Form SS241 - Referee's Report - Identification of a claimant Completed Form Examples and Samples
View practical examples and samples of how to fill out Form SS241 - Referee's Report - Identification of a claimant. Learn how to accurately complete your referee report with our step-by-step guides and data extraction examples.
Example: Filling Form SS241 - Referee's Report for Claimant Identification
How this form was filled:
This example demonstrates how an AI can accurately extract claimant identification details from an unstructured professional character reference email to populate Form SS241. By parsing the email's prose, the system identifies key identity attributes, professional credentials, and relationship history required for the official referee's report.
Source document used: Professional Character Reference Email
Dear Department of Human Services, I am writing this letter to formally confirm the identity of Mr. Marcus Julian Thorne, who has requested I act as his referee for his current benefit application. I have known Marcus personally for over 12 years, having been a close family friend since he relocated to the region. His reference number is 4452-9812-0034-7761. For the purpose of your records, Marcus was born on 14/05/1988 in Melbourne, Victoria. He currently resides at 42 Marigold Crescent, Hawthorn, 3122. During our long acquaintance, I have always known him by his current name and he has never used an alias or maiden name. As an established community leader, I am confirming these details based on my personal knowledge of his life and character. I certify that I am currently serving as the Lead Coordinator at the St. Jude Community Outreach Center, located at 12 High Street, where we manage various public records. For your verification processes, our ABN is 99 888 777 666. If you require further clarification regarding this reference, please do not hesitate to reach me at 03 5550 1234. I have signed the formal report document today, May 15, 2026, and look forward to the successful processing of his application. Sincerely, Dr. Eleanor Vance, Lead Coordinator, St. Jude Community Outreach Center.
Information used to fill out the document:
- Claimant Name: Marcus Julian Thorne
- Reference Number: 4452-9812-0034-7761
- DOB: 14/05/1988
- Address: 42 Marigold Crescent, Hawthorn, 3122
- Referee Details: Dr. Eleanor Vance, St. Jude Community Outreach Center
- Relationship: Personal, 12 years
- ABN: 99 888 777 666
- Verification Date: 15/05/2026
What this filled form sample shows:
- Contextual Extraction: AI identifies the claimant's name and DOB despite them being embedded in a conversational letter.
- Data Mapping: Successfully maps '12 years' of acquaintance to the form's 'Years Known Claimant' requirement.
- Form Normalization: Automatically splits the long Reference Number into the four distinct parts required by Form SS241.
- Reference Verification: Logic recognizes the context of 'personal knowledge' versus 'organisation records' to select the correct checkbox.
Form specifications and details:
| Form Name: | Form SS241 - Referee's Report - Identification of a claimant |
| Document Format: | PDF Government Form |
| Use Case: | Identity Verification |
| Target Audience: | Authorized Referees |
| Categories: | identification forms, VA claim forms |
| Created: | May 19, 2026 06:46 PM |