You are on page 1of 15

MOD

Income and Assets

iA

Return this form online or to one of our Service Centres by

/

/

Your Centrelink Reference Number

Purpose of this form

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

Filling in this form

• Please use black or blue pen.
• Print in BLOCK LETTERS.
• Mark boxes like this

with a  or .

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

Returning your form(s)

Check that all required questions are answered and that the form is signed and dated.
You can return this form and any supporting documents:
• online – submit your documents online. For more information about how to access an
Online Account or how to lodge documents online, go to
humanservices.gov.au/submitdocumentsonline
• by post.
• in person – if you are unable to submit this form and any supporting documents online
or by post, you can provide them in person to one of our Service Centres.
www.

For more information

Go to our website humanservices.gov.au or call us or visit one of our Service Centres.
ABSTUDY
1800 132 317
Employment Services
132 850
Parenting Payment
136 150
Youth and Students
132 490
www.

If you need a translation of any documents for our business, we can arrange this for you
free of charge.
To speak to us in languages other than English, call 131 202.
Note: Call charges apply – calls from mobile phones may be charged at a higher rate.
If you have a hearing or speech impairment, you can contact the TTY service on
Freecall™ 1800 810 586. A TTY phone is required to use this service.

Mod(iA).1412

1 of 15

g. Astra) 7 Your partner’s date of birth / / Current market value Amount owed $ $ Your share 8 Year % Partner’s share % Your partner’s Centrelink Reference Number (if known) If you (and/or your partner) have more than 2 motor vehicles. Other Family name First given name Second given name 2 What is your estimate of the current market value of your (and/or your partner’s) household contents and personal effects? Your date of birth / / 3 Your Centrelink Reference Number (if known) 4 Your contact phone number Current market value Amount owed $ $ Your share % Partner’s share % 11 Do you (and/or your partner) own.1 10 Please read this before answering the following question. partly own or have a ( 5 financial interest in any motor vehicles. Ford) Model (e.g. Include: • all furniture (including soft furnishings such as curtains). 9 Are you (and your partner) completing this form as part of a claim for a Centrelink payment? No Go to next question Yes Go to 14 CLK0Mod(iA) 1412 Mod(iA). Holden) Second given name Model (e. It is not the replacement or insured value.g.g.g. antiques and works of art • electrical appliances such as televisions and fridges • jewellery for personal use and hobby collections (e. Your name Mr Mrs Miss Ms The current market value of an item is what you would get if you sold it. Do NOT include: • fixtures such as stoves and built-in items.g. motor cycles or trailers. car) Make (e. motor cycles or trailers? ) Do you have a partner? No Go to 9 Yes Go to next question No Go to next question Yes Give details below 1 Type of asset (e. Focus) 6 Year Your partner’s name Mr Mrs Miss Ms Other Family name Current market value Amount owed $ $ Your share % Partner’s share % First given name 2 Type of asset (e. attach a separate sheet with details. car) Make (e. coins). stamps.1412 2 of 15 .g.

g. term deposits. Quintrex) Model (e. 1 % Partner’s share Name of bank. boat) Make (e. with the current balance in the type of currency in which it is invested. Type of account Balance of account $ Currency if not AUD Your share 3 Name of bank. caravans or motor homes. Do NOT include shares. joint accounts. Jayco) Model (e. caravan) Include savings accounts. Coastrunner) Year Current market value Amount owed $ $ Your share 2 Type of asset (e.g. No Go to next question Yes Give details below 1 Type of asset (e.g. partly own or have a financial 13 Give details below of all accounts held by you (and/or your interest in any boats or caravans/motor homes? partner) in banks. building society or credit union Account number (this may not be your card number) % Make (e. accounts you hold in trust or under any other name. We will convert this into Australian dollars. managed investments or an account used exclusively for funding from the National Disability Insurance Scheme. or money held in church or charitable development funds.g.g. Do NOT include a boat or caravan that is your principal home. building societies or credit unions. Accounts and term deposits outside Australia should be included. Heritage) Type of account Year Balance of account $ Current market value Amount owed $ $ Currency if not AUD Your share Your share % Partner’s share % Partner’s share % % Partner’s share % % Partner’s share % % 2 Name of bank.12 Do you (and/or your partner) own. building society or credit union Account number (this may not be your card number) If you (and/or your partner) have more than 2 boats. Copies can be provided. passbooks). attach a separate sheet with details. cheque accounts. building society or credit union Account number (this may not be your card number) Type of account Balance of account $ Currency if not AUD Your share Mod(iA).1412 3 of 15 . statements.g. Attach proof of all account balances (e. ATM slip.g.

Do NOT include: • friendly society bonds or life insurance bonds • details of home. Type of account Balance of account $ No Go to next question Yes Give details below Currency if not AUD Your share % Partner’s share Attach the policy document and the latest statement for each policy.13 Continued 14 Do you (and/or your partner) have a life insurance policy that can be cashed in? 4 Name of bank. whole of life. attach a separate sheet with details. mortgage or similar policies.g. % 1 Name of insurance company 5 Name of bank. building society or credit union Account number (this may not be your card number) Policy number Surrender value $ Your share Type of account % Partner’s share % 2 Name of insurance company Balance of account $ Policy number Currency if not AUD Your share % Partner’s share $ % Your share If you (and/or your partner) have more than 5 accounts. 4 of 15 % . car. contents. paid up and endowment policies). building society or credit union Account number (this may not be your card number) Include: • policies with a surrender value (e.1412 Surrender value % Partner’s share If you (and/or your partner) have more than 2 insurance policies. attach a separate sheet with details. Mod(iA).

We will convert this into Australian dollars. attach a separate sheet with details. Current value as per latest statement 1 Name of company Partner’s share Your share $ % % 2 Name of company Type of investment Current amount invested Purchase price incl. attach a separate sheet with details. Currency if not AUD $ Your share % Partner’s share % 17 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? 3 Name of company No Yes Type of investment Current amount invested Currency if not AUD $ Your share % Partner’s share % If you (and/or your partner) have more than 3 bonds or debentures. including a pre-paid funeral? Bonds refer to government and semi-government bonds. Do NOT include: • friendly society bonds. instalments but not interest APIR code Name of product Currency if not AUD $ Your share % Partner’s share % Purchase price incl. No Yes No Go to 18 Yes Give details below 1 Name of company Name of product Go to next question Give details below $ Attach a document which gives details for each bond or debenture. Include: • investments in and/or outside Australia. Mod(iA). with the current balance in the type of currency in which it is invested.1412 5 of 15 Go to next question Attach a copy of each contract. Bonds or debentures outside Australia should be included. instalments but not interest APIR code $ 2 Name of company Current value as per latest statement Type of investment Current amount invested $ Partner’s share Your share % % If you (and/or your partner) have more than 2 funeral bonds/ funeral investments. funeral bonds or life insurance bonds • accommodation bonds for residing in an aged care facility.15 Do you (and/or your partner) have any bonds or debentures? 16 Do you (and/or your partner) have any funeral bonds/ funeral investments. .

attach a separate sheet with details. Partner’s share % % If you (and/or your partner) have more than 3 share holdings. Amount lent / No 1 Name of company $ Lent by you $ % Lent by your partner Number of shares or other securities ASX code (if known) Country if not Australia Your share % 2 Who did you lend the money to? Partner’s share % Date lent / Amount lent / Current balance on loan % 2 Name of company $ Lent by you $ % Lent by your partner Number of shares or other securities ASX code (if known) Country if not Australia Your share % 3 Who did you lend the money to? Partner’s share % Date lent / Amount lent / Current balance on loan $ % 3 Name of company $ Lent by you % Lent by your partner Number of shares or other securities ASX code (if known) Country if not Australia Your share % If you (and/or your partner) have more than 3 loans. Mod(iA). person or organisation? convertible notes or other securities LISTED on an Australian Stock Exchange (e.1412 6 of 15 . Do NOT include: • managed investments • investments purchased with a margin loan. whether they are made to family members.g.18 Do you (and/or your partner) have money on loan to another 19 Do you (and/or your partner) own any shares. Do NOT include loans to get accommodation in a hostel. other people or organisations or trusts. Attach a document which gives details for each loan (if available). options. attach a separate sheet with details. ASX. No Go to next question Yes Give details below Include shares traded in exempt stock markets. 1 Who did you lend the money to? Date lent / Current balance on loan Go to next question Yes Give details below Attach the latest statement for each share holding. rights. APX or Chi-X) or a stock exchange outside Australia? Include all loans. NSX.

g. attach a separate sheet with details. balanced.g. investment trust) Type of product/option (e.20 Do you (and/or your partner) own any shares. 1 Name of company Type of shares Current market value Number of shares Your share $ No Go to next question Yes Give details below Attach a document which gives details (e. Do NOT include: • conventional life insurance policies • investments purchased with a margin loan. certificate with number of units or account balance) for each investment. Attach the latest statement detailing your share holding for each company (if available). NOT listed on a stock exchange? and/or outside Australia? Do NOT include: • managed investments • investments purchased with a margin loan.g. balanced. growth) Number of units APIR code (if known) Current market value Currency if not AUD 4 Name of company Type of shares Current market value $ Number of shares Your share $ Partner’s share % Your share % If you (and/or your partner) have more than 2 managed investments. growth) Number of units APIR code (if known) Current market value Currency if not AUD Number of shares Your share $ Partner’s share % % $ 3 Name of company Your share Type of shares Current market value Number of shares Your share $ % Partner’s share % 2 Name of company Partner’s share % % Name of product (e. Mod(iA). No Go to next question Yes Give details below Include: • investment trusts • personal investment plans • life insurance bonds • friendly society bonds. investment trust) Type of product/option (e. attach a separate sheet with details. options or rights in 21 Do you (and/or your partner) have any managed investments in PUBLIC companies. APIR code – is commonly used for fund managers to identify individual financial products.g. If you (and/or your partner) have more than 4 share holdings.1412 % Partner’s share 7 of 15 % .g. Partner’s share % % 1 Name of company 2 Name of company Type of shares Current market value Name of product (e.

Partner’s share % % If you (and/or your partner) have more than 2 margin loans. $ Partner’s share % % 2 Name of margin loan company Yes 24 In the last 12 months have you (and/or your partner) borrowed an amount which is secured against your home? Current portfolio APIR code (if known) Current margin loan balance Your share $ Include: • Home Equity Conversion Loan • Reverse Equity Mortgage. land. No No Address of the organisation 1 What you gave away or sold for less than its market value Postcode (e. money. Yes Give details below Yes Give details below Name of the organisation agreement entered into with sold for less than their market value. Date given or sold / 1 Name of margin loan company What it was worth / $ Your share What you got for it $ Partner’s share % % Current portfolio APIR code (if known) Was this gift to a Special Disability Trust (SDT)? No Current margin loan balance Your share If you (and/or your partner) have given away or sold for less than its market value more than 3 items. attach a separate sheet with details. 23 In the last 5 years have you (and/or your partner) given away. car.g.1412 Your partner If you (and/or your partner) have more than 1 loan. assets. What it was worth Your share You % Yes 8 of 15 . money. Include forgiven loans and shares in private companies. car. any cash. car. attach a separate sheet with details. farm) Attach the latest statement detailing your margin loan(s) for each investment. property or income? Go to next question Go to next question Attach a copy of the loan agreement or contract. second home. second home. land. land. second home.g. farm) Entered into by: Date given or sold / / What you got for it $ $ Partner’s share % % Was this gift to a Special Disability Trust (SDT)? No Yes 2 What you gave away or sold for less than its market value (e. attach a separate sheet with details. or surrendered a right to. farm) Date given or sold / / What you got for it $ What it was worth $ Your share Partner’s share % Was this gift to a Special Disability Trust (SDT)? No Mod(iA).22 Do you (and/or your partner) own any managed investments or 23 Continued securities purchased with a margin loan? No Go to next question Yes Give details below 3 What you gave away or sold for less than its market value (e. Do NOT include: • a mortgage taken out to purchase your home.g. money.

If you have a SMSF or SAF. reaching 67 years by 1 July 2023. go to our website humanservices. for each income stream product. Date of birth Qualifying age at 1 July 1952 to 31 December 1953 1 January 1954 to 30 June 1955 1 July 1955 to 31 December 1956 From 1 January 1957 65 years and 6 months 66 years 66 years and 6 months 67 years Do you (or your partner) have any money invested in superannuation where the fund is still in accumulation phase and not paying a pension? Do you (and/or your partner) receive income from any income stream products? Include: • superannuation funds such as retail. Your partner If you (and/or your partner) have more than 2 superannuation investments.1412 Commencement date Date of joining/investment 9 of 15 . Mod(iA). If you do not have this form.g. State Super pension) • superannuation pension (non-defined benefit). See table below. 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. 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. 1 Name of institution/fund manager 1 Name of product provider/SMSF/SAF Name of fund Type of income stream Product reference number Date of joining/investment / Current market value $ Product reference number / Owned by You Commencement date / Owned by: You / Your partner Your partner 2 Name of product provider/SMSF/SAF 2 Name of institution/fund manager Type of income stream Name of fund Product reference number Product reference number / Current market value $ / / Owned by: You / Your partner Owned by You If you (and/or your partner) have more than 2 income stream products. ComSuper pension. No Go to next question Yes Give details below You (and/or your partner) will need to attach a Details of income stream product form (SA330) or a similar schedule. Attach the latest statement for each superannuation investment. attach a separate sheet with details. From 1 July 2017. www. corporate or employer and public sector • retirement savings accounts • Self Managed Superannuation Funds (SMSF) and Small APRA Funds (SAF) if the funds are complying.25 Please read this before answering the following question. attach the financial returns and member statement for the fund. The qualifying age will then rise by 6 months every 2 years. the qualifying age for Age Pension will increase from 65 years to 65 years and 6 months. YOU should answer this question ONLY if you (and/or your partner) are age pension age or claiming Age Pension. industry. 26 Please read this before answering the following question. attach a separate sheet with details. No Go to next question Yes Give details below An income stream product is a regular series of payments which may be made for a lifetime or a fixed period by: • a financial institution • a retirement savings account • a superannuation fund • a Self Managed Superannuation Fund (SMSF) • a Small APRA Fund (SAF).au/forms or call us.gov.

GROSS income from employment includes amounts voluntarily salary sacrificed into superannuation and the value of employer provided fringe benefits. cyber currency (e. commercial licences (e.g. travellers cheques.g. antiques). Include: • all investments from outside Australia (including superannuation) not declared elsewhere on this form. time share. Partner’s share % % 30 Do you (and/or your partner) CURRENTLY receive any income from work other than self-employment? If you (and/or your partner) have more than 2 investments. stamps. bitcoin). any other investments not declared elsewhere on this form? Include taxi plates. coins. or do 28 Do you (and/or your partner) have any other assets (in or outside Australia) that you have not already advised us about on this form? you receive income from. wine. Do NOT include an account used for funding from the National Disability Insurance Scheme. attach a separate sheet with details. art. racehorses. fishing.27 Do you (and/or your partner) have any money invested in. No Go to 32 Yes Give details in the next column Attach the 2 most recent payslips from each employer. Mod(iA). private trusts. 1 Type of investment Current market value Amount owed Currency if not AUD Your share Partner’s share % Name of organisation/company % 2 Description of asset Current value of investment Income received in last 12 months Current market value Amount owed Currency if not AUD Your share Currency if not AUD Your share Partner’s share % Partner’s share % % 2 Type of investment % If you (and/or your partner) have more than 2 other assets. No Go to next question Yes Give details below No Go to next question Yes Give details below 1 Description of asset Attach a document which gives details for each investment.g. Name of organisation/company 29 Do you (and/or your partner) receive payments from an income protection policy? Current value of investment Income received in last 12 months Currency if not AUD Your share No Yes Go to next question Attach the policy document and the latest statement for this policy.1412 10 of 15 . attach a separate sheet with details. Do NOT include: • income from real estate in or outside Australia. greyhounds. hunting). private companies or business • social security payments • an account used exclusively for funding from the National Disability Insurance Scheme. collectables (e.

have you (and/or your partner) stopped working for any employers (including self-employment)? Who works for this employer? Is this work: Full-time Part-time You Your partner Seasonal No Go to next question Yes Give details below Casual Attach documents which confirm that you stopped work (e. 1 Employer’s name Yes Address 2 Employer’s name Address Postcode Phone number ( Postcode ) Phone number Who worked for this employer? You ( 2 Employer’s name ) Your partner Australian Business Number (ABN) Address Who works for this employer? Is this work: Full-time Part-time You Your partner Seasonal Casual Personnel. attach a separate sheet with details. use of a car as part of a salary package.g. Personnel. If you do not have this form.1412 ) 11 of 15 .gov.g. service or clock-card number Postcode Phone number Hours worked per fortnight per fortnight GROSS amount earned per fortnight (before tax and $ other deductions) per fortnight Is this your usual wage? No ( Who worked for this employer? You Your partner If you (and/or your partner) stopped working for more than 2 employers.au/forms or call us. Address No Go to next question Yes Attach details that indicate the type of fringe benefit and its value. Mod(iA). attach a separate sheet with details. Postcode Phone number ( ) Australian Business Number (ABN) 32 In the last 12 months. Yes If you (and/or your partner) currently get income from more than 2 jobs. letter from employer or Employment Separation Certificate form (SU001)). service or clock-card number Hours worked per fortnight per fortnight GROSS amount earned per fortnight (before tax and $ other deductions) per fortnight Is this your usual wage? No www. go to our website humanservices. and whether or not the amount provided is ‘grossed up’ or not ‘grossed up’. rent/mortgage paid)? 1 Employer’s name Fringe benefits – means a benefit received as part of earned income but not as a wage or salary.30 Continued 31 Do you (and/or your partner) get any fringe benefits provided by an employer (e.

Phone number ( ) Job description Mod(iA). any leave entitlement payments from an employer you have worked for? 2 Type of leave entitlement payment Include: • annual leave • maternity leave • long service leave or sick leave you received when you stopped work • entitlements that you cashed in before you stopped work • money in a long-service leave fund or scheme that you have not cashed in.gov.gov. letter from employer or Employment Separation Certificate form (SU001)). If you do not have this form. letter from employer or Employment Separation Certificate form (SU001)).au/forms or call us. Employer’s details Name of business 34 Have you (and/or your partner) received a redundancy payment Australian Business Number (ABN) in the last 2 years? Address No Go to next question Yes Give details below Attach documents which confirm any redundancy payments (e. No Go to next question Yes Give details below Amount (before tax and other deductions) Number of working days covered by the payment $ Date paid or date payable / / Leave entitlement for You Your partner Employer’s details Name of business Attach documents which confirm each leave entitlement payment (e. Australian Business Number (ABN) Address www.33 In the last 12 months. 1 Type of leave entitlement payment Postcode Amount (before tax and other deductions) Phone number Number of working days covered by the payment ( ) Job description $ Date paid or date payable / / Leave entitlement for You Your partner If you (and/or your partner) have more than 2 entitlements.au/forms or call us. go to our website humanservices. have you (and/or your partner) received or 33 Continued do you (and/or your partner) expect to receive.g. If you do not have this form. attach a separate sheet with details.1412 12 of 15 . go to our website humanservices. Postcode www.g.

or • New Enterprise Incentive Scheme (NEIS) Allowance. Include pensions from other countries.35 Do you (and/or your partner) receive payments from sources 36 Do you (and/or your partner) receive payments from an authority other than Centrelink income support payments? or agency outside Australia? For example: • a payment from Department of Veterans' Affairs (DVA). 1 Type of payment Who pays it? Country which pays it? Reference number (if known) Date commenced (if known) / Paid to: You Authority or agency which pays it? / Your partner Date commenced (if known) 2 Type of payment / Your partner Country which pays it? Reference number (if known) Date commenced (if known) / You You 2 Type of payment Who pays it? Paid to: / Paid to: / Authority or agency which pays it? Your partner If you (and/or your partner) receive more than 2 payments. benefits. Date commenced (if known) / / Paid to: You Your partner If you (and/or your partner) receive more than 2 payments from an authority or agency outside Australia. Note: You must include details of pensions. allowances. 1 Type of payment Attach a document from the issuing authority or agency which gives details including the amount in the foreign currency (e.1412 13 of 15 . or • Community Development Employment Projects (CDEP) wages. No Go to next question No Go to next question Yes Give details below Yes Give details below Attach a letter or other document(s) that shows the reference number and details for each payment (other than payments made by us). latest pension certificate) for each payment. allowances and other payments even if they are not taxable in the county of payment. attach a separate sheet with details. superannuation.g. attach a separate sheet with details. Mod(iA). compensation and war related payments.

parent/guardian). such as non-monetary payments for services • scholarships. educational assistance or allowance • any other income. attach a separate sheet with details. Amount paid per fortnight Date started paying $ / Your share 1 Type of payment / % Partner’s share % Who pays it? 2 Name of person Amount per fortnight Number of meals you provide each day Relationship to you Your share $ Partner’s share % % 2 Type of payment Amount paid per fortnight Date started paying $ / Your share / % Partner’s share Who pays it? % Amount per fortnight If you (and/or your partner) receive money from more than 2 people living with you. Do NOT include immediate family members (son. attach a separate sheet with details. Mod(iA). granny flat). No Go to next question Yes Give details below Include: • gratuities • match or sporting payments • other income or payment from other countries • payment in kind. daughter.g.37 Do you (and/or your partner) receive money from any boarders 39 Do you (and/or your partner) receive any payments from other or lodgers living with you? sources that you have not already advised us about on this form? Include boarders or lodgers who live with you or in accommodation at the property you live in (e. Who paid it? $ Amount per fortnight $ Type of lump sum Amount paid Who pays it? 14 of 15 % . insurance or damages lump sum payments • funding from the National Disability Insurance Scheme. attach a separate sheet with details. 1 Name of person Do NOT include funding from the National Disability Insurance Scheme. Your share $ Partner’s share % % 3 Type of payment 38 In the last 12 months. have you (or your partner) received a lump sum payment that you have not already advised on this form? Do NOT include: • compensation.1412 Your share Partner’s share % If you (and/or your partner) receive more than 3 types of payments. Number of meals you provide each day Relationship to you No Go to next question Yes Give details below Attach the most recent statement/certificate that gives details for each type of payment. No Go to next question Yes Give details below Who received this lump sum payment? You Date paid / / Your partner If you (and/or your partner) have received more than 1 lump sum payment.

• the Australian Government Department of Human Services can make relevant enquiries to make sure I receive the correct entitlement. This information is required to process your application or claim.1412 15 of 15 / . Investment bond/debenture documents (If you answered Yes at question 15) Funeral service contract (If you answered Yes at question 17) Money on loan documents (if available) (If you answered Yes at question 18) Share certificates or latest statement for each shareholding LISTED on a stock exchange (If you answered Yes at question 19) Share certificates or latest statement for each shareholding NOT Listed on a stock exchange (If you answered Yes at question 20) Managed investment certificates or similar documents (If you answered Yes at question 21) IMPORTANT INFORMATION www. including the Privacy Act 1988. tax returns and member’s statements for SMSF and SAF funds (If you answered Yes at question 25) Your signature Latest schedules for income stream products or Details of income stream product form (SA330) (If you answered Yes at question 26) Documents with details of investments (If you answered Yes at question 27) Date Income protection policy documents and latest statements (If you answered Yes at question 29) / The 2 most recent payslips from each employer (If you answered Yes at question 30) / Partner’s signature Documents with details of the fringe benefits (If you answered Yes at question 31) Documents which confirm that you stopped work OR Employment Separation Certificate form (SU001) (If you answered Yes at question 32) Date / Documents which confirm leave entitlement payment OR Employment Separation Certificate form (SU001) (If you answered Yes at question 33) Documents which confirm redundancy payments OR Employment Separation Certificate form (SU001) (If you answered Yes at question 34) Letters/documents with details of other Australian government payments (If you answered Yes at question 35) Mod(iA). deferred annuities. Your information may be used by the department or given to other parties for the purposes of research.au/privacy or by requesting a copy from the department. Documents with details of bank. I understand that: • giving false or misleading information is a serious offence.gov. You can get more information about the way in which the Department of Human Services will manage your personal information. building society or credit union account balances (Required at question 13) Insurance policy documents and latest statements (If you answered Yes at question 14) Most recent statements/certificates with details of other payments (If you answered Yes at question 39) 41 Privacy and your personal information Your personal information is protected by law. and is collected by the Australian Government Department of Human Services for the assessment and administration of payments and services. 42 Statement Latest statement for margins loans for each investment (If you answered Yes at question 22) I declare that: • the information I have provided in this form is complete and correct. only supply copies of original documents. documents and other attachments 40 Continued are you (and/or your partner) providing with this form? If you are not sure. investigation or where you have agreed or it is required or authorised by law.40 Which of the following forms. including our privacy policy at humanservices. Documents with details of payments by authorities or agencies outside Australia (If you answered Yes at question 36) Where you are asked to supply documents. rollover funds and superannuation funds. check the question to see if you should attach the documents. Copy of the loan agreement or contract (If you answered Yes at question 24) Latest statements for approved deposit funds.