other Name | ||
| Other Name | Text |
Please provide the alternative name you have been known by. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Type of Other Name | Text |
Please specify the type of other name, for example, name at birth, previous married name, or alias. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| First Other Name | Text |
Please provide your partner's first other name. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| First Other Name Type | Text |
Please specify the type of this first other name, such as name at birth or previous married name. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Gender | ||
| Male | Checkbox |
Check this box if your gender is male.
|
| Female | Checkbox |
Check this box if your gender is female.
|
| Non-binary | Checkbox |
Check this box if your gender is non-binary.
|
| General | ||
| Instructions | Button | |
| Instructions | Button | |
| Q1GoToQ4 | Button | |
| Q7GoToQ11 | Button | |
| Q8GoToQ11 | Button | |
| Q16.Address1 | Text | |
| Q16.Address2 | Text | |
| Q23GoToQ31 | Button | |
| Q25GoToQ31 | Button | |
| Q26GoToQ28A | Button | |
| Q26GoToQ28B | Button | |
| Q32GoToQ33A | Button | |
| Q32GoToQ33B | Button | |
| Q32GoToQ33C | Button | |
| Q32GoToQ59A | Button | |
| Q32GoToQ59B | Button | |
| Q32GoToQ59C | Button | |
| Q32GoToQ59D | Button | |
| Q33GoToQ36 | Button | |
| Q35GoToQ37 | Button | |
| DummyCalcQ49 | Text | |
| Q49GoToQ58 | Button | |
| Q51GoToQ58 | Button | |
| DummyCalcQ52 | Text | |
| Q52GoToQ59 | Button | |
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| Q66GoToQ68 | Button | |
| Q74GoToQ78 | Button | |
| Q78YGoToQ80 | Button | |
| Q78YPGoToQ80 | Button | |
| Clear button | Button | |
| Income Limit Status | ||
| Below the income limit | Checkbox |
Check this box if your combined total adjusted taxable income plus deemed income from an account-based income stream is below the income limit for the Commonwealth Seniors Health Card.
|
| Income Below Limit Confirmation | Text |
Indicate if your combined total adjusted taxable income and deemed income are below the income limit for the Commonwealth Seniors Health Card.
|
| Above the income limit | Checkbox |
Check this box if your combined total adjusted taxable income plus deemed income from an account-based income stream is above the income limit for the Commonwealth Seniors Health Card.
|
| Interpreter Requirement | ||
| No | Checkbox |
Check this box if you do not need an interpreter when dealing with us.
|
| Hearing Impairment Details | Text |
Please provide specific details regarding the applicant's hearing impairment.
|
| Yes | Checkbox |
Check this box if you need an interpreter when dealing with us, including for hearing or speech impairment.
|
| Known by Other Names | ||
| No | Checkbox |
Check this box if your partner has not been known by any other name(s). Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if your partner has been known by any other name(s) and you need to provide details below. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Other Name | Text |
Enter any other name your partner has been known by, such as a 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
|
| Known by Other Names Question | ||
| No | Checkbox |
Check this box if you have not been known by any other names.
|
| Yes | Checkbox |
Check this box if you have been known by other names and need to provide details.
|
| Other Names Details | Text |
Provide details of any other names you have 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
|
| Lived Outside Australia Question | ||
| No | Checkbox |
Check this box if you have never lived outside Australia for any period.
|
| Yes | Checkbox |
Check this box if you have ever lived outside Australia for any period.
|
| Country Lived Outside Australia | Text |
Please provide the name of a country you have lived in outside Australia.
|
| Living in Same Home as Partner | ||
| No | Checkbox |
Check this box if you do not currently live in the same home as your partner. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if you currently live in the same home as your partner. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Reason for Not Living with Partner | Text |
Please provide a brief explanation if you do not live in the same home as your partner. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Low Income Health Care Card Application | ||
| No | Checkbox |
Check this box if you do not want to apply for a Low Income Health Care Card.
|
| Yes | Checkbox |
Check this box if you want to apply for a Low Income Health Care Card. You will be required to complete and return a 'Claim for a Health Care Card (SS050)' form.
|
| Most Recent Visa Details | ||
| Visa Change Details Entry Number | Text |
Enter the sequential number for this set of most recent visa details related to a change in your visa status. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Visa Subclass | Text |
Provide the subclass of your most recent visa. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Visa Granted Day | Text |
Enter the day your most recent visa was granted. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Visa Granted Month | Text |
Enter the month your most recent visa was granted. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Visa Granted Year | Text |
Enter the year your most recent visa was granted. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Citizenship Details | ||
| Other | Checkbox |
Check this box if your country of citizenship is not Australia and you need to provide details below. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Other Country of Citizenship | Text |
Please provide the name of the country of citizenship if it is not Australia. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Citizenship Granted Day | Text |
Enter the day the citizenship was granted. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Citizenship Granted Month | Text |
Enter the month the citizenship was granted. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Citizenship Granted Year | Text |
Enter the year the citizenship was granted. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Parents Visa Question | ||
| No | Checkbox |
Check this box if neither of your parents arrived on a refugee or humanitarian visa. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Yes | Checkbox |
Check this box if either of your parents arrived on a refugee or humanitarian visa. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Partner DVA Benefits | ||
| No | Checkbox |
Check this box if your partner does not receive any of the listed DVA benefits. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if your partner receives one or more of the listed DVA benefits. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner Lived Outside Australia Status | ||
| Q58_No | CheckBox | |
| Yes, lived outside Australia | Checkbox |
Check this box if your partner has lived in any country other than Australia for any period and you need to provide details. Fill only if 'What is your current relationship status?' is 'Married' or 'Registered relationship' or 'De facto'.
Depends on:
Married, Registered relationship, De facto
|
| Country | Text |
Please provide the name of the country where your partner has lived. Fill only if 'What is your current relationship status?' is 'Married' or 'Registered relationship' or 'De facto'.
Depends on:
Married, Registered relationship, De facto
|
| Partner Status | ||
| No | Checkbox |
Check this box if you do not have a partner.
|
| Partner CRN | Text |
Please provide your partner's Centrelink Customer Reference Number if it is known.
|
| Yes | Checkbox |
Check this box if you have a partner.
|
| Partner's Arrival Visa Type | ||
| Permanent | Checkbox |
Check this box if your partner arrived on a Permanent visa.
|
| Temporary | Checkbox |
Check this box if your partner arrived on a Temporary visa.
|
| New Zealand passport (Special Category visa) | Checkbox |
Check this box if your partner arrived on a New Zealand passport (Special Category visa).
|
| Temporary Visa Type | Text |
Please provide the specific type of temporary visa your partner arrived on.
|
| Not sure | Checkbox |
Check this box if you are not sure what type of visa your partner arrived on.
|
| Partner's Australian Citizenship and Birth Status | ||
| No | Checkbox |
Check this box if your partner is not an Australian citizen who was born in Australia.
|
| Yes | Checkbox |
Check this box if your partner is an Australian citizen who was born in Australia.
|
| Partner's Australian Citizenship Details | ||
| Australia | Checkbox |
Check this box if your partner's country of citizenship is Australia.
|
| DummyCalcQ51 | Text | |
| Citizenship Granted Day | Text |
Enter the day your partner's Australian citizenship was granted. Fill only if 'Australia' is 'Yes'.
Depends on:
Australia
|
| Citizenship Granted Month | Text |
Enter the month your partner's Australian citizenship was granted. Fill only if 'Australia' is 'Yes'.
Depends on:
Australia
|
| Citizenship Granted Year | Number |
Enter the year your partner's Australian citizenship was granted. Fill only if 'Australia' is 'Yes'.
Depends on:
Australia
|
| Partner's Australian South Sea Islander Descent Status | ||
| No | Checkbox |
Check this box if your partner is not of Australian South Sea Islander descent.
|
| Yes | Checkbox |
Check this box if your partner is of Australian South Sea Islander descent.
|
| Partner's Bank Account Details | ||
| Partner's Bank Name | Text |
Enter the name of your partner's bank, building society, or credit union where payments should be made. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Branch Number (BSB) | Text |
Enter your partner's Branch number (BSB) for the bank account. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Account Number | Text |
Enter your partner's bank account number. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Account Holder Name | Text |
Enter the name(s) in which your partner's bank account is held. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Centrelink Customer Reference Number | ||
| Partner's CRN Part 1 | Text |
Enter the first part of your partner's Centrelink Customer Reference Number. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's CRN Part 2 | Text |
Enter the second part of your partner's Centrelink Customer Reference Number. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's CRN Part 3 | Text |
Enter the third part of your partner's Centrelink Customer Reference Number. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's CRN Part 4 | Text |
Enter the fourth part of your partner's Centrelink Customer Reference Number. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Centrelink Pension or Benefit Recipient | ||
| No | Checkbox |
The user should check this box if their partner does not receive a Centrelink pension or benefit.
|
| Yes | Checkbox |
The user should check this box if their partner receives a Centrelink pension or benefit.
|
| Partner's Commonwealth Seniors Health Card Claim Status | ||
| No | Checkbox |
Check this box if your partner is not also claiming the Commonwealth Seniors Health Card.
|
| DummyCalcQ8 | Text | |
| Yes | Checkbox |
Check this box if your partner is also claiming the Commonwealth Seniors Health Card.
|
| Partner's Contact Details | ||
| Home Phone Number | Text |
Enter your partner's home phone number, including the area code. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Mobile Phone Number | Text |
Enter your partner's mobile phone number. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Work Phone Number | Text |
Enter your partner's work phone number, including the area code. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Alternative Phone Number | Text |
Enter an alternative phone number for your partner, including the area code. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Text |
Enter your partner's email address. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
|
| Partner's Country of Birth | ||
| Partner's Country of Birth | Text |
Please provide the country where your partner was born. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Partner's Current Country of Residence | ||
| Australia | Checkbox |
Check this box if your partner currently lives in Australia on a long-term basis.
|
| Other | Checkbox |
Check this box if your partner currently lives in a country other than Australia on a long-term basis.
|
| Other Country of Residence | Text |
Please provide the name of the country where your partner currently lives, if it is not Australia.
|
| Additional Country Details | Text |
Please provide any additional details regarding your partner's current country of residence. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Partner's Employer Provided Benefits | ||
| Partner's Employer Provided Benefits Above $1,000 | Number |
Enter the total amount of your partner's employer provided benefits, less the first $1,000. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Employer Provided Benefits | Number |
Enter the total amount of your partner's employer provided benefits less the first $1,000. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Estimated Taxable Income | ||
| Partner Estimated Taxable Income | Number |
Provide your partner's estimated taxable income for the current financial year. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner Taxable Income (No Tax Return) | Number |
Provide the amount of taxable income your partner received if they are not required to lodge an income tax return. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Foreign Income | ||
| Partner's Foreign Income | Number |
Enter the total amount of foreign income your partner received that did not pay Australian income tax on, in Australian dollars. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Foreign Income | Number |
Provide the total amount of foreign income your partner received that was not subject to Australian income tax. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's History of Living in Australia | ||
| No | Checkbox |
Check this box if your partner has never lived in Australia.
|
| Yes | Checkbox |
Check this box if your partner has lived in Australia at some point in time.
|
| Partner's Income Tax Return Lodgement Status | ||
| Partner's Income Tax Offset Explanation | Text |
Please provide an explanation if your partner's income was below the tax-free threshold or as a result of an Australian Taxation Office tax offset. Fill only if 'No, partner has not lodged an income tax return' is 'Yes'.
Depends on:
No, partner has not lodged an income tax return
|
| No, partner has not lodged an income tax return | Checkbox |
Check this box if your partner has not lodged an income tax return for the financial year. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's income was below tax-free threshold or due to ATO tax offset | Checkbox |
Check this box if your partner has not lodged an income tax return because their income was below the tax-free threshold or as a result of an Australian Taxation Office tax offset. Fill only if 'No, partner has not lodged an income tax return' is 'Yes'.
Depends on:
No, partner has not lodged an income tax return
|
| Partner's only income was a government pension or allowance | Checkbox |
Check this box if your partner has not lodged an income tax return because their only income was a government pension or allowance. Fill only if 'No, partner has not lodged an income tax return' is 'Yes'.
Depends on:
No, partner has not lodged an income tax return
|
| None of the above reasons for partner not lodging tax return | Checkbox |
Check this box if none of the listed reasons explain why your partner has not lodged an income tax return. Fill only if 'No, partner has not lodged an income tax return' is 'Yes'.
Depends on:
No, partner has not lodged an income tax return
|
| Yes, partner has lodged an income tax return | Checkbox |
Check this box if your partner has lodged an income tax return for the financial year. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Net Investment Loss | ||
| Partner's Net Rental Property Losses | Number |
Enter the total net rental property losses for your partner. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Net Financial Investment Losses | Number |
Enter the total net financial investment losses for your partner. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Net Rental Property Losses | Number |
Enter your partner's net rental property losses. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Net Financial Investment Losses | Number |
Enter your partner's net financial investment losses. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Other Citizenship Details | ||
| Other | Checkbox |
Check this box if your partner's country of citizenship is not Australia and you need to provide details for another country.
|
| Other Country of Citizenship | Text |
Enter the country of citizenship for your partner if it is not Australia. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Citizenship Granted Day | Text |
Enter the day your partner's other citizenship was granted. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Citizenship Granted Month | Text |
Enter the month your partner's other citizenship was granted. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Citizenship Granted Year | Text |
Enter the year your partner's other citizenship was granted. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Partner's Parents' Visa Status | ||
| No | Checkbox |
Check this box if neither of your partner's parents arrived on a refugee or humanitarian visa. Fill only if 'What is your current relationship status?' is 'Married' or 'Registered relationship' or 'De facto'.
Depends on:
Married, Registered relationship, De facto
|
| Yes | Checkbox |
Check this box if either of your partner's parents arrived on a refugee or humanitarian visa. Fill only if 'What is your current relationship status?' is 'Married' or 'Registered relationship' or 'De facto'.
Depends on:
Married, Registered relationship, De facto
|
| Partner's Pre-1965 Arrival in Australia Details | ||
| No | Checkbox |
Check this box if your partner did not start living in Australia before 1965. Fill only if 'What is your current relationship status?' is 'Married' or 'Registered relationship' or 'De facto'.
Depends on:
Married, Registered relationship, De facto
|
| Yes | Checkbox |
Check this box if your partner started living in Australia before 1965 and you will provide further details. Fill only if 'What is your current relationship status?' is 'Married' or 'Registered relationship' or 'De facto'.
Depends on:
Married, Registered relationship, De facto
|
| Arrival Year (Pre-1965) | Number |
Provide the year your partner first started living in Australia, if before 1965. Fill only if 'What is your current relationship status?' is 'Married' or 'Registered relationship' or 'De facto'.
Depends on:
Married, Registered relationship, De facto
|
| Ship or Airline Name | Text |
Enter the name of the ship or airline on which your partner arrived in Australia. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Place of Arrival | Text |
Enter the name of the place where your partner first arrived or disembarked in Australia. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Name at Arrival | Text |
Enter your partner's name as it was when they first arrived in Australia. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Signature Date | ||
| Partner's Signature Day | Text |
Enter the day your partner signed the form as a two-digit number. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Signature Month | Text |
Enter the month your partner signed the form as a two-digit number. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Signature Year | Text |
Enter the year your partner signed the form as a four-digit number. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Superannuation Contributions | ||
| Partner's Reportable Employer Superannuation Contributions | Number |
Enter your partner's total reportable employer superannuation contributions. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Personal Deductible Superannuation Contributions | Number |
Enter your partner's total personal deductible superannuation contributions. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Reportable Employer Superannuation Contributions | Number |
Enter the total amount of your partner's reportable employer superannuation contributions. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Personal Deductible Superannuation Contributions | Number |
Enter the total amount of your partner's personal deductible superannuation contributions. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Taxable Income | ||
| Partner's Taxable Income | Number |
Please provide the taxable income for your partner for the specified financial year. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Income If No Tax Return Lodged | Number |
Please provide your partner's total income received if they are not required to lodge an income tax return. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Total Income | ||
| Partner's Total Income | Number |
Enter your partner's total income, which is the sum of their taxable income, foreign income, total net investment loss, value of employer provided benefits, and total superannuation contributions. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Total Income | Number |
Enter the partner's total income, which is calculated as the sum of all income categories from A to E. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Travel History Outside Australia | ||
| No | Checkbox |
Check this box if your partner has not travelled outside Australia.
|
| Not applicable – never travelled to Australia | Checkbox |
Check this box if your partner has never travelled to Australia.
|
| Yes | Checkbox |
Check this box if your partner has travelled outside Australia, including short trips and holidays.
|
| Number of Foreign Trips | Text |
Please provide the total number of times your partner has travelled outside Australia.
|
| Year Last Entered Australia | Number |
Please enter the year your partner last entered Australia after travelling abroad. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Passport Number | Text |
Please provide your partner's passport number used for their most recent travel. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Passport Country of Issue | Text |
Please provide the country that issued your partner's passport. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Visa Change Details | ||
| Q55_No | CheckBox | |
| Q55 | CheckBox | |
| Visa Details Record Number | Text |
Please enter the record number for this set of most recent visa details.
|
| Most Recent Visa Subclass | Text |
Please enter the subclass of your partner's most recent visa. Fill only if 'Q55' is 'Yes'.
Depends on:
Q55
|
| Most Recent Visa Granted Day | Text |
Please enter the day your partner's most recent visa was granted. Fill only if 'Q55' is 'Yes'.
Depends on:
Q55
|
| Most Recent Visa Granted Month | Text |
Please enter the month your partner's most recent visa was granted. Fill only if 'Q55' is 'Yes'.
Depends on:
Q55
|
| Most Recent Visa Granted Year | Number |
Please enter the year your partner's most recent visa was granted. Fill only if 'Q55' is 'Yes'.
Depends on:
Q55
|
| Partner's Visa Details on Arrival | ||
| Visa Subclass | Text |
Enter the subclass of your partner's visa upon arrival. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Visa Grant Day | Date |
Enter the day your partner's visa was granted. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Visa Grant Month | Date |
Enter the month your partner's visa was granted. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Visa Grant Year | Date |
Enter the year your partner's visa was granted. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Wish to Provide Bank Details | ||
| No | Checkbox |
Check this box if your partner does not wish to provide their bank details. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if your partner wishes to provide their bank details. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Payment summary (Question 72D) | ||
| Payment summary (You) | Checkbox |
Check this box if you are providing a payment summary related to question 72D.
|
| Payment summary (Your partner) | Checkbox |
Check this box if your partner is providing a payment summary related to question 72D. Fill only if 'Is your partner also claiming the Commonwealth Seniors Health Card?' is 'Yes'.
Depends on:
Yes
|
| Period Not Living Together | ||
| DummyCalcQ35 | Text | |
| Period Start Day | Text |
Enter the two-digit day of the month when the period of not living together began. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Period Start Month | Text |
Enter the two-digit month when the period of not living together began. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Period Start Year | Text |
Enter the four-digit year when the period of not living together began. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Period End Day | Text |
Enter the two-digit day of the month when the period of not living together ended. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Period End Month | Text |
Enter the two-digit month when the period of not living together ended. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Period End Year | Text |
Enter the four-digit year when the period of not living together ended. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Indefinite | Checkbox |
Check this box if the period of not living with your partner is indefinite or ongoing, and you do not have an end date. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Permanent Address | ||
| Address Line 1 | Text |
Enter the first line of your permanent address.
|
| Address Line 2 | Text |
Enter the second line of your permanent address.
|
| Suburb/Town/State | Text |
Enter the suburb, town, or state of your permanent address.
|
| Postcode | Text |
Enter the postcode of your permanent address.
|
| Permission For Partner To Speak | ||
| No | Checkbox |
Check this box if you do not give permission for your partner to speak with us on your behalf. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if you give permission for your partner to speak with us on your behalf. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Permission for Partner to Speak on Behalf | ||
| No | Checkbox |
Check this box if you do not give permission for your partner to speak on your behalf. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if you give permission for your partner to speak on your behalf. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Postal Address | ||
| Postal Street Address | Text |
Please provide the first line of your postal street address, including unit number, street number, and street name.
|
| Postal Suburb/Town/State | Text |
Please provide the suburb, town, or state for your postal address.
|
| Postal Postcode | Text |
Please enter the postcode for your postal address.
|
| Pre-1965 Arrival Details | ||
| Arrival Year | Text |
Enter the year you first started living in Australia, if before 1965. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Ship or Airline Name | Text |
Enter the name of the ship or airline on which you arrived in Australia. Fill only if 'Q29' is 'Yes'.
Depends on:
Q29
|
| First Arrival Place | Text |
Enter the name of the place where you first arrived or disembarked in Australia. Fill only if 'Q29' is 'Yes'.
Depends on:
Q29
|
| Name on Arrival | Text |
Provide the full name you used when you first arrived in Australia. Fill only if 'Q29' is 'Yes'.
Depends on:
Q29
|
| Pre-1965 Residence Question | ||
| Q29_No | CheckBox | |
| Q29 | CheckBox | |
| Preferred Spoken Language | ||
| Preferred Spoken Language | Text |
Enter your preferred language for spoken communication. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Preferred Written Language | ||
| Preferred Written Language | Text |
Please enter your preferred written language. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Previously Provided Tax File Number Status | ||
| No | Checkbox |
Check this box if you and your partner have not previously given your tax file number(s).
|
| Not sure | Checkbox |
Check this box if you are not sure whether you and your partner have previously given your tax file number(s).
|
| Yes | Checkbox |
Check this box if you and your partner have previously given your tax file number(s).
|
| DummyCalcQ66 | Text | |
| Proof of your date of birth | ||
| Proof of your date of birth (You) | Checkbox |
Check this box if you are providing proof of your date of birth.
|
| Proof of your date of birth (Your partner) | Checkbox |
Check this box if your partner is providing proof of their date of birth. Fill only if 'Is your partner also claiming the Commonwealth Seniors Health Card?' is 'Yes'.
Depends on:
Yes
|
| Reason for Lower Income | ||
| Explanation for Lower Income | Text |
Provide a detailed explanation for why your income will be lower in the current financial year. Fill only if 'Lower' is 'Yes'.
Depends on:
Lower
|
| Reason For Not Living Together | ||
| Partner's illness | Checkbox |
Check this box if the reason you are not living with your partner is due to your partner's illness. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Your illness | Checkbox |
Check this box if the reason you are not living with your partner is due to your own illness. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Partner is in prison | Checkbox |
Check this box if the reason you are not living with your partner is because your partner is in prison. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Partner's employment | Checkbox |
Check this box if the reason you are not living with your partner is due to your partner's employment. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Other | Checkbox |
Check this box if none of the above options describe why you are not living with your partner, and provide further details. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Other Reason Summary | Text |
Please provide a brief summary of the other reason for not living with your partner. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Detailed Explanation | Text |
Please provide a detailed explanation of the reason you are not living with your partner. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Relationship Status Options | ||
| Married | Checkbox |
Check this box if your current relationship status is married. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Date Married or Reconciled | Date |
Please provide the date you were married or most recently reconciled with your partner. Fill only if 'Married' is 'Yes'.
Depends on:
Married
|
| Registered relationship | Checkbox |
Check this box if your relationship is registered under Australian state or territory law. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| De facto | Checkbox |
Check this box if your relationship is similar to a married couple but you are not married or in a registered relationship. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Separated | Checkbox |
Check this box if you are currently separated from a partner you were previously in a marriage, registered, or de facto relationship with. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Divorced | Checkbox |
Check this box if your current relationship status is divorced. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Widowed | Checkbox |
Check this box if your current relationship status is widowed, meaning your partner from a previous marriage, registered, or de facto relationship has passed away. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Never married or lived with a partner | Checkbox |
Check this box if you have never been married or lived with a partner. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Second Account-Based Income Stream Details | ||
| Second Income Stream Product Provider Name | Text |
Enter the name of the product provider, Self Managed Superannuation Fund (SMSF), or Small APRA Fund (SAF) for the second account-based income stream. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Income Stream Product Reference Number | Text |
Enter the product reference number associated with the second account-based income stream. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Income Stream Commencement Day | Text |
Enter the day (DD) the second account-based income stream commenced. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Income Stream Commencement Month | Text |
Enter the month (MM) the second account-based income stream commenced. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Income Stream Commencement Year | Text |
Enter the year (YYYY) the second account-based income stream commenced. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| You | Checkbox |
Check this box if the second account-based income stream is owned by you. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Your partner | Checkbox |
Check this box if the second account-based income stream is owned by your partner. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Country Lived In | ||
| Second Country Name | Text |
Enter the name of the second country you have lived in. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Country Start Date Day | Text |
Enter the day you started living in this second country. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Country Start Date Month | Text |
Enter the month you started living in this second country. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Country Start Date Year | Number |
Enter the year you started living in this second country. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Country Lived In Details | ||
| 58.COR.1 | Text |
Depends on:
Yes, lived outside Australia
|
| Second Country Date From Day | Text |
Please enter the day your partner started living in the second country. Fill only if 'Yes, lived outside Australia' is 'Yes'.
Depends on:
Yes, lived outside Australia
|
| Second Country Date From Month | Text |
Please enter the month your partner started living in the second country. Fill only if 'Yes, lived outside Australia' is 'Yes'.
Depends on:
Yes, lived outside Australia
|
| Second Country Date From Year | Number |
Please enter the year your partner started living in the second country. Fill only if 'Yes, lived outside Australia' is 'Yes'.
Depends on:
Yes, lived outside Australia
|
| Second Other Name | ||
| Second Other Name | Text |
Enter the second other name you have been known by. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Other Name Type | Text |
Provide the type of this second other name, for example, name before marriage. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Other Name | Text |
Enter the second other name your partner has been known by. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Other Name Type | Text |
Enter the type of this second other name, for example, name before marriage. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Account-Based Income Stream Details | ||
| Third Account Product Provider Name | Text |
Enter the full name of the product provider, Self Managed Superannuation Fund (SMSF), or Small APRA Fund (SAF) for the third account-based income stream. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Account Product Reference Number | Text |
Enter the product reference number for the third account-based income stream. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Account Commencement Day | Text |
Enter the day of commencement for the third account-based income stream. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Account Commencement Month | Text |
Enter the month of commencement for the third account-based income stream. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Account Commencement Year | Text |
Enter the year of commencement for the third account-based income stream. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| You | Checkbox |
Check this box if the third account-based income stream is owned by you. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Your partner | Checkbox |
Check this box if the third account-based income stream is owned by your partner. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Country Lived In | ||
| Third Country Name | Text |
Please enter the name of the third country you have lived in. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Country Lived In Start Date Day | Text |
Please enter the day you started living in the third country. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Country Lived In Start Date Month | Text |
Please enter the month you started living in the third country. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Country Lived In Start Date Year | Text |
Please enter the year you started living in the third country. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Country Lived In Details | ||
| Country Name | Text |
Enter the name of the third country your partner has lived in since birth. Fill only if 'Yes, lived outside Australia' is 'Yes'.
Depends on:
Yes, lived outside Australia
|
| Date From Day | Text |
Enter the day your partner started living in this country. Fill only if 'Yes, lived outside Australia' is 'Yes'.
Depends on:
Yes, lived outside Australia
|
| Date From Month | Text |
Enter the month your partner started living in this country. Fill only if 'Yes, lived outside Australia' is 'Yes'.
Depends on:
Yes, lived outside Australia
|
| Date From Year | Text |
Enter the year your partner started living in this country. Fill only if 'Yes, lived outside Australia' is 'Yes'.
Depends on:
Yes, lived outside Australia
|
| Travel History Outside Australia | ||
| No | Checkbox |
Check this box if you have never travelled outside Australia, including short trips and holidays.
|
| Yes | Checkbox |
Check this box if you have travelled outside Australia, including short trips and holidays, and need to provide details.
|
| Confirm Travel Details | Text |
Enter text to confirm you are providing details about your travel history outside Australia. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Year Last Entered Australia | Number |
Provide the year you last entered Australia. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Passport Number | Text |
Enter your passport number. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Passport Country of Issue | Text |
Enter the country where your passport was issued. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Visa Change Question | ||
| No | Checkbox |
The user should check this box if their visa has not changed since they arrived in Australia. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Yes | Checkbox |
The user should check this box if their visa has changed since they arrived in Australia. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Visa Details on Arrival | ||
| Visa subclass | Text |
Please provide your visa subclass number or code. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Day visa granted | Text |
Please enter the day your visa was granted (DD). Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Month visa granted | Text |
Please enter the month your visa was granted (MM). Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Year visa granted | Text |
Please enter the year your visa was granted (YYYY). Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Visa Type on Arrival Options | ||
| Permanent | Checkbox |
Check this box if you arrived on a permanent visa. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Temporary | Checkbox |
Check this box if you arrived on a temporary visa. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| New Zealand passport (Special Category visa) | Checkbox |
Check this box if you arrived on a New Zealand passport, which grants a Special Category visa. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Temporary Visa Code | Text |
Please provide the specific code or identifier for your temporary visa. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Not sure | Checkbox |
Check this box if you are unsure about the type of visa you arrived on. Fill only if 'Are you an Australian citizen who was born in Australia?' is 'No'.
Depends on:
No
|
| Your Bank Account Details | ||
| Bank Name | Text |
Please provide the full name of your bank, building society, or credit union. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Branch Number (BSB) | Text |
Please enter the Branch number (BSB) of your bank account. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Account Number | Text |
Please provide your bank account number. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Account Holder Name | Text |
Please enter the full name(s) in which the bank account is held. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Your Employer Provided Benefits | ||
| Your Employer Provided Benefits (Value Above $1,000) | Number |
Provide the total amount of your employer provided benefits less the first $1,000 for you.
|
| Your Employer Provided Benefits | Number |
Enter the total amount of your employer-provided benefits exceeding the first $1,000.
|
| Your Estimated Taxable Income | ||
| Your Estimated Taxable Income | Number |
Please provide your estimated taxable income that you expect to receive in the current financial year.
|
| Your Taxable Income (if no tax return) | Number |
Please provide the amount of taxable income you received if you are not required to lodge an income tax return.
|
| Your Foreign Income | ||
| Your Foreign Income Not Taxed | Number |
Enter the amount of foreign income you received on which you did not pay Australian income tax.
|
| Your Untaxed Foreign Income | Number |
Enter the amount of foreign income you received on which you did not pay Australian income tax.
|
| Your Income Tax Return Lodgement Status | ||
| Reason for not lodging income tax return | Text |
Provide the reason why you have not lodged an income tax return for the financial year. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| No | Checkbox |
This box should be checked if you have not lodged an income tax return for the financial year.
|
| Income was below tax free threshold or tax offset | Checkbox |
This box should be checked if you have not lodged an income tax return because your income was below the tax free threshold or as a result of an Australian Taxation Office tax offset. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Only income was government pension or allowance | Checkbox |
This box should be checked if you have not lodged an income tax return because your only income was a government pension or allowance. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| None of the above | Checkbox |
This box should be checked if you have not lodged an income tax return for reasons other than those listed above. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Yes | Checkbox |
This box should be checked if you have lodged an income tax return for the financial year.
|
| Your Name | ||
| Mr | Checkbox |
Check this box if your title is Mr.
|
| Mrs | Checkbox |
Check this box if your title is Mrs.
|
| Miss | Checkbox |
Check this box if your title is Miss.
|
| Ms | Checkbox |
Check this box if your title is Ms.
|
| Mx | Checkbox |
Check this box if your title is Mx (a gender-neutral title).
|
| Other Title | Text |
Please provide your title if it is not one of the predefined options. Fill only if 'Mx' is selected.
Depends on:
Mx
|
| Family Name | Text |
Please enter your family name as it appears on official documents.
|
| First Given Name | Text |
Please enter your first given name as it appears on official documents.
|
| Second Given Name | Text |
Please enter your second given name as it appears on official documents.
|
| Your Net Investment Loss | ||
| Your Net Rental Property Losses | Number |
Please provide the total amount of your net rental property losses.
|
| Your Net Financial Investment Losses | Number |
Please provide the total amount of your net financial investment losses.
|
| Your Net Rental Property Losses | Number |
Provide the total amount of your net rental property losses.
|
| Your Net Financial Investment Losses | Number |
Provide the total amount of your net financial investment losses.
|
| Your Partner's Date of Birth | ||
| Day of Birth | Text |
Enter the day of your partner's birth. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Month of Birth | Text |
Enter the month of your partner's birth. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Year of Birth | Text |
Enter the four-digit year of your partner's birth. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Your Partner's Gender | ||
| Male | Checkbox |
Check this box if your partner identifies as male. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Female | Checkbox |
Check this box if your partner identifies as female. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Non-binary | Checkbox |
Check this box if your partner identifies as non-binary. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Your Partner's Name | ||
| Q37.Title_Mr | CheckBox | |
| Q37.Title_Mrs | CheckBox | |
| Q37.Title_Miss | CheckBox | |
| Q37.Title_Ms | CheckBox | |
| Q37.Title_Mx | CheckBox | |
| Other Prefix | Text |
Provide any other title or prefix for your partner's name not listed in the options. Fill only if 'Q37.Title_Mx' is 'Yes'.
Depends on:
Q37.Title_Mx
|
| Family Name | Text |
Provide your partner's family name or surname. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| First Given Name | Text |
Provide your partner's first given name. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Second Given Name | Text |
Provide your partner's second given name. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Your Partner's Permanent Address | ||
| Address Line 1 | Text |
Enter the first line of your partner's permanent address. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Address Line 2 | Text |
Enter the second line of your partner's permanent address. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Address Line 3 | Text |
Enter the third line of your partner's permanent address, typically including suburb or city. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Postcode | Text |
Enter the postcode for your partner's permanent address. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Your Partner's Postal Address | ||
| Address Line 1 | Text |
Enter the first line of your partner's postal address. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Address Line 2 | Text |
Enter the second line of your partner's postal address. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Suburb/Town/City | Text |
Enter the suburb, town, or city for your partner's postal address. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Postcode | Text |
Enter the postcode for your partner's postal address. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Your Partner's Tax File Number Details | ||
| Partner No TFN | Checkbox |
Check this box if your partner does not have a Tax File Number (TFN). Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner Yes TFN | Checkbox |
Check this box if your partner has a Tax File Number (TFN) and you will provide it. Fill only if 'Do you have a partner?' is 'Yes'.
Depends on:
Yes
|
| Partner's Tax File Number Part 1 | Text |
Provide the first part of your partner's tax file number. Fill only if 'Partner Yes TFN' is 'Yes'.
Depends on:
Partner Yes TFN
|
| Partner's Tax File Number Part 2 | Text |
Provide the second part of your partner's tax file number. Fill only if 'Partner Yes TFN' is 'Yes'.
Depends on:
Partner Yes TFN
|
| Partner's Tax File Number Part 3 | Text |
Provide the third part of your partner's tax file number. Fill only if 'Partner Yes TFN' is 'Yes'.
Depends on:
Partner Yes TFN
|
| Your Signature and Date | ||
| Sign | Text | |
| Day of Signature | Text |
Please enter the day you are signing this form.
|
| Month of Signature | Text |
Please enter the month you are signing this form.
|
| Year of Signature | Number |
Please enter the year you are signing this form.
|
| Your Signature | Text |
Please provide your signature to declare the information in this form is complete and correct.
|
| Your Superannuation Contributions | ||
| Reportable Employer Superannuation Contributions | Number |
Enter the total amount of reportable employer superannuation contributions you made.
|
| Personal Deductible Superannuation Contributions | Number |
Enter the total amount of personal deductible superannuation contributions you made.
|
| Your Reportable Employer Superannuation Contributions | Number |
Please enter the total amount of your reportable employer superannuation contributions.
|
| Your Personal Deductible Superannuation Contributions | Number |
Please enter the total amount of your personal deductible superannuation contributions.
|
| Your Tax File Number Details | ||
| Q67Y_No | CheckBox | |
| You - Yes | Checkbox |
Check this box if you have a tax file number.
|
| Your TFN First Part | Text |
Please enter the first segment of your Australian Tax File Number. Fill only if 'You - Yes' is 'Yes'.
Depends on:
You - Yes
|
| Your TFN Second Part | Text |
Please enter the second segment of your Australian Tax File Number. Fill only if 'You - Yes' is 'Yes'.
Depends on:
You - Yes
|
| Your TFN Third Part | Text |
Please enter the third segment of your Australian Tax File Number. Fill only if 'You - Yes' is 'Yes'.
Depends on:
You - Yes
|
| Your TFN Fourth Part | Text |
Please enter the fourth segment of your Australian Tax File Number. Fill only if 'You - Yes' is 'Yes'.
Depends on:
You - Yes
|
| Your Taxable Income | ||
| Your Taxable Income | Number |
Enter your taxable income for the financial year.
|
| Your Received Income (if no tax return filed) | Number |
Enter the amount of income you received if you were not required to lodge an income tax return.
|
| Your Total Income | ||
| Your Total Income | Number |
Enter your total income, which is the sum of sections A, B, C, D, and E.
|
| Your Total Income F | Number |
Provide your total income, which is the sum of amounts from sections A, B, C, D, and E.
|
| Your Wish to Provide Bank Details | ||
| No | Checkbox |
Check this box if you do not wish to provide your bank details.
|
| Provide Bank Details | Text |
Enter 'Yes' if you wish to provide your bank details, or 'No' if you do not.
|
| Yes | Checkbox |
Check this box if you wish to provide your bank details.
|