Form SA333, Claim for Carer Payment and Carer Allowance Completed Form Examples and Samples

View practical examples and samples of how to fill out Form SA333, Claim for Carer Payment and Carer Allowance. Learn how to accurately complete your application with our step-by-step guides.
Completed Form SA333 for Carer Payment and Carer Allowance

Source document used: Personal Carer's Caregiver Summary/Diary

Date: January 15, 2026. Note to social worker regarding my application for Sarah's care. My name is Elena Maria Rodriguez (CRN 123-456-789-0). I am applying for support for my mother, Mrs. Beatrice Maria Rodriguez, born 12/03/1950. She lives at 42 Maple Street, Apartment 3B, Melbourne, 3000. It has been a difficult year; she is quite frail. She requires the help of 1 person to move around the house, and she sometimes falls over, so we installed rails. Getting in and out of her chair is a struggle, requiring a lot of help. She has significant issues with vision and hearing, often needing help with medication and grooming. Sarah is usually aware of where she is, but her memory of recent events is sometimes poor. She has never wandered or threatened anyone, though she does sometimes seem depressed. I have provided full-time care for her at our home for the last 5 years. I am currently working as a part-time florist at 'Bloom & Grow' for about 12 hours per 4-week period. I am attaching my medical report (SA332(a)) and the income forms today, Jan 15th, 2026. My phone number is 0398765432.