This form contains 165 fields organized into 43 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Accommodation Type
Boarding house/hostel/private hotel, hospital or disability housing	Checkbox	Check this box if you or your partner live in a boarding house, hostel, private hotel, hospital, or disability housing.
Boarding Accommodation Type Details	Text	Enter any additional details regarding your boarding house, hostel, private hotel, hospital, or disability housing accommodation.
Private house or townhouse/unit/flat	Checkbox	Check this box if you or your partner live in a private house, townhouse, unit, or flat.
Community housing	Checkbox	Check this box if you or your partner live in community housing.
Defence housing	Checkbox	Check this box if you or your partner live in defence housing.
Caravan/cabin/mobile home	Checkbox	Check this box if you or your partner live in a caravan, cabin, or mobile home.
Boat	Checkbox	Check this box if you or your partner live on a boat.
Other	Checkbox	Check this box if your accommodation type is not listed as one of the other options.
Other Accommodation Type Details	Text	Provide specific details if your accommodation type is 'Other' and not listed in the options above. Fill only if 'Other' is 'Yes'. Depends on: Other
Assets Owned
Financial investments	Checkbox	Check this box if you own, partly own, or have a financial interest in financial investments, such as bank accounts, shares, or managed investments.
Property (other than home)	Checkbox	Check this box if you own, partly own, or have a financial interest in property other than the home you live in.
Motor vehicles	Checkbox	Check this box if you own, partly own, or have a financial interest in motor vehicles, including cars, motor cycles, or trailers.
Boats, caravans or motor homes	Checkbox	Check this box if you own, partly own, or have a financial interest in any boats, caravans, or motor homes.
Household contents and personal effects	Checkbox	Check this box if you own, partly own, or have a financial interest in household contents and personal effects.
Antiques and works of art	Checkbox	Check this box if you own, partly own, or have a financial interest in antiques and works of art.
Jewellery and hobby collections	Checkbox	Check this box if you own, partly own, or have a financial interest in jewellery for personal use and hobby collections (e.g., stamps, coins).
Other assets	Checkbox	Check this box if you own, partly own, or have a financial interest in any other assets not specifically listed, and provide details in the space below.
Other Asset Type	Text	Enter the type of other asset you own that is not listed above. Fill only if 'Other assets' is selected. Depends on: Other assets
Other Asset Details	Text	Provide a detailed description of the other asset you own. Fill only if 'Other assets' is selected. Depends on: Other assets
Board and Lodgings Payment Status
Total Board and Lodgings Charged	Number	Enter the total amount charged per day, week, fortnight, 4 weeks or calendar month for board and lodgings.
No	Checkbox	Check this box if you and your partner do not pay board and/or lodgings.
Yes	Checkbox	Check this box if you and your partner pay board and/or lodgings.
Business Involvement Status
No	Checkbox	Check this box if you and your partner are not involved in any type of business.
Yes	Checkbox	Check this box if you or your partner are involved in any type of business.
Centrelink Income Support Payment Details
DummyCalcQ22	Text
No	Checkbox	Check this box if you are not claiming or receiving a Centrelink income support payment.
Yes	Checkbox	Check this box if you are claiming or receiving a Centrelink income support payment.
Name of Payment	Text	Please provide the name of the Centrelink income support payment you are claiming or receiving. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Confirmation of Income Sources
Other Income Source Details	Text	Enter the details of any other income sources not explicitly listed in the options above.
No	Checkbox	Check this box if you did not tick any of the income source boxes at question 26.
Yes	Checkbox	Check this box if you ticked one or more of the income source boxes at question 26.
Consent to Link Records (Partner)
No	Checkbox	Check this box if your partner does not consent to Centrelink linking your and their customer records.
Yes	Checkbox	Check this box if your partner consents to Centrelink linking your and their customer records.
Consent to Link Records (You)
No	Checkbox	Check this box if you do not consent to Centrelink linking your and your partner's Centrelink customer records.
Yes	Checkbox	Check this box if you consent to Centrelink linking your and your partner's Centrelink customer records.
Contact Details
Home Phone Number	Text	Please enter your home phone number, including the area code. Max length: 10 characters
Mobile Phone Number	Text	Please enter your mobile phone number. Max length: 10 characters
Email Address	Text	Please enter your email address.
Current Market Value of Assets
Estimated Current Market Value	Number	Please enter your best estimate of the current market value of the assets you have ticked at question 28. Fill only if 'Financial investments', 'Property (other than home)', 'Motor vehicles', 'Boats, caravans or motor homes', 'Household contents and personal effects', 'Antiques and works of art', 'Jewellery and hobby collections', 'Other assets' is selected, any. Max length: 10 characters Depends on: Financial investments, Property (other than home), Motor vehicles, Boats, caravans or motor homes, Household contents and personal effects, Antiques and works of art, Jewellery and hobby collections, Other assets
Declaration
Sign	Text
Your Signature Date	Date	Enter the date you signed this declaration. Max length: 10 characters
Your Signature	Text	Please provide your signature in this field.
Partner's Signature Date	Date	Enter the date your partner signed this declaration. Fill only if 'Your partner's name' is filled Max length: 10 characters Depends on: Partner's Family Name, Partner's First Given Name, Partner's Second Given Name
Documents Provided
A full copy of your signed lease or tenancy agreement	Checkbox	Check this box if you are providing a full copy of your signed lease or tenancy agreement because you answered Yes at question 20. Fill only if 'No' is 'Yes'. Depends on: No
Payslip(s) for the last 8 weeks from each employer	Checkbox	Check this box if you are providing payslips for the last 8 weeks from each employer because you answered Yes at question 24. Fill only if 'question 24' is 'Yes'. Depends on: Yes
A letter or other document(s) showing details for each payment	Checkbox	Check this box if you are providing a letter or other document(s) showing details for each payment because you answered Yes at question 27. Fill only if 'question 27' is 'Yes'. Depends on: Yes
Fee Payment Start Date
Fee Payment Start Date	Date	Provide the date you and your partner started paying these fees. Max length: 10 characters
First Other Name
Other Name	Text	Please provide the other 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, alias, or previous married name. Fill only if 'Yes' is 'Yes'. Depends on: Yes
First Payment Details
Q23	Text
Type of Payment	Text	Specify the type of payment being reported. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Description	Text	Provide a detailed description of the payment, including any relevant information. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Amount	Number	Enter the monetary amount of the payment. Fill only if 'Yes' is 'Yes'. Max length: 10 characters Depends on: Yes
Frequency	Text	Indicate how often this payment is received (e.g., weekly, fortnightly, monthly). Fill only if 'Yes' is 'Yes'. Depends on: Yes
Formal Lease Agreement Status
No	Checkbox	Check this box if you and your partner do not have a formal lease or tenancy agreement.
Yes	Checkbox	Check this box if you and your partner have a formal lease or tenancy agreement.
General
Instructions	Button
Instructions	Button
Q13GoToQ21	Button
Q14GoToQ16	Button
Q15GoToQ17.0	Button
Q15GoToQ17.1	Button
Q18GoToQ20	Button
Q21GoToQ30	Button
22.GoToQ30	Button
Print button	Button
Clear button	Button
Home Ownership Status
No	Checkbox	Check this box if you do not live in a home that you own or jointly own with another person.
DummyCalcQ13	Text
Yes	Checkbox	Check this box if you live in a home that you own or jointly own with another person.
Income from Work Other Than Self-Employment Status
No	Checkbox	Check this box if you and your partner are not currently paid or expecting to be paid any income from work other than self-employment.
Yes	Checkbox	Check this box if you and/or your partner are currently paid or expecting to be paid income from work other than self-employment.
Other Names Inquiry
No	Checkbox	Check this box if you have not been known by any other name(s).
Yes	Checkbox	Check this box if you have been known by other name(s) and need to provide details below.
Other Name Details	Text	Please provide details regarding the other names you have been known by.
Page 1
Submission Deadline Date	Date	Please provide the date by which you will submit this form and all supporting documents. Max length: 10 characters
Contact for Arrangement Date	Date	Please provide the earliest date by which you will contact us to make an arrangement if you cannot meet the submission deadline. Fill only if 'Submission Deadline Date' is filled. Max length: 10 characters Depends on: Submission Deadline Date
Partner's Customer Reference Number
Customer Reference Number (CRN)	Text	Max length: 3 characters
Customer Reference Number (CRN)	Text	Max length: 3 characters
Customer Reference Number (CRN)	Text	Max length: 3 characters
Customer Reference Number (CRN)	Text	Max length: 1 characters
Partner's Date of Birth
Partner's Date of Birth	Date	Provide the date of birth for your partner. Max length: 10 characters
Partner's Name
Mr	Checkbox	Check this box if your partner's title is Mr.
Mrs	Checkbox	Check this box if your partner's title is Mrs.
Miss	Checkbox	Check this box if your partner's title is Miss.
Ms	Checkbox	Check this box if your partner's title is Ms.
Mx	Checkbox	Check this box if your partner's title is Mx.
Partner's Other Title	Text	Enter your partner's title if it is not one of the standard options provided (Mr, Mrs, Miss, Ms, Mx). Fill only if 'Mx' is selected. Depends on: Mx
Partner's Family Name	Text	Enter your partner's family name or surname.
Partner's First Given Name	Text	Enter your partner's first given name.
Partner's Second Given Name	Text	Enter your partner's second given name, if applicable.
Permission for Partner to Speak for Partner
No	Checkbox	Check this box if your partner does not give permission for you to speak to the service on their behalf.
Yes	Checkbox	Check this box if your partner gives permission for you to speak to the service on their behalf.
Permission for Partner to Speak for You
No	Checkbox	Check this box if you do not give permission for your partner to speak to us on your behalf.
Yes	Checkbox	Check this box if you give permission for your partner to speak to us on your behalf.
Privacy notice
Q34	Text
Readily Available Funds
Amount of Readily Available Funds	Number	Enter the total amount of money you have readily available, including savings, money in bank accounts, term deposits, shares, or safety deposit boxes. Max length: 10 characters
Relationship Status
Married	Checkbox	Check this box if you are currently married.
DummyCalcQ12	Text	Depends on: Married
Date Married or Reconciled	Date	Enter the date you were married or last reconciled with your partner. Fill only if 'Married' is 'Yes'. Max length: 10 characters Depends on: Married
Registered relationship	Checkbox	Check this box if your relationship is registered under Australian state or territory law.
Date Registered Relationship	Date	Enter the date your registered relationship started or was last reconciled with your partner. Fill only if 'Registered relationship' is 'Yes'. Max length: 10 characters Depends on: Registered relationship
De facto	Checkbox	Check this box if your relationship is similar to a married couple but is not married or a registered relationship.
Date De Facto Relationship	Date	Enter the date your de facto relationship started or was last reconciled with your partner. Fill only if 'De facto' is 'Yes'. Max length: 10 characters Depends on: De facto
Rent, Maintenance, or Site Fees
Rent, Maintenance, or Site Fees Amount	Number	Enter the total amount you and your partner pay for rent, maintenance, or site fees. Max length: 10 characters
Payment Frequency	Combobox	Enter the frequency of the rent, maintenance, or site fee payment (e.g., day, week, fortnight, 4 weeks, or calendar month). 4 Weeks Day Fortnight Month Week
Second Other Name
Second Other Name	Text	Please provide the second other name the individual has been known by. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Type of Second Other Name	Text	Please specify the type of this second other name, for example, previous married name. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Second Payment Details
Payment Type	Text	Please enter the type of this second payment. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Payment Description	Text	Please provide a description of this second payment. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Payment Amount	Number	Please enter the amount of this second payment. Fill only if 'Yes' is 'Yes'. Max length: 10 characters Depends on: Yes
Payment Frequency	Text	Please enter how often this second payment is received. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Separable Board and Lodgings Costs
No	Checkbox	Check this box if you cannot separate the amounts you (and your partner) pay for board and/or lodgings.
Total Board and Lodgings Charge Period (Cannot Separate)	Text	Enter the period for which the total board and lodgings are charged if you cannot separate the costs (e.g., day, week, fortnight, 4 weeks, or calendar month). Fill only if 'No' is 'No'. Depends on: No
Total Board and Lodgings Amount (Cannot Separate)	Number	Enter the total monetary amount paid for board and lodgings if you cannot separate the costs. Fill only if 'No' is 'No'. Max length: 10 characters Depends on: No
Total Board and Lodgings Payment Frequency (Cannot Separate)	Combobox	Enter the frequency of payment for the total board and lodgings amount if you cannot separate the costs (e.g., day, week, fortnight, 4 weeks, or calendar month). Fill only if 'No' is 'No'. 4 Weeks Day Fortnight Month Week Depends on: No
Yes	Checkbox	Check this box if you can separate the amounts you (and your partner) pay for board and/or lodgings into board (meals) and lodgings (accommodation only).
Board (Meals) Amount (Can Separate)	Number	Enter the monetary amount paid specifically for board (meals) if you can separate the costs. Fill only if 'Yes' is 'Yes'. Max length: 10 characters Depends on: Yes
Board (Meals) Payment Frequency (Can Separate)	Combobox	Enter the frequency of payment for the board (meals) amount if you can separate the costs (e.g., day, week, fortnight, 4 weeks, or calendar month). Fill only if 'Yes' is 'Yes'. 4 Weeks Day Fortnight Month Week Depends on: Yes
Lodgings (Accommodation) Amount (Can Separate)	Number	Enter the monetary amount paid specifically for lodgings (accommodation only) if you can separate the costs. Fill only if 'Yes' is 'Yes'. Max length: 10 characters Depends on: Yes
Lodgings (Accommodation) Payment Frequency (Can Separate)	Combobox	Enter the frequency of payment for the lodgings (accommodation only) amount if you can separate the costs (e.g., day, week, fortnight, 4 weeks, or calendar month). Fill only if 'Yes' is 'Yes'. 4 Weeks Day Fortnight Month Week Depends on: Yes
Sources of Payments or Income
Income from financial investments	Checkbox	Check this box if you receive income from financial investments, such as bank accounts, shares, or managed investments.
Payment from DVA	Checkbox	Check this box if you receive a payment from the Department of Veterans' Affairs (DVA).
Self-Employment Allowance	Checkbox	Check this box if you receive a Self-Employment Allowance.
Income from a rental property	Checkbox	Check this box if you receive income from a rental property.
Income from an income stream product	Checkbox	Check this box if you receive income from an income stream product.
Money from boarders or lodgers	Checkbox	Check this box if you receive money from any boarders or lodgers living with you.
Regular compensation/insurance payments	Checkbox	Check this box if you receive regular compensation or insurance payments.
Other Payment Type	Text	Provide the type of other payment or income source not listed in question 26.
Other sources of payments or income	Checkbox	Check this box if you receive payments or income from sources not listed above.
Details of Other Payments/Income	Text	Provide comprehensive details about the other payments or income sources you have indicated in question 26. Fill only if 'Other sources of payments or income' is 'Yes'. Depends on: Other sources of payments or income
SRSS Payment Claim Status
No	Checkbox	Check this box if you are not claiming or receiving an SRSS payment.
Claiming Method/Status	Text	Provide details regarding your method or status of claiming or receiving the SRSS payment.
Yes	Checkbox	Check this box if you are claiming or receiving an SRSS payment.
Third Payment Details
Third Payment Type	Text	Enter the type of the third payment received. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Third Payment Description	Text	Provide a detailed description of the third payment. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Third Payment Amount	Number	Enter the financial amount of the third payment. Fill only if 'Yes' is 'Yes'. Max length: 10 characters Depends on: Yes
Third Payment Frequency	Text	State how often the third payment is received. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Total Amount Charged
Total Amount	Number	Enter the total monetary amount being charged. Max length: 10 characters
Billing Period	Combobox	Enter the period for which the amount is charged, such as day, week, fortnight, 4 weeks, or calendar month. 4 Weeks Day Fortnight Month Week
Your Customer Reference Number
Customer Reference Number Part 1	Text	Please enter the first part of your customer reference number. Max length: 3 characters
Customer Reference Number Part 2	Text	Please enter the second part of your customer reference number. Max length: 3 characters
Customer Reference Number Part 3	Text	Please enter the third part of your customer reference number. Max length: 3 characters
Customer Reference Number Part 4	Text	Please enter the fourth part of your customer reference number. Max length: 1 characters
Your Date of Birth
Date of Birth	Date	Enter your date of birth. Max length: 10 characters
Your 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.
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.
Other Title	Text	Enter your title if it is not one of the provided options (Mr, Mrs, Miss, Ms, Mx). Fill only if 'Mx' is selected. Depends on: Mx
Family Name	Text	Enter your family name or surname.
First Given Name	Text	Enter your first given name.
Second Given Name	Text	Enter your second given name, if applicable.
Your Permanent Address
Permanent address line 1	Text	Enter the first line of your permanent address.
Permanent address line 2	Text	Enter the second line of your permanent address.
Permanent address line 3	Text	Enter the third line of your permanent address, such as suburb and state.
Postcode	Text	Enter your permanent address postcode. Max length: 4 characters
Your Postal Address
Address Line 1	Text	Enter the first line of your postal address.
Address Line 2	Text	Enter the second line of your postal address.
Address Line 3	Text	Enter the third line of your postal address, which may include suburb, city, or state.
Postcode	Text	Enter the postal code for your address. Max length: 4 characters

Mod P, Details of your partner Instructions