Page 3

Q1. Do you have a partner

You (1)

You (2)

Q2. Is your partner also claiming Age Pension

You (1)

You (2)

Q3. Is your partner using this form or a separate form for a

You (1)

You (2)

You (3)

You (4)

Q4. Your Customer Reference Number (if known)

You

Partner

Q5. Your name

You (1)

You (2)

You (3)

You (4)

You (5)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Q6. Your date of birth (DD MM YYYY)

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Partner (10)

Page 4

Q7. Do you need an interpreter

You (1)

You (2)

You (3)

Partner (1)

Partner (2)

Partner (3)

Q8. What is your preferred spoken language

You

Partner

Q9. What is your preferred written language

You

Partner

Q10. Have you been known by any other name(s)

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

You (10)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Partner (10)

Q11. Your gender

You (1)

You (2)

You (3)

Partner (1)

Partner (2)

Partner (3)

Page 5

Q12. Your permanent address

You

Partner

Q13. Your postal address (if different to above)

You

Partner

Q14. this before answering the following question. Read

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

You (10)

You (11)

You (12)

You (13)

You (14)

You (15)

You (16)

You (17)

You (18)

You (19)

You (20)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Partner (10)

Partner (11)

Partner (12)

Partner (13)

Partner (14)

Partner (15)

Partner (16)

Partner (17)

Partner (18)

Partner (19)

Partner (20)

Q15. This question is voluntary and will not affect your

You (1)

You (2)

You (3)

You (4)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Q16. This question is voluntary and will not affect your

You (1)

You (2)

You (3)

Partner (1)

Partner (2)

Partner (3)

Page 6

Q17. If you answered ‘Yes’ at question 1, do you give permission

You (1)

You (2)

You (3)

Partner (1)

Partner (2)

Partner (3)

Q18. Do you want to authorise a person or organisation to

You (1)

You (2)

You (3)

Partner (1)

Partner (2)

Partner (3)

Q19. What country are you currently living in

You (1)

You (2)

You (3)

You (4)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Q20. Have you travelled outside Australia, including short ever

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Q21. Are you an Australian citizen Australia? who was born in

You (1)

You (2)

You (3)

Partner (1)

Partner (2)

Partner (3)

Page 7

Q22. What is your country of birth

You

Partner

Q23. What is your country of citizenship

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

You (10)

You (11)

You (12)

You (13)

You (14)

You (15)

You (16)

You (17)

You (18)

You (19)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Partner (10)

Partner (11)

Partner (12)

Partner (13)

Partner (14)

Partner (15)

Partner (16)

Partner (17)

Partner (18)

Partner (19)

Q24. Read this if you are not claiming on this form

Partner

Q25. What type of visa did you arrive on

You (1)

You (2)

You (3)

You (4)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Q26. Your visa details on arrival

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Q27. Has your visa changed since you arrived in Australia

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

You (10)

You (11)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Partner (10)

Partner (11)

Q28. When did you most recently start living in Australia

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

Partner (1)

Partner (2)

Partner (3)

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Partner (5)

Partner (6)

Partner (7)

Partner (8)

Page 8

Q29. Did you start living in Australia before 1965

You (1)

You (2)

You (3)

You (4)

You (5)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Q30. this before answering the following question. Read

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

You (10)

You (11)

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You (26)

You (27)

You (28)

You (29)

You (30)

You (31)

You (32)

You (33)

You (34)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Partner (10)

Partner (11)

Partner (12)

Partner (13)

Partner (14)

Partner (15)

Partner (16)

Partner (17)

Partner (18)

Partner (19)

Partner (20)

Partner (21)

Partner (22)

Partner (23)

Partner (24)

Partner (25)

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Partner (27)

Partner (28)

Partner (29)

Partner (30)

Partner (31)

Partner (32)

Partner (33)

Partner (34)

Page 9

Q31. Where do you want your payment made

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Q32. this before answering the following question. Read

You (1)

You (2)

You (3)

Partner (1)

Partner (2)

Partner (3)

Page 10

Q33. this before answering the following questions. Read

You (1)

You (2)

You (3)

You (4)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Q34. Do you have a tax file number

You (1)

You (2)

You (3)

Partner (1)

Partner (2)

Partner (3)

Q35. this before answering the following question. Read

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Page 11

Q36. Tick of the boxes below to tell us about your one

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

You (10)

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You (49)

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You (51)

You (52)

You (53)

You (54)

You (55)

You (56)

Q37. Do you live in the same home as your partner

You (1)

You (2)

Q38. Why are you not living with your partner

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Q39. Period not living with your partner (DD MM YYYY)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Partner (10)

Partner (11)

Partner (12)

Partner (13)

Partner (14)

Partner (15)

Partner (16)

Partner (17)

Partner (18)

Q40. Give the following details about your deceased partner

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Partner (10)

Q41. Your ex-partner’s family name

Partner (1)

Partner (2)

Partner (3)

Q42. Your ex-partner’s current address (if known)

Partner

Page 12

Q43. Do you share your accommodation with anyone other

You (1)

You (2)

You (3)

Q44. this before answering the following question. Read

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

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You (16)

Page 14

Q45. Do you (and/or your partner) own a home that you do not

You (1)

You (2)

Q46. What is the reason you (and/or your partner) do not live in

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

Q47. Have you (and/or your partner) sold your former home

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

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You (14)

You (15)

You (16)

You (17)

You (18)

You (19)

You (20)

You (21)

You (22)

You (23)

Q48. What type of accommodation best describes where you

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Partner (10)

Partner (11)

Partner (12)

Q49. Do you pay site or mooring fees for your (and your

Partner (1)

Partner (2)

Q50. Is your (or your partner’s) name on the rental contract or

Partner (1)

Partner (2)

Page 15

Q51. Is the primary tenant paying the market rate of rent

You (1)

You (2)

You (3)

Q52. Do you (and your partner) live with the primary tenant and

You (1)

You (2)

You (3)

You (4)

Q53. What is the name of the aged care home or nursing home

You

Q54. What date did you (and/or your partner) move in

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

You (10)

You (11)

You (12)

You (13)

You (14)

You (15)

You (16)

Q55. How long will you (and/or your partner) be staying

You (1)

You (2)

You (3)

You (4)

Q56. What date do you (and/or your partner) expect to leave

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

You (10)

You (11)

You (12)

You (13)

You (14)

You (15)

You (16)

Q57. this before answering the following question. Read

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Q58. Did you (and/or your partner) make a gift and/or loan in

Partner (1)

Partner (2)

Q59. What was the additional amount paid as a gift and/or loan

Partner (1)

Partner (2)

Page 16

Q60. What date did you (and/or your partner) move into the

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

You (10)

You (11)

You (12)

You (13)

You (14)

You (15)

You (16)

Q61. Did you (and/or your partner) pay an entry contribution

You (1)

You (2)

You (3)

You (4)

You (5)

Q62. Did you (and/or your partner) make a gift and/or loan in

You (1)

You (2)

Q63. What was the additional amount paid as a gift and/or loan

You (1)

You (2)

Q64. Did you (and/or your partner) pay any money or transfer

Partner (1)

Partner (2)

Q65. Which option describes how you (and/or your partner)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Q66. Who was transferred the money or assets in return for

Partner (1)

Partner (2)

Q67. What was the amount paid

Partner

Q68. What (if any) assets were transferred

Partner

Q69. What was the market value of the transferred assets

Partner

Page 17

Q70. Do you (and your partner) share your accommodation

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

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You (14)

You (15)

You (16)

You (17)

You (18)

You (19)

You (20)

You (21)

You (22)

You (23)

You (24)

You (25)

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You (27)

You (28)

You (29)

You (30)

You (31)

You (32)

You (33)

You (34)

You (35)

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You (37)

You (38)

You (39)

You (40)

You (41)

You (42)

You (43)

You (44)

You (45)

You (46)

You (47)

You (48)

Q71. Do you (and your partner) share your accommodation

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Q72. Do you (and your partner) pay board and/or lodgings

Partner (1)

Partner (2)

Partner (3)

Q73. Can you separate the amounts you (and your partner) pay

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Q74. What is the amount (and partner) pay you your

Partner (1)

Partner (2)

Q75. On what date did you (and your partner) start paying

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Page 18

Q76. What type of accommodation do you (and your partner)

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

Q77. What is the being charged per day, week, total amount

You

Q78. Do you (and/or your partner) have a formal lease or

You (1)

You (2)

You (3)

Q79. Are you (and/or your partner) permanently blind

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Q80. Indicate who is permanently blind

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Q81. Is your partner claiming or receiving a Centrelink

Partner (1)

Partner (2)

Partner (3)

Q82. Are you (and/or your partner) claiming Rent Assistance

Partner (1)

Partner (2)

Partner (3)

Q83. Are you (and/or your partner) receiving any payment from

Partner (1)

Partner (2)

Partner (3)

Page 19

Q84. Are you (and/or your partner) receiving any payment from

You (1)

You (2)

Q85. Which payment do you (and/or your partner) receive from

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

Q86. Do you (and/or your partner) receive Self-Employment

You (1)

You (2)

You (3)

Q87. this before answering the following question. Read

Partner (1)

Partner (2)

Partner (3)

Q88. Have you (or your partner) told us about this before

Partner (1)

Partner (2)

Partner (3)

Q89. Do you (and/or your partner) receive payments from an

Partner (1)

Partner (2)

Partner (3)

Page 20

Q90. Which of the following forms and/or documents are you

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You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

You (9)

You (10)

You (11)

You (12)

You (13)

Page 21

Q91. You (and your partner) need to read this

You

Q92. Declaration

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You (6)

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You (8)

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You (14)

You (15)

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You (18)

You (19)

You (20)

You (21)

Q93. this before answering the following question. Read

Partner (1)

Partner (2)

Partner (3)

Q94. Are you (and/or your partner) a registered member with

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Partner (10)

Page 23

Q1. Have you previously claimed or received a Pension Bonus

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You (7)

You (8)

You (9)

You (10)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Partner (9)

Partner (10)

Q2. Has your relationship status changed since your Pension

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You (21)

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You (24)

Partner (1)

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Partner (3)

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Partner (20)

Partner (21)

Partner (22)

Partner (23)

Partner (24)

Q3. this before answering the following questions about Read

You

Partner

Q4. When did you stop meeting the work test

You (1)

You (2)

You (3)

You (4)

You (5)

You (6)

You (7)

You (8)

Partner (1)

Partner (2)

Partner (3)

Partner (4)

Partner (5)

Partner (6)

Partner (7)

Partner (8)

Q5. Are you claiming a bonus on the basis of your work

You (1)

You (2)

Partner (1)

Partner (2)

Q6. Are you claiming a bonus on the basis of your partner’s

You (1)

You (2)

You (3)

Partner (1)

Partner (2)

Page 24

Q7. Provide details about the work you have done to meet the

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Partner (1)

Partner (2)

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Q8. Since your Pension Bonus Scheme registration date have

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Page 25

Q9. Since your Pension Bonus Scheme registration date

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Q10. Since your Pension Bonus Scheme registration date have

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Q11. Since your Pension Bonus Scheme registration date have

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Q12. Since your Pension Bonus Scheme registration date have

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Q13. Since your Pension Bonus Scheme registration date

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Page 26

Q14. Since your Pension Bonus Scheme registration date have

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Q15. Since your Pension Bonus Scheme registration date have

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Page 27

Q16. In the period from 5 years before your registration date

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Page 28

Q17. You need to provide all documents that provide details

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Q18. You need to read this

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Q19. Declaration

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Other Federal · SA002

Claim for Age Pension and Pension Bonus (SA002)

Form for claiming the Age Pension and Pension Bonus from Services Australia.

Issued by: Services Australia
Form number: SA002
Jurisdiction: Federal
Length: 28 pages

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