This form contains 147 fields organized into 41 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Australian Citizenship by Birth
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.
Next Question Number Text
Enter the number of the next question to proceed to if you are not an Australian citizen born in Australia.
Australian Citizenship Status
Australian Citizenship Checkbox
Check this box if you are an Australian citizen.
Date Citizenship Granted Date
Provide the date your Australian citizenship was granted. Fill only if 'Australian Citizenship' is 'Yes'.
Max length: 10 characters
Depends on: Australian Citizenship
Cohabitation Status
No Checkbox
Check this box if you do not currently live in the same home as your partner. Fill only if 'Your partner's name' is filled
Depends on: Partner's Family Name, Partner's First Given Name, Partner's Second Given Name
Yes Checkbox
Check this box if you currently live in the same home as your partner. Fill only if 'Your partner's name' is filled
Depends on: Partner's Family Name, Partner's First Given Name, Partner's Second Given Name
Live With Partner - No Text
Enter your response if you do not live in the same home as your partner. Fill only if 'Your partner's name' is filled
Depends on: Partner's Family Name, Partner's First Given Name, Partner's Second Given Name
Current Country of Residence
Australia Checkbox
Check this box if your current country of residence is Australia.
Other Checkbox
Check this box if your current country of residence is a country other than Australia.
Country of Residence Text
Please provide the name of the country where you currently live on a long-term basis.
Current Country of Residence (Details) Text
Please provide the full name of the country where you currently reside on a long-term basis, or any additional details if needed. Fill only if 'Other' is selected.
Depends on: Other
Current Residence Status Code
Current Residence Status Code Text
Enter the code that represents your current residence status.
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 and final part of your customer reference number.
Max length: 1 characters
Date of Birth
Date of Birth Date
Please enter your date of birth.
Max length: 10 characters
Email Address
Email Address Text
Please provide your email address.
Employer Details
Employer Name Text
Enter the full legal name of the employer. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Address Line 1 Text
Enter the first line of the employer's street address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Address Line 2 Text
Enter the second line of the employer's street address, if applicable. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Address Line 3 Text
Enter the third line of the employer's street address, which might include suburb or city. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Postcode Text
Enter the postcode associated with the employer's address. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Phone Number Text
Enter the employer's full phone number, including the area code. Fill only if 'Yes' is 'Yes'.
Max length: 10 characters
Depends on: Yes
Employment Start Date Date
Enter the date your employment with this employer started. Fill only if 'Yes' is 'Yes'.
Max length: 10 characters
Depends on: Yes
Employment End Date Date
Enter the date your employment with this employer ended. Fill only if 'Yes' is 'Yes'.
Max length: 10 characters
Depends on: Yes
First Country Lived In
DummyCalcQ19 Text
First Country Name Text
Please enter the name of the first country you lived in. Fill only if 'Yes, List all countries' is 'Yes'.
Depends on: Yes, List all countries
First Country Date From Date
Please provide the date you started living in this first country. Fill only if 'Yes, List all countries' is 'Yes'.
Max length: 10 characters
Depends on: Yes, List all countries
General
Instructions Button
Instructions Button
Q8.Address1 Text
Q8.Address2 Text
Q11GoToQ12.0 Button
Q11GoToQ12.1 Button
Q11GoToQ12.2 Button
Q12GoToQ15 Button
Q17GoToQ19 Button
Q20GoToQ23 Button
Print button Button
Clear button Button
Home Phone Number Details
Home Phone Number Text
Please enter your home phone number, including the area code.
Max length: 10 characters
My name Checkbox
Check this box if the home phone account is in your name.
My partner's name Checkbox
Check this box if the home phone account is in your partner's name. Fill only if 'Your partner's name' is filled
Depends on: Partner's Family Name, Partner's First Given Name, Partner's Second Given Name
Another name Checkbox
Check this box if the home phone account is in a name other than yours or your partner's.
Income From Work Question
No Checkbox
Check this box if you have not received any income from work other than self-employment in the last 12 weeks.
DummyCalcQ20 Text
Yes Checkbox
Check this box if you have received income from work other than self-employment in the last 12 weeks and need to provide details.
Lived Outside Australia Question
No, Go to next question Checkbox
Check this box if you have never lived outside Australia for any period.
Yes, List all countries Checkbox
Check this box if you have ever lived outside Australia for any period.
Mobile Phone Number Details
Mobile Number Text
Please provide your mobile phone number.
Max length: 10 characters
My name Checkbox
Check this box if the mobile phone account is in your name.
My partner's name Checkbox
Check this box if the mobile phone account is in your partner's name. Fill only if 'Your partner's name' is filled
Depends on: Partner's Family Name, Partner's First Given Name, Partner's Second Given Name
Another name Checkbox
Check this box if the mobile phone account is in a name other than your own or your partner's.
New Zealand Citizen Status
New Zealand Citizen Passport Holder Checkbox
Check this box if you are a New Zealand citizen who arrived in Australia on a New Zealand passport.
Date Arrived in Australia Date
Provide the date you arrived in Australia. Fill only if 'New Zealand Citizen Passport Holder' is 'Yes'.
Max length: 10 characters
Depends on: New Zealand Citizen Passport Holder
Other Name (Row 1)
Other Name Text
Please provide the other name you have been known by. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Type of Name Text
Please specify the type of other name, such as name at birth, alias, or previous married name. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Other Name (Row 2)
Other Name (Row 2) Text
Please enter the other name for this entry. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Type of Name (Row 2) Text
Please specify the type of this other name, such as name before marriage, alias, or foster name. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Other Residence Status
None of the above Checkbox
Check this box if your current residence status does not match Australian Citizenship, a New Zealand citizen, a permanent visa holder, or a temporary visa holder.
Other Residence Status Details Text
Please provide details about your current residence status if none of the above options apply to you. Fill only if 'None of the above' is 'Yes'.
Depends on: None of the above
Page 6
Q23 Text
Max length: 1 characters
Signature Text
Please provide your signature to confirm the declaration.
Declaration Date Date
Please provide the date you are making this declaration.
Max length: 10 characters
Partner's Customer Reference Number
Partner's Customer Reference Number - Segment 1 Text
Please enter the first segment of your partner's customer reference number.
Max length: 3 characters
Partner's Customer Reference Number - Segment 2 Text
Please enter the second segment of your partner's customer reference number.
Max length: 3 characters
Partner's Customer Reference Number - Segment 3 Text
Please enter the third segment of your partner's customer reference number.
Max length: 3 characters
Partner's Customer Reference Number - Segment 4 Text
Please enter the fourth segment of your partner's customer reference number.
Max length: 1 characters
Partner's Date of Birth
Partner's Date of Birth Date
Please provide your partner's date of birth.
Max length: 10 characters
Partner's Full Name
Partner's Family Name Text
Please enter your partner's family name.
Partner's First Given Name Text
Please enter your partner's first given name.
Partner's Second Given Name Text
Please enter your partner's second given name.
Partner's Title
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
Provide the partner's title if it is not Mr, Mrs, Miss, Ms, or Mx.
Period Not Living with Partner
Period From Date Date
Enter the start date of the period you were not living with your partner. Fill only if 'No' is 'Yes'.
Max length: 10 characters
Depends on: No
Period To Date Date
Enter the end date of the period you were not living with your partner. Fill only if 'No' is 'Yes'.
Max length: 10 characters
Depends on: No
Indefinite Checkbox
Check this box if the period of not living with your partner is indefinite. Fill only if 'No' is 'Yes'.
Depends on: No
Permanent Address
Address Line 1 Text
Please provide the first line of your permanent address, including house number and street name.
Address Line 2 Text
Please provide the second line of your permanent address, such as the suburb, town, or city.
Postcode Text
Please enter your permanent address postcode.
Max length: 4 characters
Permanent Visa Holder Status
A permanent visa holder Checkbox
Check this box if you are currently holding a permanent visa.
Permanent Visa Grant Date Date
Please provide the date when your permanent visa was granted. Fill only if 'A permanent visa holder' is 'Yes'.
Max length: 10 characters
Depends on: A permanent visa holder
Permanent Visa Subclass Number Text
Please enter the subclass number for your permanent visa. Fill only if 'A permanent visa holder' is 'Yes'.
Depends on: A permanent visa holder
Postal Address
Postal Address Line 1 Text
Enter the first line of your postal address.
Postal Address Line 2 Text
Enter the second line of your postal address.
Postal Address Line 3 Text
Enter the third line of your postal address, typically for city or state.
Postcode Text
Provide the postal code for your address.
Max length: 4 characters
Previous Names Inquiry
No Checkbox
Check this box if you have not been known by any other name.
Yes Checkbox
Check this box if you have been known by other names and need to provide details.
Other Name Text
Please enter any other name by which you have been known, such as a name at birth, an alias, an adoptive name, or a previous married name. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Reason for Not Living with Partner
Partner's illness Checkbox
Check this box if you are not living with your partner due to your partner's illness. Fill only if 'No' is 'Yes'.
Depends on: No
Your illness Checkbox
Check this box if you are not living with your partner due to your own illness. Fill only if 'No' is 'Yes'.
Depends on: No
Partner in prison Checkbox
Check this box if you are not living with your partner because your partner is in prison. Fill only if 'No' is 'Yes'.
Depends on: No
Partner's employment Checkbox
Check this box if you are not living with your partner due to your partner's employment. Fill only if 'No' is 'Yes'.
Depends on: No
Other Checkbox
Check this box if you are not living with your partner for any other reason not listed above. Fill only if 'No' is 'Yes'.
Depends on: No
Other Reason Text
Provide a brief description of the 'Other' reason why you are not living with your partner. Fill only if 'Other' is 'Yes'.
Depends on: Other
Details for Not Living with Partner Text
Provide detailed information explaining why you are not living with your partner. Fill only if 'Other' is 'Yes'.
Depends on: Other
Regular Working Days Question
No Checkbox
Check this box if you do not have regular working days with this employer, and proceed to the next question.
Yes Checkbox
Check this box if you have regular working days with this employer, and provide details by selecting the days you work.
Regular Working Days Details Text
Please provide details regarding your regular working days with this employer.
Relationship Status
Most Recent Reconciliation Date Date
Please provide the date you most recently got back together (reconciled) with your partner, if you have ever been separated. Fill only if 'Your partner's name' is filled
Depends on: Partner's Family Name, Partner's First Given Name, Partner's Second Given Name
Married Checkbox
Check this box if your current relationship status is married. Fill only if 'Your partner's name' is filled
Depends on: Partner's Family Name, Partner's First Given Name, Partner's Second Given Name
Married Date or Last Reconciled Date Date
Please provide the date you were married or the date you 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. Fill only if 'Your partner's name' is filled
Depends on: Partner's Family Name, Partner's First Given Name, Partner's Second Given Name
Registered Relationship Date or Last Reconciled Date Date
Please provide the date your relationship was registered or the date you 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 you are not married or in a registered relationship. Fill only if 'Your partner's name' is filled
Depends on: Partner's Family Name, Partner's First Given Name, Partner's Second Given Name
De Facto Relationship Start Date or Last Reconciled Date Date
Please provide the date you started your de facto relationship or the date you last reconciled with your partner. Fill only if 'De facto' is 'Yes'.
Max length: 10 characters
Depends on: De facto
Remunerative Allowance Amount
DummyCalcQ22 Text
Weekly Remunerative Allowance Amount Number
Please enter the amount of remunerative allowance paid per week. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Remunerative Allowances Question
No Checkbox
Check this box if you do not receive any remunerative allowances from this employer.
Yes Checkbox
Check this box if you receive remunerative allowances from this employer.
Second Country Lived In
Second Country Name Text
Please provide the name of the second country you have lived in. Fill only if 'Yes, List all countries' is 'Yes'.
Depends on: Yes, List all countries
Second Country Date From Date
Please provide the date you started living in the second country. Fill only if 'Yes, List all countries' is 'Yes'.
Max length: 10 characters
Depends on: Yes, List all countries
Temporary Visa Holder Status
Temporary Visa Holder Checkbox
Check this box if your current residence status is that of a temporary visa holder.
Temporary Visa Granted Date Date
Please provide the date your temporary visa was granted. Fill only if 'Temporary Visa Holder' is 'Yes'.
Max length: 10 characters
Depends on: Temporary Visa Holder
Temporary Visa Subclass Number Text
Please provide the subclass number of your temporary visa. Fill only if 'Temporary Visa Holder' is 'Yes'.
Depends on: Temporary Visa Holder
Third Country Lived In
Third Country Name Text
Please enter the name of the third country you have lived in. Fill only if 'Yes, List all countries' is 'Yes'.
Depends on: Yes, List all countries
Third Country Date From Date
Please provide the date you started living in this third country. Fill only if 'Yes, List all countries' is 'Yes'.
Max length: 10 characters
Depends on: Yes, List all countries
Travel History Outside Australia
No Checkbox
Check this box if you have not travelled outside Australia, including for short trips and holidays.
Not applicable - never travelled to Australia Checkbox
Check this box if you have never travelled outside Australia.
Yes Checkbox
Check this box if you have travelled outside Australia, including for short trips and holidays.
Travel Details Text
Provide any additional details or reference related to your travel outside Australia.
Year Last Entered Australia Number
Provide the year you last entered Australia. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Passport Number Text
Provide your passport number. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Passport Country of Issue Text
Provide the country that issued your passport. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Work Days
Monday Checkbox
Check this box if Monday is one of your regular working days with this employer. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Tuesday Checkbox
Check this box if Tuesday is one of your regular working days with this employer. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Wednesday Checkbox
Check this box if Wednesday is one of your regular working days with this employer. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Thursday Checkbox
Check this box if Thursday is one of your regular working days with this employer. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Friday Checkbox
Check this box if Friday is one of your regular working days with this employer. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Saturday Checkbox
Check this box if Saturday is one of your regular working days with this employer. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Sunday Checkbox
Check this box if Sunday is one of your regular working days with this employer. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Your Full Name
Family Name Text
Please enter your family name, also known as your surname.
First Given Name Text
Please enter your first given name.
Second Given Name Text
Please enter your second given name.
Your Title
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
Please provide your title if it is not listed among the options.