D]ul u assi - Services Australia · D]ul u assi. Returning your form(s) Meta tibg]at lura l-formola...

1 of 33Mod(iA)MT.1707

Income and assetsD]ul u assi

Returning your form(s)Meta tibg]at lura l-formola tieg]ek

Filling in this formMili ta’ din il-formola

Purpose of this formL-g]an ta’ din il-formola

This form is part of your claim for an Australian payment.

The information in this form is used to calculate your rate of payment of Australian Pension or review your entitlement under Australian social security law.

Din il-formola hi parti mill-klejm tieg]ek g]all-pagament Awstraljan.

It-tag]rif f’din il-formola jintu\a biex na]dmu r-rata tal-pagamenti tieg]ek tal-Pensjoni Awstraljana jew biex nirrevedu l-intitolament tieg]ek skont il-li[i tas-sigurtà so`jali Awstraljana.

Check that all required questions are answered and that all forms are signed and dated.

Important Note: You must return all forms and all supporting documents and lodge them together. If you do not return all documents, your claim may not be accepted. The only exceptions will be if you are waiting for medical evidence or statements and other forms from a third party.

You can return forms and any supporting documents:

In person/by post – to the Maltese Social Security office.

The Maltese Social Security office will copy original documents for you and return them to you. The claim forms do not need to be copied. If you do copy the claim forms, please ensure you keep a copy, not the original. The Maltese Social Security office will forward all forms and supporting documentation to the Department of Human Services International Services in Australia.

ContinuedJitkompla

• Please use black or blue pen.

• Print in BLOCK LETTERS.

• Mark boxes like this with a tick or .

• Where you see a box like this Go to 5 skip to the question number shown. You do not need to answer the questions in between.

• Jekk jog][bok u\a pinna sewda jew blu.

• Ipprintja b’ITTRI KBAR.

• Immarka kaxxa b]al din b’sinjal jew .

• Meta tara kaxxa b]al din Mur g]al 5 aqbe\ g]all-mistoqsija skont in-numru indikat. M’g]andekx b\onn twie[eb il-mistoqsijiet ta’ bejniethom.

Important Note: You must return this form with your claim form and all other supporting documents and lodge them at the same time. If you do not return all documents, your claim may not be accepted. The only exceptions will be if you are waiting for medical evidence or statements and other forms from a third party.

Nota Importanti: Int trid tirritorna din il-formola mal-klejm tieg]ek u d-dokumenti l-o]ra kollha ta’ sostenn u titfag]hom fl-istess ]in. Jekk ma tirritornax id-dokumenti kollha, g]andu mnejn li l-klejm tieg]ek ma ti[ix a`èttata. L-uniì e`èzzjonijiet ser ikunu jekk int qed tistenna g]al evidenza jew stejtments u formoli mediì o]ra minn partijiet terzi.


Meta tibg]at lura l-formola tieg]ek

For more informationG]al aktar tag]rif

Ara li l-mistoqsijiet kollha me]tie[a [ew imwie[ba u li l-formoli kollha huma ffirmati u datati.

Nota Importanti: Int trid bilfors tibg]at lura l-formoli kollha u d-dokumenti kollha ta’ evidenza u titfag]hom flimkien. Jekk ma tirritornax id-dokumenti kollha, g]andu mnejn li l-klejm tieg]ek ma ti[ix a`èttata. L-uniì e`èzzjonijiet ser ikunu jekk int qed tistenna g]al evidenza jew stejtments u formoli mediì o]ra minn partijiet terzi.

Int tista’ tibg]at lura formoli u kwalunkwe dokument ta’ evidenza:

Personalment/bil-posta – lill-uffi``ju tas-Sigurtà So`jali Maltija.

L-uffi``ju tas-Sigurtà So`jali Maltija ser jikkopjalek id-dokumenti ori[inali u jag]tihomlok lura. M’hemmx g]alfejn li kkupjar tal-formoli tal-klejm. Jekk tikkopja il-formola tal-klejm, jekk jog][bok ara li \\omm kopja, mhux l-ori[inal. L-uffi``ju tas-Sigurtà So`jali Maltija ser jg]addi l-formoli u d-dokumentazzjon kollha ta’ sostenn lid-Department of Human Services International Services fl-Awstralja.

Onlajn – issottometti d-dokumenti tieg]ek onljan (barra d-dokument tal-identità). G]al aktar tag]rif dwar kif ta`èssja Kont Onlajn, jew kif titfa’ dokumenti onlajn, mur fuq humanservices.gov.au/submitdocumentsonline

Bil-posta – ibg]at lura d-dokumenti tieg]ek billi tibg]athom lid-:

Department of Human ServicesInternational ServicesPO Box 7809Canberra BC ACT 2610Australia

Jekk tibg]at id-dokumenti ori[inali lilna, a]na se nag]mlu kopja u nibg]atulek lura d-dokumenti ori[inali.

Waqt li tista’ titfa’ l-formola tieg]ek direttament mag]na, jekk titfag]ha mal-uffi``ju tas-Sigurtà So`jali Maltija dan normalment ser jag]milha aktar fa`li u aktar ta’ malajr g]alik biex tirìevi deì\joni dwar il-klejm tieg]ek.

Call us Monday to Friday between 8.00 am and 5.00 pm (Hobart Time) on +61 3 6222 3455.

Information online – If you would like further information on Centrelink services and payments, you can go to our website humanservices.gov.au

~emplilna mit-Tnejn sal-{img]a bejn is-sig]at 0800 u 1700 (]in ta’ Hobart) fuq +61 3 6222 3455.

Informazzjoni onlajn – Jekk trid aktar tag]rif dwar is-servizzi u l-pagamenti ta’ Centrelink, int tista tmur fuq il-websajt tag]na f’ humanservices.gov.au

Online – submit your documents online (excluding identity documents). For more information about how to access an Online Account or how to lodge documents online, go to humanservices.gov.au/submitdocumentsonline

By post – return your documents by sending them to:

Department of Human ServicesInternational ServicesPO Box 7809Canberra BC ACT 2610Australia

If you send original documents to us, we will make copies and return the original documents to you.

While you can lodge your form direct with us, lodging with the Maltese Social Security office will normally make it easier and faster for you to receive a decision on your claim.

http://www.humanservices.gov.au/submitdocumentsonline

http://www.humanservices.gov.au

http://www.humanservices.gov.au

http://www.humanservices.gov.au/submitdocumentsonline


9 Your partner’s nameL-isem tas-sie]eb/sie]ba tieg]ek

Personal detailsDettalji Personali

10

3

Your partner’s date of birthId-data tat-twelid tas-sie]eb/sie]ba tieg]ek

Your Centrelink Reference Number (if known)In-Numru tieg]ek tar-Referenza ta’ Centrelink (jekk tafu)

4 Your contact phone numberIn-numru tat-telefown ta’ kuntatt tieg]ek

It is important that you include the complete number (including country and area codes) as we may need to contact you on these numbers.Hu importanti li int tinkludi n-numru kollu (inklu\ il-kodi`i tal-pajji\ u tal-erja) g]ax a]na g]andna mnejn ikollna b\onn nikkuntattjawk fuq dawn in-numri.

5 Do you have a partner (married, registered partner, or de facto of the opposite-sex or same-sex)?G]andek sie]eb/sie]ba (mi\\ewwe[/mi\\ew[a, sie]eb/sie]ba rre[istrat/a, jew de facto tas-sess oppost jew tal-istess sess)?

6 Please read this before answering the following questions.Jekk jog][bok aqra dan qabel ma twie[eb il-mistoqsijiet li [ejjin.

If you are CURRENTLY in a relationship, we require your partner’s details to assess your entitlement.Jekk int B}ALISSA tinsab f’relazzjoni, a]na g]andna b\onn id-dettalji tas-sie]eb/sie]ba tieg]ek biex nassessjaw l-intitulament tieg]ek.

7 Is your partner also claiming an Australian pension?Is-sie]eb/sie]ba tieg]ek qed jikklejmja/tikklejmja wkoll pensjoni Awstraljana?

1 Your nameIsmek

MrSur

MrsSinjura

MissSinjorina

MsMs

OtherIe]or

Family nameIsem tal-Familja

First given nameL-ewwel isem mog]ti

Second given nameIt-tieni isem mog]ti

2 Your date of birthId-data tieg]ek meta twelidt

Country ( ) Area code ( )Pajji\ Kodi`i tal-erja

NoLe

Go to 12Mur g]al 12

YesIva

Go to next questionMur g]all-mistoqsija li jmiss

NoLe

Go to 9Mur g]al 9

YesIva


8 Is your partner using this form or a separate form for aclaim or to provide their details?Is-sie]eb/sie]ba tieg]ek qed ju\a/tu\a din il-formola jew formola separata g]al klejm jew biex jag]ti/tag]ti d-dettalji dwarhom?

This formDin il-formola

Separate formFormola separata

Family nameIsem tal-Familja

First given nameL-ewwel isem mog]ti

Second given nameIt-tieni isem mog]ti

/ /Day/{urnata Month/Xahar Year/Sena

MrSur

MrsSinjura

MissSinjorina

MsMs

OtherIe]or


CLK0Mod(iA)MT 1707


11 Do you give your partner permission to make enquiries on your behalf with the Department of Human Services?Int tag]ti permess lis-sie]eb/sie]ba tieg]ek biex jistaqsi/ tistaqsi g]an-nom tieg]ek lid-Department of Human Services?

You can change this authority at any time.Tista’ tibdel din l-awtorità meta trid.

Give details in the next columnAg]ti dettalji fil-kolonna li jmiss

ANDU

Go to 14Mur g]al 14

12 Do you (and/or your partner) CURRENTLY receive any income from work other than self-employment?Int (u/jew is-sie]eb/sie]ba tieg]ek) B}ALISSA qed tir`ievu xi qlig] minn xi impjieg minbarra xog]ol fejn ta]dem g]al rasek?

EarningsD]ul

12 ContinuedJitkompla

NoLe

YesIva

NoLe

YesIva

NoLe

Date you plan to stop workingData meta bi]siebek tieqaf ta]dem

YesIva

1 Name of employerIsem tal-impjegatur

AddressIndirizz

Workplace (if different from your employer’s address)Post tax-xog]ol (jekk differenti mill-indirizz tal-impjegatur)

Job descriptionDeskrizzjoni tax-xog]ol

Who works for this employer?Min ja]dem g]al dan l-impjegatur?

Amount earned before tax and other deductionsAmmont li qlajt qabel it-taxxa u tnaqqis ie]or

CurrencyMunita

Do you plan to stop working soon?Bi]siebek tieqaf ta]dem dalwaqt?

Amount earned annually including all bonuses and additional payments, before tax and other deductionsAmmont li qlajt kull sena inklu\i l-bonusijiet u lpagamenti o]ra kollha, qabel it-taxxa u tnaqqis ie]or

Type of workTip ta’ xog]ol

YouInt

Your partnerSie]eb/Sie]ba

Full-timeFull-time

How many hours do you work?Kemm-il sieg]a ta]dem?

Part-timePart-time

per weekkull [img]a

per weekkull [img]a

per yearkull sena

CountryPajji\


Please attach a copy of your most recent payslip(s).Jekk jog][bok ehme\ kopja tal-aktar payslip(s) ri`enti tieg]ek.



If you (and/or your partner) work for more than 2 employers, attach a separate sheet with details.Jekk int (u/jew is-sie]eb/sie]ba tieg]ek) ta]dmu g]al aktar minn 2 impjegaturi, ehme\ karta separata bid-dettalji.

Do you (and/or your partner) receive a fringe benefit provided by this employer?Int (u/jew is-sie]eb/sie]ba tieg]ek) tir`ievu fringe benefit mog]ti minn dan l-impjegatur?


Please attach documents which indicate the type of fringe benefit and its value.Jekk jog][bok ehme\ dokumenti li jindikaw it-tip ta’ fringe benefit u l-valur tieg]u.

13

Fringe benefit means a benefit you receive as part of your earned income but not as a wage or salary (e.g. use of a car as part of a salary package). Fringe benefit ifisser benefi``ju li tir`ievi b]ala parti mid-d]ul tieg]ek li qlajt imma mhux b]ala paga jew salarju (e\. u\u ta’ karozza, b]ala parti mill-pakkett tas-salarju).

NoLe

YesIva

In the last 12 months, have you (and/or your partner) stopped working for any employers (including self-employment)?Fl-a]]ar 12-il xahar, int (u/jew is-sie]eb/sie]ba tieg]ek)waqaftu mix-xog]ol minn kwalunkwe impjegaturi (inklu\ xog]ol g]al raskom)?

Go to 17Mur g]al 17

14

NoLe

YesIva

Give details belowAg]ti d-dettalji hawn ta]t

ANDU

Please attach details which confirm you have stopped working for an employer (e.g. letter from employer).Jekk jog][bok ehme\ dettalji li jikkonfermaw li int waqaft ta]dem g]al xi impjegatur (e\ ittra ming]and impjegatur)

1 Name of employer/ Isem l-impjegatur

Address/ Indirizz

CountryPajji\

Who stopped this work?Min waqaf minn dan ix-xog]ol?

YouInt


Date last workedData ta’ meta ]dimt l-a]]ar

Date last paidData meta t]allast l-a]]ar



NoLe

Date you plan to stop workingData meta bi]siebek tieqaf ta]dem

YesIva

2 Name of employerIsem tal-impjegatur

AddressIndirizz

Workplace (if different from your employer’s address)Post tax-xog]ol (jekk differenti mill-indirizz tal-impjegatur)

Job descriptionDeskrizzjoni tax-xog]ol

Who works for this employer?Min ja]dem g]al dan l-impjegatur?

Amount earned before tax and other deductionsAmmont li qlajt qabel it-taxxa u tnaqqis ie]or

CurrencyMunita

Do you plan to stop working soon?Bi]siebek tieqaf ta]dem dalwaqt?

Amount earned annually including all bonuses and additional payments, before tax and other deductionsAmmont li qlajt kull sena inklu\i l-bonusijiet u lpagamenti o]ra kollha, qabel it-taxxa u tnaqqis ie]or

Type of workTip ta’ xog]ol

YouInt


Full-timeFull-time

How many hours do you work?Kemm-il sieg]a ta]dem?

Part-timePart-time

per weekkull [img]a

per weekkull [img]a

per yearkull sena

CountryPajji\



ContinuedJitkompla

If you (and your partner) stopped work with more than 2 employers, attach a separate sheet with details.Jekk int (u s-sie]eb/sie]ba tieg]ek) waqaftu ta]dmu minn ma’ aktar minn \ew[ impjegaturi, ehme\ karta separata bid-dettalji.

Have you (and/or your partner) received any redundancy payments since 20 September 2006?Int (u/jew is-sie]eb/sie]ba tieg]ek) ]adtu xi pagamenti g]ax tliftu x-xog]ol mhux tort tag]kom mill-20 ta’ Settembru 2006 sal-lum?

Have you (and/or your partner) received any leave entitlement payments?Int (u/jew is-sie]eb/sie]ba tieg]ek) ]adtu xi pagamenti tal-intitolament tal-lif?



Please attach details which confirm the redundancy payment (e.g. letter from employer).Jekk jog][bok ehme\ id-dettalji li jikkonfermaw il-pagament g]ax tliftu x-xog]ol mhux tort tag]kom (e\. ittra ming]and impjegatur).

Please attach details which confirm the leave entitlement payments (e.g. letter from employer).Jekk jog][bok ehme\ id-dettalji li jikkonfirmaw il-pagamenti tal-intitulament tal-lif (e\. ittra ming]and impjegatur).

15

16

NoLe

NoLe

YesIva

YesIva

Household contentsAffarijiet tad-dar

AmountAmmont

CurrencyMunita

What is your estimate of the net market value of your (and your partner’s) normal household contents and personal effects?X’inhi l-istima tal-valur nett tas-suq tal-affarijiet ordinarji taddar u dawk personali tieg]ek (u tas-sie]eb/sie]ba tieg]ek)?

17 Please read this before answering the following question.Jekk jog][bok aqra dan qabel ma twie[eb il-mistoqsijiet li [ejjin.

Market value is what you would get if you sold your household contents and personal effects. It is not the replacement or insured value.Household contents include• all normal furniture such as soft furnishings

(e.g. curtains)• electrical appliances (other than fixtures such as

stoves and built-in items)• antiques and works of art.Personal effects include• jewellery for personal use• hobby collections (e.g. stamps, coins).Il-valur tas-suq hu dak li taqla’ jekk tbig] l-affarijiet tad-dar u dawk personali. Mhuwiex il-valur biex tibdilhom jew tinxurjahom.L-affarijiet tad-dar jinkludu• g]amara normali b]al ng]idu a]na g]amara mhux

goffa (e\. purtieri)• affarijiet li ja]dmu bl-elettriku (barra minn affarijiiet

fissi jew imwa]]lin b]al kukers u affarijiet mibnija [ol-]ajt)

• affarijiet antiki u xog]ol tal-arti.Affarijiet personali jinkludu• [ojjelli g]all-u\u personali• kollezzjonijiet ta’ passatemp (e\. bolli u muniti).

2 Name of employer/ Isem l-impjegatur

Address/ Indirizz

CountryPajji\

Who stopped this work?Min waqaf minn dan ix-xog]ol?

YouInt


Date last workedData ta’ meta ]dimt l-a]]ar

Date last paidData meta t]allast l-a]]ar



14


Life insurance policiesPoloz tal-inxurjans fuq il-]ajja

18 Do you (and/or your partner) have any life insurance policies that can be cashed in?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom xi poloz tal-inxurjans fuq il-]ajja li jistg]u jissarfu fi flus?

Do NOT include details of life office or friendly society insurance bonds in this question. You will be asked about these in a later question.Tinkludix dettalji ta’ bonds ta’ inxurjans tal-life office jew tal-friendly society f’din il-mistoqsija, Int ser ti[i mistoqsi dwar dawn f’mistoqsija aktar tard.


NoLe

YesIva


ANDU

Please attach the policy document and the latest statement for each policy listed below.Jekk jog][bok ehme\ id-dokument tal-polza u tal-a]]ar stejtment g]al kull polza llistjata hawn ta]t.

1 Name of insurance companyIsem ta’ kumpanija tal-inxurjans

CurrencyMunita

Owned by:Ta’:You

IntYour partner

Sie]eb/Sie]ba

Policy numberNumru tal-polza

Surrender valueAmmont ta’ flus meta ti[bed il-polza


CurrencyMunita

Owned by:Ta’:You

IntYour partner

Sie]eb/Sie]ba



ContinuedJitkompla

If you require more space, attach a separate sheet with details.Jekk g]andek b\onn ta’ aktar spazju, ehme\ karta separata bid-dettalji.

Do you (and/or your partner) receive payments from an income protection policy?Int (u/jew is-sie]eb/sie]ba tieg]ek) qed tir`ievu pagamenti minn polza tal-protezzjoni tal-qlig]?


Please attach the policy document and the latest statement for this policy.Jekk jog][bok heme\ id-dokument tal-polza u l-a]]ar stejtment g]al din il-polza.

19

NoLe

YesIva


CurrencyMunita

Owned by:Ta’:You

IntYour partner

Sie]eb/Sie]ba




CurrencyMunita

Owned by:Ta’:You

IntYour partner

Sie]eb/Sie]ba



18


21 Have you (and/or your partner) a contract to have funeral services provided for which an agreed sum has already been paid to the provider or used to buy funeral bonds assigned to the provider?Int (u/jew is-sie]ba/sie]ba tieg]ek) g]andkom kuntratt biex ikollkom servizzi tal-funeral li g]alihom di[à ]allastu somma miftehma lill-provveditur jew li [iet u\ata biex tixtru bonds tal-funeral assenjati lill-provveditur?

22 Do you (and/or your partner) own any motor vehicles, boats, caravans or trailers?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom xi karrozzi, dg]ajjes, karavanni jew trejlers?

VehiclesVetturi

Do NOT include a vehicle, boat, caravan or trailer in which you live.TINKLUDIX vettura, dg]ajsa, karavann jew trejler li tg]ix fih.

1

Your shareIs-sehem

tieg]ek

%

Amount owingKemm g]andek tag]ti fuqu/fuqha

CurrencyMunita

Partner’s shareIs-sehem tas

sie] eb/sie]ba

%

Make (e.g. Toyota)Tip (p.e. Toyota)

Model (e.g. Corolla)Mudell (p.e. Corolla)

YearXahar

Market valueValur tas-suq


1 Name of companyIsem ta’ kumpanija

Name of productIsem tal-prodott

APIR code (if known)Kodi`i tal-APIR (jekk mag]rufa)

Your shareIs-sehem

tieg]ek

Purchase price including instalments but not interestIl-prezz ta’ kemm xtrajtu li jinkudi pagamenti bin-nifs imma mhux img]ax

%

Current valueValur kurrenti

CurrencyMunita

Partner’s shareIs-sehem tas- sie]eb/sie]ba

%


Name of productIsem tal-prodott


Your shareIs-sehem

tieg]ek

Purchase price including instalments but not interestIl-prezz ta’ kemm xtrajtu li jinkudi pagamenti bin-nifs imma mhux img]ax

%

Current valueValur kurrenti

CurrencyMunita

Partner’s shareIs-sehem tas-

sie] eb/sie]ba

%

Do you (and/or your partner) have any funeral bonds/funeral investments, including a pre-paid funeral?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom xi bonds tal-funeral/jew investimenti tal-funeral, inklu\i funeral im]allas minn qabel?


20

NoLe

YesIva

Give details belowAg]ti d-dettalji hawn ta]t Go to next question

Mur g]all-mistoqsija li jmiss

Please attach a copy of the contract.Jekk jog][bok heme\ kopja tal-kuntratt.

NoLe

YesIva


NoLe

YesIva



Bank accountsKontijiet bankarji

23 Give details of all your (and/or your partner’s) bank accounts, including term deposits, joint accounts and accounts you hold under any other name, inside and outside Australia.Ag]ti d-dettalji kollha tieg]ek tal-kontijiet tal-bank (u/jew tas- sie] eb/sie]ba tieg]ek) inklu\i depo\iti fissi g]al `ertu \mien, kontijiet kon[unti, u kontijiet f’kwalunkwe isem ie]or, [ewwa u barra l-Awstralja.

Please attach the latest statement for each account.Jekk jog][bok ehme\ l-a]]ar stejtment g]al kull kont.

1 Name of institutionIsem tal-istituzzjoni

Type of account (e.g. savings, cheque

Tip ta’ kont (e\. tat-tfaddil, ta`-`ekkijiet)

Account numberNumru tal-kont

Account balanceBilan` kurrenti

CurrencyMunita

Name of account holder(s)Isem tad-detentur(i) tal-kont






CurrencyMunita


ContinuedJitkompla


2

Your shareIs-sehem

tieg]ek

%


CurrencyMunita


sie] eb/sie]ba

%



YearXahar


3

Your shareIs-sehem

tieg]ek

%


CurrencyMunita


sie] eb/sie]ba

%



YearXahar


4

Your shareIs-sehem

tieg]ek

%


CurrencyMunita


sie] eb/sie]ba

%



YearXahar


22


Bonds and debenturesBonds u debentures

24 Do you (and/or your partner) have any bonds or debentures?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom xi bonds jew debentures?

Include investments inside and outside Australia.Do NOT include friendly society bonds or life insurance bonds. You will be asked about these in a later question.Inkludi investimenti [ewwa u barra l-Awstralja.Tinkludix bonds tal-friendly society jew bonds tal-inxurjans fuq il-]ajja. Int ser ti[i mistoqsi dwar dawn f’domanda o]ra aktar tard.

1 Type of investmentTip ta’ investiment

Name of companyIsem tal-kumpanija

Current amount investedAmmont kurrenti investit

CurrencyMunita

Your shareIs-sehem

tieg]ek

%Partner’s shareIs-sehem tas-

sie] eb/sie]ba

%


Name of companyIsem tal-kumpanija

Current amount investedAmmont kurrenti investit

CurrencyMunita

Your shareIs-sehem

tieg]ek

%Partner’s shareIs-sehem tas-

sie] eb/sie]ba

%


ContinuedJitkompla







CurrencyMunita







CurrencyMunita



NoLe

YesIva


ANDU

Please attach the latest statement for each investment listed below.Jekk jog][bok ehme\ l-aktar stejtment ri`enti g]al kull investiment illistjat hawn ta]t.

23


SharesIshma

26 Do you (and/or your partner) own any shares, options, rights, convertible notes, warrants or other securities LISTED on an Australian Stock Exchange (e.g. ASX, NSX, APX or Chi-X)* or a stock exchange outside Australia?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom xi ishma, options, drittijiet, convertible notes (noti konvertibbli), warrants jew sigurtajiet o]ra ILLISTJATI fuq il-Bor\a Awstraljana (p.e. ASX, NSX, APX, jew Chi-X)* jew xi bor\a barra l-Awstralja?

Include shares traded in exempt stock markets.Do NOT include:• managed investments• investments purchased with a margin loan.Inkludi ishma nnegozjati fi swieq e\entati tal-ishma.Tinkludix:• investimenti mmani[[jati• investimenti mixtrija b’mar[ni tas-self (margin loan).

1 Name of company/ Isem ta’ kumpanija

Type of share/investment (e.g. ordinary share, option)Tip ta’ ishma/ investiment (e\. ishma ordinarju, option)

ASX* code (if known)Kodi`i tal-ASX* (jekk tafu)

Your shareIs-sehem

tieg]ek

Current market value (if shareis NOT listed on the ASX*)Valur kurrenti tas-suq (jekk l-ishma MHUX illistjat fuq l-ASX*)

%Partner’s shareIs-sehem tas-sie]eb/sie]ba

%

Number of shares or other securitiesNumru ta’ ishma jew sigurtajiet o]ra

Country (if share is NOT listed on the ASX*)Pajji\ (jekk l-ishma MHUX illistjat fuq l-ASX*)

Money on loanFlus b’self

25 Do you (and/or your partner) have money on loan to another person or organisation?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom xi flus li sliftu lill-persuna jew organizzazzjoni o]ra?

Include all loans, whether they are made to family members, other people or organisations or trusts.Inkludu l-flus mislufa kollha, kemm jekk [ew mislufa lill-membri tal-familja jew lil nies jew organizzazzjonijiet jew fondi (trusts) o]ra.

If you (and/or your partner) have more than 2 loans, attach a separate sheet with details.Jekk int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom aktar minn 2 ammonti ta’ flus mislufa, ehme\ karta separata bid-dettalji.


NoLe

YesIva


AND/U

Please attach a document which gives details for each loan (if available).Jekk jog][bok ehme\ dokument li jag]ti dettalji g]al kull somma mislufa (jekk g]andek)


NoLe

YesIva


AND/U

Please attach the latest statement(s) detailing your share holding for each share listed below.Jekk jog][bok ehme\ l-a]]ar stejtment(ijiet) li juri dettalji ta’ kemm g]andek ishma g]al kull ishma li hu llistjat hawn ta]t.

1 Who did you lend the money to?Lil min slift il-flus?

Lent by youMislufa minnek

%

Current balance of loanBilan` kurrenti ta’ kemm slift

CurrencyMunita

Lent by your partner

Mislufa mis-sie]eb/sie]ba tieg]ek

%

Date lent/ Data meta slift Amount lent/ Kemm slift


2 Who did you lend the money to?Lil min slift il-flus?

Lent by youMislufa minnek

%

Current balance of loanBilan` kurrenti ta’ kemm slift

CurrencyMunita

Lent by your partner

Mislufa mis-sie]eb/sie]ba tieg]ek

%

Date lent/ Data meta slift Amount lent/ Kemm slift



2726 Do you (and/or your partner) own any shares, options or rights issued in a PUBLIC company NOT listed on any stock exchange, inside or outside Australia?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom xi ishma, options jew drittijiet li [ew ma]ru[a f’kumpanija PUBBLIKA MHUX illistjata fuq kwalunkwe bor\a [ewwa jew barra l- Awstralja?

Include shares traded in exempt stock markets.Do NOT include:• managed investments• investments purchased with a margin loan.Inkludi ishma nnegozjati fi swieq e\entati tal-ishma.Tinkludix:• investimenti mmani[[jati• investimenti mixtrija b’mar[ni tas-self (margin loan).


Your shareIs-sehem

tieg]ek

%

Current market valueValur kurrenti tas-suq

CurrencyMunita

Partner’s shareIs-sehem tas-sie]eb/sie]ba

%

Type of sharesTip ta’ ishma

Number of sharesNumru ta’ ishma


Your shareIs-sehem

tieg]ek

%

Current market valueValur kurrenti tas-suq

CurrencyMunita


%

Type of sharesTip ta’ ishma

Number of sharesNumru ta’ ishma


ContinuedJitkompla



NoLe

YesIva


AND/U

Please attach the latest statement(s) detailing your share holding for each share listed below.Jekk jog][bok ehme\ l-a]]ar stejtment(ijiet) ri`enti li juru n-numru ta’ ishma g]al kull ishma llistjati hawn ta]t.




Your shareIs-sehem

tieg]ek



%






Your shareIs-sehem

tieg]ek



%






Name of product (e.g. investment trust)Isem tal-prodott (e\. fond tal-investiment)

Type of product/option (e.g. balanced, growth)Tip tal-prodott/option (e\. ibbilan`jat, tat-tkabbir)

Your shareIs-sehem

tieg]ek

%

Current market value of investmentValur kurrenti tal-investiment

CurrencyMunita


sie] eb/sie]ba

%

APIR* code (if known)Kodi`i tal-APIR* (jekk mag]rufa)

Number (if applicable)Numru (jekk dan japplika g]alik)




Your shareIs-sehem

tieg]ek

%


CurrencyMunita


sie] eb/sie]ba

%



Managed investments and superannuationInvestimenti u superannwazzjoni mmani[[jati

28 Do you (and/or your partner) have any managed investments, inside or outside Australia?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom xi investimenti mmani[[jati, [ewwa jew barra l-Awstralja?

Include investment trusts, personal investment plans, life office and friendly society bonds.Do NOT include:• life insurance policies or superannuation and

rollover investments• investments purchased with a margin loan.*APIR is a commonly used code for fund managers in Australia to identify individual financial products.Inkludi fondi tal-investiment, pjani personali tal-investiment, bonds tal-life office u tal-friendly society.Tinkludix:• poloz tal-inxurjans fuq il-]ajja jew tas-

superannwazzjoni jew investimenti tat-tip rollover• Investimenti mixtrija b’margin loan.*APIR hi kodi`i komuni li tintu\a minn mani[ers tal-fondi fl-Awstralja biex jidentifikaw prodotti finanzjarji individwali.


NoLe

YesIva


AND/U

Please attach documents which show details for each investment listed below.Jekk jog][bok ehme\ dokumenti li juru d- dettalji ta’ kull investiment illistjat hawn ta]t.




Your shareIs-sehem

tieg]ek

%


CurrencyMunita


sie] eb/sie]ba

%





30 In the last 12 months, have you (and/or your partner) borrowed an amount which is secured against your home?Fl-a]]ar 12-il xahar int (u/jew is-sie]eb/sie]ba tieg]ek) isselliftu ammont li kien assigurat kontra darkom?

Include:• Home Equity Conversion Loan• Reverse Equity Mortgage.Do NOT include:• a mortgage taken out to purchase your home.Inkludu:• Konver\joni ta’ Self f’Ekwità tad-Dar (Home Equity

Conversion Loan)• Self garantit mis-Sehem fid-Dar ta’ Min Jissellef

(Reverse Equity Mortgage)Tinkludix:• ipoteka (mortgage) li ]adt biex tixtri d-dar tieg]ek


Name of the organisation agreement entered into withIsem l-organizzazzjoni li mag]ha d]alt fil-ftehim

Address of the organisationL-indirizz tal-organizzazzjoni

Entered into by:D]alt ma’ :

YouInt


CountryPajji\


29 Do you (and/or your partner) own any managed investments or securities purchased with a margin loan?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom xi investimenti mmani[[jati jew sigurtajiet mixtrija b’margin loan?

1 Name of margin loan companyIsem il-kumpanija tal-margin loan

Your shareIs-sehem tieg]ek

%

Current portfolioPortafoll kurrenti



%

Current margin loan balanceBilan` kurrenti tal-margin loan


NoLe

YesIva


ANDU

Please attach the latest statement detailing your margin loan(s) for each investment.Jekk jog][bok heme\ l-a]]ar stejtment li jag]ti dettalji tal-margin loan(s) tieg]ek g]al kull investiment.


NoLe

YesIva


AND/U

Please attach a copy of the loan agreement or contract.Jekk jog][bok heme\ kopja tal-ftehim jew il-kuntratt tas-self.

2 Name of margin loan companyIsem il-kumpanija tal-margin loan


%

Current portfolioPortafoll kurrenti



%

Current margin loan balanceBilan` kurrenti tal-margin loan


Do you (and/or your partner) have any money invested in Australian superannuation where the fund is still in accumulation phase and not paying a pension?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom flus investiti fis-superannwazzjoni Awstraljana fejn il-fond g]adu fil-fa\i ta’ akkumulazzjoni u mhux qed i]allas pensjoni?

Include:• superannuation funds such as retail, industry,

corporate or employer and public sector• retirement savings accounts• any money held in a Self Managed Superannuation

Fund (SMSF) and Small APRA Fund (SAF) if the funds are complying.

Inkludi• fondi tas-superannwazzjoni b]al tal-imnut (retail),

industrija, korporattiv jew ta' min i]addem u tas-settur pubbliku

• kontijiet tat-tfaddil ta' min jirtira• kwalunkwe flus mi\muma f'Self Managed

Superannuation Fund (SMSF) (Superannwazzjoni Awto[estita (SMSF)) u Small APRA Fund (SAF) (Fond |g]ir tal-APRA (SAF)) jekk il-fondi huma konformi.



YOU should answer this question ONLY if you (and/or your partner) are age pension age or claiming Age Pension.INT g]andek twie[eb din il-mistoqsija BISS jekk int (u/jew is-sie]eb/sie]ba tieg]ek) g]alaqtu l-età tal-pensjoni tal-età jew qed tikklejmjaw il-Pensjoni tal-Età.

See table below for age pension qualifying age.Ara t-tabella ta’ hawn ta]t g]all-età tal-pensjoni tal-età.

Date of birth Qualifying age

On or before 30 June 1952 You meet the age requirements now

1 July 1952 to 31 December 1953

65 years 6 months

1 January 1954 to 30 June 1955

66 years

1 July 1955 to 31 December 1956

66 years 6 months

From 1 January 1957 67 years

Data tat-twelid L-Età tal-eli[ibilità

Fil- jew qabel it-30 ta’ {unju 1952

Int tissodisfa r-rekwi\iti tal-età issa

mill-1 ta’ Lulju 1952 sal-31 ta’ Di`embru 1953

65 sena u 6 xhur

mill-1 ta’ Jannar 1954 sat-30 ta’ {unju 1955

66 sena

mill-1 ta’ Lulju 1955 sal-31 ta’ Di`embru 1956

66 sena u 6 xhur

Mill-1 ta’ Jannar 1957 67 sena


NoLe

YesIva

Give details on the next pageAg]ti dettalji fuq il-pa[na li jmiss

ANDU

Please attach the latest statement for each superannuation investment. If you have a SMSF or SAF, attach the financial returns and member statement for the fund.Jekk jog][bok heme\ l-a]]ar stejtment g]al kull investiment tas-superannwazzjoni. Jekk int g]andek SMSF jew SAF, heme\ id-dikjarazzjonijiet finanzjarji u l-istejtment tal-membri g]all-fond.




Income stream productsProdotti tal-fluss tad-d]ul


An income stream is a regular series of payments which may be made for a lifetime or fixed period by a financial institution or employer subject to Australian prudential regulations.Where the income stream is from a country other than Australia it will be assessed differently than if it were from a source inside Australia.An income stream may be payable by:• a financial institution• a retirement savings account• a superannuation fund• a Self Managed Superannuation Fund (SMSF)• a Small APRA Fund (SAF).Types of income streams include:• account-based pension (also known as allocated

pension)• market-linked pension (also known as term

allocated pension)• annuities• defined benefit pension (e.g. ComSuper pension,

State Super pension)• superannuation pension (non-defined benefit).Fluss tad-d]ul hi serje regolari ta’ pagamenti li g]andhom mnejn isiru g]al g]omrok jew g]all-perjodu fiss, minn isitituzzjoni finanzjarja jew minn impjegatur skont ir-regolamenti prudenzjali Awstraljani.Meta l-fluss tad-d]ul hu minn pajji\ ie]or minbarra l- Awstralja dan ser ji[i assessjat mod ie]or milli kieku kien minn sors [ewwa l-Awstralja.Fluss tad-d]ul (income stream) jista’ jit]allas minn:• istituzzjoni finanzjarja• kont tat-tfaddil tal-irtirar• fond tas-superannwazzjoni• Self Managed Superannuation Fund (SMSF)• Small APRA Fund (SAF)Tipi ta’ flussi tad-d]ul jinkludu:• account based pension (mag]ruf ukoll b]ala pensjoni

allokata)• market-linked pension (pensjoni marbut mas-suq)

(mag]rufa wkoll b]ala d]ul m]allas mill-fond tas-superannwazzjoni (term allocated pension)

• annwitajiet• pensjoni b’benefi``ju definit (p.e. pensjoni ComSuper,

pensjoni State Super)• pensjoni tas-superannwazzjoni (benefi``ju mhux

definit).

1 Name of institution/fund managerIsem l-istituzzjoni/mani[er tal-fond

Name of fundIsem tal-fond

Current market valueValur kurrenti tal-

Owned by:Ta’:

CurrencyMunita

YouInt


Product reference numberNumru tar-referenza tal-prodott

Date of joining/investmentData meta sirt membru/ investiment


2 Name of institution/fund managerIsem l-istituzzjoni/mani[er tal-fond

Name of fundIsem tal-fond

Current market valueValur kurrenti tal-

Owned by:Ta’:

CurrencyMunita

YouInt



Date of joining/investmentData meta sirt membru/ investiment



Do you (and/or your partner) receive income from any income stream products?Inti (u/jew is-sie]eb/sie]ba tieg]ek) ir`evejtu d]ul minn kwalunkwe prodott tal-fluss tad-d]ul?

32 32ContinuedJitkompla

ContinuedJitkompla

You (and/or your partner) will need to attach a Details of Income Stream Product form (SA330) or a similar schedule, for each Australian income stream product. The form or similar schedule must be completed by your product provider or the trustee of the Self Managed Superannuation Fund (SMSF) or Small APRA Fund (SAF) or the SMSF administrator.If you do not have this form, go to our website humanservices.gov.au/forms or call the Department of Human Services.Int (u/jew is-sie]eb/sie]ba tieg]ek) tridu tehm\u l-formola tad-Dettalji tal-Prodott tal-Fluss tad-D]ul (Details of Income Stream Product) (SA330) jew skeda simili, g]al kull prodott tal-fluss tad-d]ul Awstraljan. Din il-formola jew skeda simili jridu jimtlew mill-provveditur tal-prodott jew it-trustee tas-Self Managed Superannuation Fund (SMSF) jew is-Small APRA Fund (SAF) jew l-amministratur tas-SMSF.Jekk int m'g]andekx din il-formola, mur fuq il-websajt tag]na f' humanservices.gov.au/forms jew `empel lid-Department of Human Services.


NoLe

YesIva


ANDU

1 Name of product provider/SMSF/SAFIsem il-provveditur tal-prodott/SMSF/SAF

Type of income streamTip ta’ fluss tad-d]ul


Owned by:Ta’:

Commencement dateData tal-bidu

YouU

Your partnerUw partner


2 Name of product provider/SMSF/SAFIsem il-provveditur tal-prodott/SMSF/SAF

Type of income streamTip ta’ fluss tad-d]ul


Owned by:Ta’:

Commencement dateData tal-bidu

YouU

Your partnerUw partner


If you (and/or your partner) have more than 2 income stream products, attach a separate sheet with details.Jekk (int u jew is-sie]eb/sie]ba tieg]ek) g]andkom aktar minn 2 prodotti tal-fluss tad-d]ul, heme\ karta separata bid-dettalji.

http://www.humanservices.gov.au/forms





Other investmentsInvestimenti o]ra

33 Do you (and/or your partner) have any money invested in, or do you receive income from, any other investments not declared elsewhere on this form?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom flus investiti fil-, jew qed tir`ievu d]ul minn, kwalunkwe investimenti o]ra mhux iddikjarati band’o]ra fuq din il-formola?

Include all investments inside and outside Australia not declared elsewhere on this form.Do NOT include real estate inside or outside Australia, private trusts, private companies or business. You will be asked about these in later questions.Inkludi l-investimenti kollha [ewwa u barra l-Awstralja mhux iddikjarati band’o]ra fuq din il-formola.Tinkludix propjetà [ewwa jew barra l-Awstralja, fondi privati, kumpaniji jew negozji privati. Int ser ti[i mistoqsi dwar dawn f’mistoqsijiet li jidhru aktar tard.



CurrencyMunita

%

Current value of investmentValur kurrenti tal-investiment

Income received in last 12 monthsD]ul li da]]alt fl-a]]ar 12-il xahar


%

Name of organisation/companyIsem tal-organizzazzjoni/kumpanija



CurrencyMunita

%




%



NoLe

YesIva


ANDU

Please attach documents which show details for each investment listed below.Jekk jog][bok ehme\ dokumenti li juru dettalji ta’ kull investiment illistjat hawn ta]t.



CurrencyMunita

%




%



GiftingG]oti ta’ rigali

34 In the last five years have you (and/or your partner) given away, sold for less than their value, or surrendered a right to, any cash, assets, property or income?Fl-a]]ar 5 snin, int (u/jew is-sie]eb/sie]ba tieg]ek) tajtu, bg]ettu g]al inqas mill-valur tag]hom, jew `]adtu dritt g]al kwalunkwe cash, assi, propjetà jew d]ul?

Include forgiven loans and shares in private companies.Inkludi self ma]fur u ishma f’kumpaniji privati.


NoLe

YesIva


1 What you gave away or sold for less than its value (e.g. money, care, second home, land, farm)X’tajt jew bg]ett g]al inqas mill-valur tag]hom (e\. flus, kura, it-tieni dar, art, farma)

Date given or soldData mog]tija jew mibjug]a

Amount you received for the itemAmmont li da]]alt minn dan l-o[[ett

What it was worthKemm kien jiswa?

CurrencyMunita

Was this gift to a Special Disability Trust (SDT)?Dan kien rigal lil Fond Spe`jali tad- Di\abilità (Special Disability Trust) (STD)?

Your shareIs-sehem

tieg]ek


% %

YesIva

NoLe








CurrencyMunita


Your shareIs-sehem

tieg]ek


% %

YesIva

NoLe






CurrencyMunita


Your shareIs-sehem

tieg]ek


% %

YesIva

NoLe




1 Type of paymentTip ta‘ pagament

Received byIrèvut minn:

How often paid?Kemm spiss tit]allas?

Currency of paymentMunita tal-pagament

Amount of payment before deductionsAmmont ta’ pagament qabel it-tnaqqis

Paid in name ofIm]allas f’isem

Authority paying itL-Awtorità li ]allsitu

Country paying itPajji\ li jag]ti l-pagament

Reference numberNumru ta’ referenza

YouInt



Received byIrèvut minn:

How often paid?Kemm spiss tit]allas?

Currency of paymentMunita tal-pagament

Amount of payment before deductionsAmmont ta’ pagament qabel it-tnaqqis

Paid in name ofIm]allas f’isem

Authority paying itL-Awtorità li ]allsitu

Country paying itPajji\ li jag]ti l-pagament

Reference numberNumru ta’ referenza

YouInt


If you (and/or your partner) have more than 2 types of payments, attach a separate sheet with details.Jekk int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom aktar minn 2 tipi ta’ pagamenti, hem\u karta separata bid-dettalji.

Other pension-type payments from outside AustraliaPagamenti o]ra tat-tip tal-pensjoni minn barra l-Awstralja.

35 Do you (and/or your partner) receive income from outside Australia?Int (u/jew is-sie]eb/sie]ba tieg]ek) tirìevu d]ul minn barra l-Awstralja?

Include:• payments for retirement or old age• payments for disability or invalidity• payments for widowhood or survivorship• payments for children• superannuation payments• payments for war injury• payments for war service• payments as a war widow• war restitution payments• compensation payments• other pensions, benefits or allowances from outside

Australia.Inkludi:• pagamenti tal-irtirar jew tal-età anzjana• pagamenti g]ad-di\abilità jew invalidità• pagamenti g]ar-romol jew ta’ minn jibqa’ ]aj/]ajja• pagamenti g]at-tfal• pagamenti tas-superannwazzjoni• pagamenti ta’ korrimenti matul il-gwerra• pagamenti g]as-servizz tal-gwerra• pagamenti b]ala armla tal-gwerra• pagamenti tar-restituzzjoni tal-gwerra• pagamenti tal-kumpens• pensjonijiet, benefi``ji jew allowances o]ra minn

barra l-Awstralja.


NoLe

YesIva

Give details in the next columnAg]ti dettalji fil-kolonna li jmiss

ANDU

Please attach the most recent document showing payment details for each of the pensions, benefits or allowances paid (e.g. pension certificate).Jekk jog][bok ehme\ l-aktar dokument riènti li juri d-dettalji tal-pagament g]al kull pensjoni, benefi``ju jew allowance m]allsa (e\. èrtifikat tal-pensjoni)


Money from boarders and lodgersFlus minn boarders u lodgers

37 Do you (and/or your partner) receive money from any boarders or lodgers living with you?Int (u/jew is-sie]eb/sie]ba tieg]ek) tir`ievu flus ming]and boarders jew lodgers li jg]ixu mag]kom?

Include boarders or lodgers who live with you or in accommodation at the property you live in (e.g. granny flat).Do NOT include family members (e.g. son, daughter, parent).Inkludi boarders jew lodgers li jg]ixu mieg]ek jewf’akkomodazzjoni fil-propjetà li tg]ix fiha (e\. granny flat).Tinkludix membri tal-familja (e\. iben, bint, [enitur).

If you (and/or your partner) have more than 2 types of payments, attach a separate sheet with details.Jekk int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom aktar minn 2 tipi ta’ pagamenti, ehm\u karta separata bid-dettalji.

Will you (and/or your partner) be claiming any pension, benefit, allowance, superannuation, compensation or similiar payment in the next 12 months?Int (u/jew is-sie]eb/sie]ba tieg]ek) ser tikklejmjaw kwalunkwe pensjoni, benefi``ju, allowance, superannwazzjoni, kumpens jew pagament simili fit-12-il xahar li [ejjin?

36


NoLe

YesIva



Who is claiming this payment?Min ser jikklejmja dan il-pagament?

When are you going to claim?Meta ser tikklejma?

Country claiming fromPajji\ minn fejn tikklejmja

YouInt

Your partner Sie]eb/Sie]ba/ /

Day/{urnata Month/Xahar Year/Sena


NoLe

YesIva


1 Name of boarder or lodgerIsem tal-boarder jew lodger

CurrencyMunita

How often paidKemm spiss tit]allas

Date boarder or lodger started payingId-data meta l-boarder jew il-lodger beda j]allas

Relationship to you (e.g. friend, cousin)Kif ji[i minnek (e\. ]abib/a, ku[in/a)

Number of meals you provide each dayNumru ta’ ikliet li tag]ti kuljum

each daykuljum

Amount paid for board or lodgingKemm tit]allas g]all-bord jew g]all-lodgink



Who is claiming this payment?Min ser jikklejmja dan il-pagament?

When are you going to claim?Meta ser tikklejma?

Country claiming fromPajji\ minn fejn tikklejmja

YouInt

Your partner Sie]eb/Sie]ba/ /



Do you (and/or your partner) receive payments from Australian Government sources other than Centrelink income support payments?Int (u/jew is-sie]eb/sie]ba tieg]ek) tir`ievu pagamenti ming]and sorsi tal-Gvern Awstraljan minbarra l-pagamenti tas-sapport tad-d]ul ta’ Centrelink?

For example, an Australian family assistance payment.Pere\empju, pagament ta’ g]ajnuna g]all-familja Awstraljana.

38

If you (and/or your partner) have more than 2 payments, attach a separate sheet with details.Jekk int (u/jew is-sie]eb/sie]ba tieg]ek) tir`ievu aktar minn 2 pagamenti, heme\ karta separata bid-dettalji.


If you (and/or your partner) have more than 3 boarders or lodgers, attach a separate sheet with details.Jekk int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom aktarminn 3 boarders jew lodgers, ehme\ karta separata bid-dettalji.


CurrencyMunita





each daykuljum




CurrencyMunita





each daykuljum




NoLe

YesIva


AND/U

Please attach a letter or other document(s) that shows the reference number and details for each payment (other than payments made by us).Jekk jog][bok heme\ ittra jew dokument(i) o]ra li juru n-numru tar-referenza u d-dettalji ta’ kull pagament (barra mill-pagamenti li n]allsu a]na).


Who pays itMin i]allsu

Paid toJit]allas lil:

YouInt


Reference number (if known)Numru ta’ referenza (jekk mag]rufa)

Date commenced (if known)Data meta beda (jekk hi mag]rufa)





YouInt


Reference number (if known)Numru ta’ referenza (jekk mag]rufa)

Date commenced (if known)Data meta beda (jekk hi mag]rufa)



Other paymentsPagamenti o]ra

Give details on the next pageAg]ti dettalji fuq il-pa[na li jmiss


40 Do you (and/or your partner) receive any income from other sources, not previously mentioned on this form?Int (u/jew is-sie]eb/sie]ba tieg]ek) tirìevu kwalunkwe d]ul minn sorsi o]ra, li ma semmejthomx qabel f’din il-formola?

Include income from:• gratuities• other government departments (e.g. study

allowance, War Widow’s/ Service Pension)• match or sporting payments• other payments made from inside or outside

Australia• any other income you have not included elsewhere

on this form.Note: Income includes any payment in kind, such as non-monetary payments for services.Do NOT include compensation or damages payments. You will be asked about these in a later question.Inkludu d]ul minn:• flus li jit]allsu lil persuna li ser tirtira• dipartimenti o]ra tal-gvern (e\. allowance tal-istudju,

Pensjoni tal-Armla tal-Gwerra/tas-Servizz)• pagamenti ta’ xi log]ba jew ta’ xi attività sportiva• pagamenti o]ra li saru minn [ewwa jew barra l-

Awstralja• kwalunkwe d]ul ie]or li int ma nkludejtx band’o]ra fuq

din il-formola.Nota: D]ul jinkludi kwalunkwe pagament b’o[[etti, b]al ng]idu a]na pagamenti li ma jinvolvux flus g]as-servizzi.Tinkludix pagamenti ta’ kumpens jew ta’ dannu. Int ser ti[i mistoqsi dwar dawn f’mistoqsija aktar tard.

ANDU

Please attach documents which show details of the payment (e.g. statement from other Government departments).Jekk jog][bok ehme\ dokumenti li juru dettalji tal-pagament (e\. stejtment minn dipartimenti o]ra tal-Gvern).

NoLe

YesIva

If you (and/or your partner) have more than 3 lump sum payments, attach a separate sheet with details.Jekk int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom aktar minn 3 pagamenti ta’ somom f’daqqa, ehme\ karta separata bid-dettalji.

Lump sum paymentPagament ta’ somma f’daqqa



39 In the last 12 months, have you (and/or your partner) received a lump sum payment that is not declared elsewhere on this form?Fl-a]]ar 12-il xahar, int (u/jew is-sie]eb sie]ba tieg]ek) irèvejtu pagament ta’ somma f’daqqa li mhix iddikjarata band’o]ra fuq din il-formola?

Do NOT include compensation, insurance or damages lump sum payments. You will be asked about these in a later question.Tinkludix kumpens, pagamenti ta’ somma f’daqqa ta’ inxurjans jew ta’ dannu. Int ser ti[i mistoqsi dwar dawn f’mistoqsija o]ra aktar tard.

NoLe

YesIva

1 Type of lump sum/ Tip ta’ somma f’daqqa

Payment received byPagament irèvut minn:

Date paidData meta t]allset

Amount paidAmmont im]allas

CurrencyMunita

YouInt

Your partnerSie]eb/Sie]ba/ /






CurrencyMunita

YouInt







CurrencyMunita

YouInt






41 Do you (and/or your partner) have any cash holdings?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom xi flus fl-idejn?

Cash holdingsKemm g]andkom flus fl-idejn

Include notes and coins you have in a safety deposit box, or you are holding instead of putting it into a bank account, or someone else is looking after for you.Do NOT include cash you have for shopping and other day to day expenses.Inkludi noti u muniti li g]andkom f’xi kaxxa tas-sigurtà tad-depo\ itu jew jekk qed i\\ommu flus minflok ma tpo[[uhom f’kont tal-bank, jew xi ]add ie]or qed jie]u ]siebhom.Tinkludix flus li g]andek b\onn biex tag]mel ix-xirja jew g]all-ispejje\ ta’ kuljum.

Your shareIs-sehem

tieg]ek

%

Total amountAmmont totali

CurrencyMunita


%

CompensationKumpens


42 Are you (and/or your partner) receiving or entitled to claim an insurance payout, damages, or compensation (if made wholly or partly in respect of lost earnings or lost capacity to earn resulting from personal injury)?Int (u/jew is-sie]eb/sie]ba tieg]ek) qed tirìevu jew intom intitolati biex tikklejmjaw pagament tal-inxurjans, dannu, jew kumpens (jekk sar kollu jew parzjalment g]al d]ul mitluf jew telf ta’ ]ila li taqla’, kaw\a ta’ korriment personali)?

You will need to complete and attach a Compensation and damages form (Mod C). If you do not have this form, go to our website humanservices.gov.au/forms or call the Department of Human Services.Int trid timla u tehme\ formola tal- Kumpens u dannu (Mod C). Jekk int m'g]andekx din il-formola, mur fuq il-websajt tag]na f' humanservices.gov.au/forms jew èmpel lid-Department of Human Services.

NoLe

YesIva

NoLe

YesIva





YouInt


Amount received before tax and other deductionsAmmont li rèvejt qabel it- taxxa u tnaqqis ie]or

CurrencyMunita


If part of amount is for children – how muchJekk parti mill-ammont hu g]at-tfal - kemm




YouInt


Amount received before tax and other deductionsAmmont li rèvejt qabel it- taxxa u tnaqqis ie]or

CurrencyMunita


If part of amount is for children – how muchJekk parti mill-ammont hu g]at-tfal - kemm

If you (and/or your partner) have more than 2 other payments, attach a separate sheet with details.Jekk int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom aktar minn 2 pagamenti, ehme\ karta separata bid-dettalji.




PropertyPropjetà


43 Do you (and/or your partner) own or partly own any property inside or outside Australia, other than the home in which you live?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom jew g]andkom biss parti ta’ propjetà [ewwa jew barra l-Awstralja, barra d-dar li tg]ixu fiha?

You will need to complete and attach a Real estate details form (Mod R). A separate form must be used for each property. If you do not have this form, go to our website humanservices.gov.au/forms or call the Department of Human Services.Int trid timla u tehme\ formola tad-Dettalji tal-Propjetà (Mod R). Trid tintu\a formola separata g]al kull propjetà. Jekk int m'g]andekx din il-formola, mur fuq il-websajt tag]na f' humanservices.gov.au/forms jew èmpel lid-Department of Human Services.

NoLe

YesIva

Private trust/private company/businessFond privat/kumpanija privata/negozju


44 Are, or have you (and/or your partner), been involved in a private trust?Int, jew int (u/jew is-sie]eb/sie]ba tieg]ek) kontu involuti f’fond privat?

You may be, or have been:• a trustee• an appointor• a beneficiaryor have:• made a loan to a private trust• made a gift of cash, assets, or private property to a

private trust in the last 5 years• relinquished control of a private trust since

1 January 2002• a private annuity• a life interest• an interest in a deceased estate.Int g]andek mnejn, jew kont:• depo\itarju/a• kustodju• benefi`jarju/ajew:• slift lil fond privat• tajt b]ala rigal flus fl-idejn, assi, propjetà privata lil

fond privat fl-a]]ar 5 snin• èdejt il-kontroll ta’ fond privat mill-1 ta’ Jannar 2002

‘l hawn• annwalità privata• interess g]al g]omrok• interess f’propjetà ta’ persuna li mietet.

You will need to complete and attach a Private Trust form (Mod PT). If you do not have this form, go to our website humanservices.gov.au/forms or call the Department of Human Services.Int ser ikollok timla u tehme\ formola tal-Fond Privat (Mod PT). Jekk int m'g]andekx din il-formola, mur fuq il-websajt tag]na f' humanservices.gov.au/forms jew èmpel lid-Department of Human Services.

NoLe

YesIva







46 Are you (and/or your partner) involved in any type of business?Int (u/jew is-sie]eb/sie]ba tieg]ek) tinsabu involuti f’xi tip ta’ negozju?

Include:• farming• self-employed• sole-trader• partnership• sub-contractor.Inkludi:• xog]ol fuq farma• xog]ol g]al rasek• tinnegozja wa]dek• fi s]ab• sotto-kuntrattur.

NoLe

YesJa


45 Are, or have you (and/or your partner), been involved in a private company?Int, jew int (u/jew is-sie]eb/sie]ba tieg]ek) qedin jew kontuinvoluti f’kumpanija privata?

You may be, or have been:• a director• a shareholderor have:• made a loan to a private company• transferred shares in a private company since

1 January 2002• made a gift of cash, assets or property to a private

company in the last 5 years.Int g]andek mnejn int, jew kont:• direttur• kellek ishmajew:• slift flus lill-kumpanija privata• ittrasferejt ishma f’kumpanija privata mill-1 ta’ Jannar

2002 ‘l hawn• tajt b]ala rigal flus fl-idejn, assi jew propjetà lill-

kumpanija privata fl-a]]ar 5 snin.

You will need to complete and attach a Private Company form (Mod PC). If you do not have this form, go to our website humanservices.gov.au/forms or call the Department of Human Services.Int ser ikollok timla u tehme\ formola tal-Kumpanija Privata (Mod PC). Jekk int m'g]andekx din il-formola, mur fuq il-websajt tag]na f' humanservices.gov.au/forms jew `empel lid-Department of Human Services.

NoLe

YesIva

You will need to complete and attach a Business details form (Mod F). If the business owns real estate you will also need to complete and attach a Real estate details form (Mod R) for each property. If you do not have these forms, go to our website humanservices.gov.au/forms or call the Department of Human Services.Int ser ikollok b\onn timla u tehme\ formola tad-Dettalji tan-Negozju (Mod F). Jekk in-negozju g]andu propjetà, int ser ikollok b\onn timla u tehme\ ukoll formola tad-Dettalji tal-Propjetà (Mod R) g]al kull propjetà. Jekk m'g]andekx dawn il-formoli, mur fuq il-websajt tag]na f' humanservices.gov.au/forms jew`empel lid-Department of Human Services.






AccommodationAkkomodazzjoni

48 Which of the following best describes where you live?Liema wa]da minn dawn li [ejjin tiddiskrievi l-a]jar mod fejn tg]ix?

In a place where you pay private rent or board and lodgingF’post fejn qed t]allsu l-kera privata jew bord jew qed tillo[[jaw.

In a retirement villageF’villa[[ tal-irtirar

Other (give details below)Ie]or (Ag]ti d-dettalji hawn ta]t)

In a home you (and/or your partner) own This includes paying it off (mortgage).F’dar li hi tieg]ek (u/jew tas-sie]eb/sie]ba tieg]ek). Dan jinkludi jekk g]adkom qed t]allsuha (ipoteka).

Go to 49Mur g]al 49

In accommodation which you have the right to use free for lifeSuch as a granny flat to use for life.F’akkomodazzjoni li int g]andek id-dritt tu\aha g]al g]omrok bla ]las.B]al ng]idu a]na l-u\u ta’ granny flat g]al g]omrok.

In a residential aged care home (nursing home or hostel) which provides nursing careF’dar ta’ kura residenzjali tal-anzjani (nersink home jew ]ostel) li tipprovdi kura tan-nersink

Go to 63Mur g]al 63

Go to 53Mur g]al 53

Go to 55Mur g]al 55

Go to 56Mur g]al 56

Go to 63Mur g]al 63

1 Description of assetDeskrizzjoni tal-assi

Current market valueIl-valur kurrenti tas-suq

Asset owned byL-assi huma ta’:

CurrencyMunita

YouInt





CurrencyMunita

YouInt





CurrencyMunita

YouInt


Other assetsAssi o]ra



47 Do you (and/or your partner) own or partly own any other assets not previously mentioned on this form?Int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom jew g]andkom biss parti ta’ assi o]ra li ma kontx semmejt qabel fuq din il- formola?

Include assets inside or outside Australia.Inkludi assi [ewwa jew barra l-Awstralja.

If you (and/or your partner) have more than 3 other assets, attach a separate sheet with details.Jekk int (u/jew is-sie]eb/sie]ba tieg]ek) g]andkom aktar minn 3 assi o]ra, ehme\ karta separata bid-dettalji.

NoLe

YesIva


Go to 63Mur g]al 63

Go to 63Mur g]al 63

52

54

Is the land on which your principal home stands on more than one title?Din l-art li fuqha hemm id-dar tieg]ek prinìpali g]andha aktar minn titlu wie]ed?

Do you still own your former home?Int g]ad g]andek id-dar li kellek qabel?

You will need to complete and attach a Real estate details form (Mod R). If you do not have this form, go to our website humanservices.gov.au/forms or call the Department of Human Services.Int trid timla u tehme\ formola tad-Dettalji tal-Propjetà (Mod R). Jekk int m'g]andekx din il-formola, mur fuq il-websajt tag]na f' humanservices.gov.au/forms jew èmpel lid-Department of Human Services.

Go to 63Mur g]al 63


Go to 63Mur g]al 63

How much?Kemm?

CurrencyMunita



53 Did you pay an entry contribution for your accommodation in the retirement village?}allast kontribuzzjoni biex tid]ol fl-akkomodazzjoni tieg]ek fil-villa[[ tal-irtirar?

Retirement villageVilla[[ tal-irtirar

NoLe

YesIva

NoLe

YesIva

NoLe

YesIva

Your principal homeId-dar prinìpali tieg]ek



Go to 51Mur g]al 51

49

50

51

Is your principal home, or the land on which your principal home stands, used for commercial (business) purposes?Id-dar prinìpali tieg]ek, jew l-art li hemm fuqha id-dar prinìpali tieg]ek, huma w\ati g]all-fini kummer`jali (negozju)?

Have you previously told Centrelink about your principal home, or the land on which it stands, which is used for commercial (business) purposes?Int kont av\jat lil Centrelink qabel dwar id-dar prinìpali tieg]ek, jew l-art li hi mibnija fuqha, li hi w\ata g]all-fini kummer`jali (negozju)?

Is the land on which your principal home stands more than two hectares (five acres) in area?L-art li hemm fuqha d-dar prinìpali tieg]ek tinsab fuq erja ta’ aktar minn \ew[ ettari (]ames acres)?


NoLe

YesIva

NoLe

NoLe

YesIva

Attach a copy of the latest balance sheet, profit and loss statements, tax returns and your (and/or your partner’s) latest personal tax return.Ehme\ kopja tal-a]]ar balance sheet, stejtment tal-profitt u tat-telf, formoli tat-taxxa, u l-a]]ar formola tat-taxxa personali tieg]ek (u/jew tas-sie]eb/sie]ba tieg]ek).



YesIva








Residential aged care home (nursing home or hostel) which provides nursing careDar ta’ kura residenzjali tal-anzjani (nersink home jew ]ostel) li jipprovdu kura tan-nersink

56

60

On what date did you move into your accommodation in the nursing home or hostel?Meta mort toqg]od fil-post tieg]ek fid-dar tan-nersink jew ]ostel?

What date did your partner leave your former home?F’liema data s-sie]eb/sie]ba tieg]ek ]alla/]alliet id-dar tieg]ek li kont tg]ix fiha qabel?




Go to 63Mur g]al 63

Go to 59Ga naar 62

57

58

59

Do you still own your former home?G]ad g]andek id-dar li kont tg]ix fiha qabel?

Do you have a partner?G]andek sie]eb/sie]ba?

Does your partner still live in your former home?Is-sie]eb/sie]ba tieg]ek g]adu/g]adha jg]ix/tg]ix fid-dar li kellek qabel?

Go to 63Mur g]al 63

NoLe

YesIva

NoLe

YesIva

NoLe

YesIva

Life interestInteress g]al g]omrok


Go to 63Mur g]al 63

55 Did you pay a sum of money and/or transfer any assets to another person in return for this accommodation for life?}allast somma flus u/jew ittrasferejt xi assi lil persuna o]ra b]ala skambju g]al din l-akkomodazzjoni g]al g]omrok?

AND/ORU/JEW

What asset was transferredLiema assi [ie ttrasferit

Market value of assets transferredValur tas-suq tal-assi ittrasferiti

CurrencyMunita

Go to 63Mur g]al 63

NoLe

YesIva

Name of person or organisationIsem tal-persuna jew l-organizzazzjoni

AddressIndirizz

CountryPajji\

Date paid/transferredData meta ]allast/jew ittrasferejt

Amount paidAmmont li ]allast

CurrencyMunita





ChecklistLista tal-i`èkjar

63 Use this checklist to remind you which documents you must attach.U\a din il-lista tal-i`èkkjar biex tfakkrek liema dokumenti int g]andek tehme\.If you are not sure, check the question to see if you should attach the documents.Jekk m’intix èrt/a, i`èkkja l-mistoqsija biex tara jekk hemi\tx id-dokumenti.

Where you are asked to supply original documents, only supply copies of original documents.Fejn [ejt mitlub/a tipprovdi d-dokumenti ori[inali, ipprovdi biss kopji tad-dokumenti ori[inali.

YouInt

Your partnerSie]eb/ Sie]ba

Most recent payslip(s)(If you answered Yes at question 12)

L-aktar payslip(s) riènti(Jekk we[ibt Iva f’mistoqsija 12)

Documents which show details of fringebenefits

(If you answered Yes at question 13)Dokumenti li juru d-dettalji tal-fringe

benefits(Jekk we[ibt Iva f’mistoqsija 13)

Documents which show details of stoppedworking for an employer

(If you answered Yes at question 14)Dokumenti li juru d-dettalji li waqaft ta]dem

ma’ xi impjegatur(Jekk we[ibt Iva f’mistoqsija 14)

Documents which show details ofredundancy payments

(If you answered Yes at question 15)Dokumenti li juru dettalji ta’ pagamenti

meta spi`àjt mix-xog]ol g]ax ma kienxhemm aktar xog]ol g]alik

(Jekk we[ibt Iva f’mistoqsija 15)

Documents which show details of leaveentitlement payments

(If you answered Yes at question 16)Dokumenti li juru d-dettalji ta’ pagamenti

tal-intitulament tal-lif(Jekk we[ibt Iva f’mistoqsija 16)

Latest insurance policy documents andlatest statements

(If you answered Yes at question 18)L-aktar dokumenti riènti tal-polza tal-

inxurjans u l-a]]ar stejtments(Jekk we[ibt Iva f’mistoqsija 18)

Go to 63Mur g]al 63


61

62

Did your partner leave your former home more than two years ago?Is-sie]eb/sie]ba tieg]ek ]allew id-dar tieg]ek li kont tg]ix fiha qabel aktar minn sentejn ilu?

Did you leave your former home more than two years ago?Int ]allejt id-dar tieg]ek li kont tg]ix fiha qabel aktar minn sentejn ilu?


Go to 63Mur g]al 63

You will need to complete and attach a Real estate details form (Mod R). If you do not have this form, go to our website humanservices.gov.au/forms or call the Department of Human Services.Int trid timla u tehme\ formola tad- Dettalji tal-Propjetà (Mod R). Jekk int m'g]andekx din il-formola, mur fuq il-websajt tag]na f' humanservices.gov.au/forms jew èmpel lid-Department of Human Services.

NoLe

YesIva

NoLe

YesIva






63 63

YouInt


Income protection policy documents andlatest statements

(If you answered Yes at question 19)Dokumenti dwar polza tal-protezzjoni

tad-d]ul u l-a]]ar stejtments.(Jekk we[ibt Iva f’mistoqsija 19)

Funeral Service contract(If you answered Yes at question 21)

Kuntratt tas-Servizz tal-Funeral(Jekk we[ibt Iva f’mistoqsija 21)

Latest bank account statements(If required at question 23)

L-a]]ar stejtments tal-kont tal-bank(Jekk hemm b\onn f’mistoqsija 23)

Latest statements for bonds and debentures(If you answered Yes at question 24)

L-a]]ar stejtments g]al bonds udebentures


Loan contract and latest statements(If you answered Yes at question 25)

Kuntratt ta’ self u l-a]]ar stejtments(Jekk we[ibt Iva f’mistoqsija 25)

Latest statements for shares LISTED on astock exchange

(If you answered Yes at question 26)L-a]]ar stejtments tal-ishma illistjati

fuq il-bor\a(Jekk we[ibt Iva f’mistoqsija 26)

Latest statements for shares NOT listedon a stock exchange

(If you answered Yes at question 27)L-a]]ar stejtments tal-ishma MHUX illistjati

fuq il-bor\a(Jekk we[ibt Iva f’mistoqsija 27)

Documents which show details ofmanaged investments

(If you answered Yes at question 28)Dokumenti li juru dettalji ta’ investimenti

mmani[[jati(Jekk we[ibt Iva f’mistoqsija 28)

Latest statement for margin loansfor each investment

(If you answered Yes at question 29)L-a]]ar stejment tal-margin loans

g]al kull investiment(Jekk we[ibt Iva f’mistoqsija 29)

Copy of the loan agreement or contract(If you answered Yes at question 30)

Kopja tal-ftehim jew kuntratt tas-self(Jekk we[ibt Iva f’mistoqsija 30)

YouInt


Latest statements for approved depositfunds, deferred annuities, rollover funds

and superannuation funds, tax returns andmember’s statements for

SMSF and SAF funds(If you answered Yes at question 31)

L-a]]ar stejtments g]all-fondi tad-depo\ituapprovat, annwitajiet deferiti, fondi ‘rollover’

u fondi tas-superannwazzjoni, karti tat-taxxa u stejtments tal-membri g]all-fondi

tas-SMSF u tas-SAF(Jekk we[ibt Iva f’mistoqsija 31)

Latest schedules for income streamproducts or a Details of income stream

product form (SA330)(If you answered Yes at question 32)

L-a]]ar skedi tal-prodotti tal-fluss tad-d]uljew formola tad-Dettalji tal-prodott

tal-fluss tad-d]ul (Details of incomestream product) (SA330)


Documents which show details ofother investments

(If you answered Yes at question 33)Dokumenti li juru dettalji

ta’ investimenti o]ra(Jekk we[ibt Iva f’mistoqsija 33)

Documents which show details ofpayments from outside Australia

(If required at question 35)Dokumenti li juru dettalji ta’ pagamenti minn

barra l-Awstralja(Jekk hemm b\onn f’mistoqsija 35)

Letters/documents with details of otherAustralian government payments

(If you answered Yes at question 38)Ittri/dokumenti bid-dettalji ta’ pagamenti

o]ra tal-gvern Awstraljan.(Jekk we[ibt Iva f’mistoqsija 38)

Documents which show details ofother payments

(If you answered Yes at question 40)Dokumenti li juru dettalji ta’ pagamenti o]ra


A Compensation and damages form(Mod C)

(If you answered Yes at question 42)Formola ta’ Kumpens u dannu (Mod C)


ContinuedJitkompla

ContinuedJitkompla


63

YouInt


A Real estate details form (Mod R)(If you answered Yes at questions 43, 46,

51, 52, 54, 61 and 62)Formola tad-Dettalji tal-propjetà (Mod R)

(Jekk we[ibt Iva f’mistoqsija 43, 46, 51,52, 54, 61 u 62)

A Private Trust form (Mod PT)(If you answered Yes at question 44)

Formola ta’ Fond Privat (Mod PT)(Jekk we[ibt Iva f’mistoqsija 44)

A Private Company form (Mod PC)(If you answered Yes at question 45)

Formola ta’ Kumpanija Privata (Mod PC)(Jekk we[ibt Iva f’mistoqsija 45)

A Business details form (Mod F)(If you answered Yes at question 46)

Formola tad-Dettalji tan-Negozju (Mod F)(Jekk we[ibt Iva f’mistoqsija 46)

A copy of the latest balance sheet, profitand loss statements, tax returns and your(and/or your partner’s) latest personal tax

return(If required at question 50)

Kopja tal-aktar balance sheet, stejtmentstal-profitt u tat-telf, formoli tat-taxxa ri`enti

u l-formola tat-taxxa personali l-aktar ri`entitieg]ek (u jew tas-sie]eb/sie]ba tieg]ek)

(Jekk hemm b\onn f’mistoqsija 50)

ContinuedJitkompla


64

Privacy and your personal informationYour personal information is protected by law (including the Privacy Act 1988) and is collected by the Australian Government Department of Human Services for the assessment and administration of payments and services. This information is required to process your application or claim. Your information may be used by the department, or given to other parties where you have agreed to that, or where it is required or authorised by law (including for the purpose of research or conducting investigations). You can get more information about the way in which the department will manage your personal information, including our privacy policy, at humanservices.gov.au/privacyPrivatezza u t-tag]rif personali dwarekIt-tag]rif personali dwarek hu protett mill-li[i (inklu\a l-Att tal-Privatezza 1988 (Privacy Act 1988)) u hu mi[bur mid-Department of Human Services tal-Gvern Awstraljan g]all-assessjament u l-amministrazzjoni tal-pagamenti u tas-servizzi.Dan it-tag]rif hu me]tie[ biex tkun ipproèssata l-applikazzjoni jew il-klejm tieg]ek.It-tag]rif dwarek jista’ jintu\a mid-dipartiment, jew jing]ata lill-partijiet o]ra meta taqbel li jsir dan, jew ikun mitlub jew awtorizzat mill-li[i (inklu\ g]all-finijiet ta’ rièrka jew biex isiru investigazzjonijiet).Int tista’ tikseb aktar tag]rif dwar il-mod kif id-dipartiment ser jimmani[[ja t-tag]rif personali dwarek, inklu\ il-politika tag]na dwar il-privateza, f’ humanservices.gov.au/privacy

IMPORTANT INFORMATIONTAG}RIF IMPORTANTI

StatementStejtment

65 StatementI declare that:• the information I have provided on this form is correct.I understand that:• giving false or misleading information is a serious

offence.• the Australian Government Department of Human

Services can make relevant enquiries necessary to make sure I receive the correct entitlement.

• I must return all supporting documents at the same time as I lodge my claim form. If I do not return all documents, my claim may not be accepted. The only exceptions will be if I am waiting for medical evidence or statements and other forms from a third party.

StejtmentJien niddikjara:• it-tag]rif li tajt fug din il-formola hu korrett. Nifhem li:• it-g]oti ta' tag]rif falz jew li qarrieqa hu offi\a serja.• Id-Department of Human Services tal-Gvern Awstraljan

jista' jag]mel it-tfittxija neèssarja u relevanti biex jara li nirìevi I-intitulament korrett.

• Irrid nirritorna d-dokumenti kollha ta’ sostenn fl-istess ]in hekk kif nitfa’ l-formola tal-klejm tieg]i. Jekk ma nibg]atx lura d-dokumenti kollha, g]andu mnejn li l-klejm tieg]i ma ti[ix a`èttata. L-uniì e`èzzjonijiet ser ikunu jekk inkun qed nistenna evidenza jew stejtments u formoli o]ra mediì minn partijiet terzi.

Your signatureIl-firma tieg]ek

Your partner’s signatureIl-firma tas-sie]eb/sie]ba tieg]ek

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http://www.humanservices.gov.au/privacy

http://www.humanservices.gov.au/privacy

D]ul u assi - Services Australia · D]ul u assi. Returning your form(s) Meta tibg]at lura l-formola...

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