Fillable Printable Claim for Age Pension and Pension Bonus
Fillable Printable Claim for Age Pension and Pension Bonus
Claim for Age Pension and Pension Bonus
SA002.1503
Claim for Age Pension
and Pension Bonus
1 of 25
• Please use black or blue pen.
• Print in BLOCK LETTERS.
• Mark boxes like this
with a 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.
When to use this form
Use this form to claim the following:
Age Pension
The Age Pension provides income support and access to a range of concessions for
eligible older Australians. The Age Pension is paid at different rates depending on a person’s
circumstances and includes incentives for people to maximise their overall income.
Pension Bonus
The Pension Bonus is a tax free lump sum payment for registered members of the
Pension Bonus Scheme who have deferred claiming Age Pension and stayed in paid work.
The scheme is closed to new registrations. If you are registered in the scheme you must
claim the bonus at the same time you claim Age Pension. Conditions apply.
Filling in this form
Returning your form
Check that all required questions are answered and that the form is signed and dated.
Return this form and any supporting documents to us within 14 days so we can process
your application or claim. If you cannot do this within 14 days, contact us for extra time.
If extra time is required, you must contact us at the earliest possible date to make an
arrangement.
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
www.
humanservices.gov.au/submitdocumentsonline
• by post – return your documents by sending them to:
Department of Human Services
Seniors Services
Reply Paid 7808,
Canberra BC ACT 2610
• 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.
What else you may
need to provide
You may need to provide identity documents. For a list of acceptable documents refer to
Confirming your identity in the
Information you need to know about your claim for Age
Pension and Pension Bonus
(Ci006) (Information Booklet).
In your claim pack, you should have the following:
•
Claim for Age Pension and Pension Bonus
form (SA002)
•
Income and Assets
form (SA369).
Forms in your claim
pack
You can access your Centrelink, Medicare and Child Support Online Services through myGov.
myGov is a fast, simple way to access a range of government services online with one
username, one password, all from one secure location. To create a myGov account, go to www.
my.gov.au
Online Services
SA002.1503
2 of 25
If you have a partner and you are both claiming Age Pension, you may choose to complete
one claim pack together or complete a separate claim pack for each person.
If your partner is not claiming Age Pension they still need to provide their details. They can
do so on this form or a separate
Partner Details
form (Mod P). If you do not have this form,
go to www.humanservices.gov.au/forms
Complete the claim form(s) and any additional forms required. You may choose to use an
accountant or financial adviser to complete your
Income and Assets
form (SA369) but you
must sign it. If you need other people to assist with completing your forms, make sure you
give them the forms as soon as possible.
To make sure you are paid from the earliest possible date, you should lodge your claim as
soon as possible. You may lodge your claim form without the other forms and documentation,
however, they will need to be provided before the claim can be processed. Age Pension
claims can be lodged up to 13 weeks before you reach age pension age.
How to claim
Make an appointment with the ophthalmologist/optometrist who usually treats you
(and/or your partner). You should have been given a
Request for Ophthalmologist/
Optometrist Report
form (SA013). If you do not have this form, go to
www.humanservices.gov.au/agepension
When you (and/or your partner) make the appointment, tell the receptionist that you (and/or
your partner) need the optician to complete a form for us, as they may need to allow more
time. The optician may complete the report and give it back to you (or your partner) or they
may send it directly to us. Make sure the report has your (or your partner’s) name and
address on it.
Age Pension for
people who are
permanently blind
Department of
Veterans’ Affairs
Disability Pension
payment option
If you (and/or your partner) currently get a Disability Pension from the Department of
Veterans’ Affairs (DVA), you can both choose to have your Age Pension paid by DVA
instead of us. You will need to complete the claim forms but lodge them with DVA
(contact your local DVA office for lodgement details).
For more information
Refer to the Information Booklet at www.humanservices.gov.au/agepension
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.
SA002.1503
3 of 25
Age Pension
Do you have a partner?
1
Go to 4
We require your partner’s details to assess your
claim.
Go to next question
No
Yes
Is your partner also claiming Age Pension?
2
Your partner can provide their details on this form
or a separate
Partner Details
form (Mod P).
Go to next question
Your partner can claim on this form or on a
separate claim form.
Go to next question
No
Yes
Indicate if your partner is using this form or a separate form
for a claim or to provide their details.
3
This form
Separate form
Your name
Other
Family name
4
First given name
Second given name
MsMissMrsMr
Your name
Other
Family name
First given name
Second given name
MsMissMrsMr
Have you ever used or been known by any other name
(e.g. name at birth, maiden name, previous married name,
Aboriginal or tribal name, alias, adoptive name, foster name)?
5
Other name
Type of name (e.g. name at birth)
1
Other name
Type of name (e.g. maiden name)
2
If you have more than 2 other names, attach a separate
sheet with details.
If you have more than 2 other names, attach a separate
sheet with details.
Have you ever used or been known by any other name
(e.g. name at birth, maiden name, previous married name,
Aboriginal or tribal name, alias, adoptive name, foster name)?
Other name
Type of name (e.g. name at birth)
1
Other name
Type of name (e.g. maiden name)
2
You Your partner
Go to next question
Give details below
No
Yes
Go to next question
Give details below
No
Yes
4
5
CLK0SA002 1503
SA002.1503
4 of 25
Your date of birth
/ /
7
Your permanent address
Postcode
8
Your sex
6
Male
Female
Your postal address (if different to above)
9
Postcode
Attach an original document as proof of your date
of birth.
If you are claiming Age Pension, attach an original
document as proof of your date of birth.
Your sex
Male
Female
/ /
Your date of birth
You Your partner
Your permanent address
Postcode
Your postal address (if different to above)
Postcode
7
8
6
9
10
Your contact details Your contact details
Home phone number
Is this a silent number?
Email
@
Fax number
Work phone number
Alternative phone number
( )
( )
( )
( )
No Yes
Mobile phone number
Home phone number
Is this a silent number?
Email
@
Fax number
Work phone number
Alternative phone number
( )
( )
( )
( )
No Yes
Mobile phone number
10
If you provide an email address or mobile phone number,
you may receive electronic messages (SMS or email)
from us. To read the Terms and Conditions, go to
www.humanservices.gov.au/em or visit one of our service
centres.
Please read this before answering the following question.
If you provide an email address or mobile phone number,
you may receive electronic messages (SMS or email)
from us. To read the Terms and Conditions, go to
www.humanservices.gov.au/em or visit one of our service
centres.
Please read this before answering the following question.
SA002.1503
Are you of Aboriginal or Torres Strait Islander Australian
origin?
If you are of both Aboriginal and Torres Strait Islander
Australian origin, please tick both ‘Yes’ boxes.
Questions 11 and 12 are optional and will not affect your
payment. If you do answer, the information will help us
to continue to improve services to Aboriginal and Torres
Strait Islander Australians and Australian South Sea
Islanders.
Australian South Sea Islanders are the descendants of
Pacific Islander labourers brought from the Western
Pacific in the 19th Century.
11
Are you of Australian South Sea Islander origin?
12
No
Yes – Aboriginal Australian
Yes – Torres Strait Islander Australian
No
Yes
Do you need an interpreter when dealing with us?
This includes an interpreter for people who have a hearing
or speech impairment.
13
Go to 15
No
Yes
Do you want to authorise another person or organisation to
make enquiries, get Centrelink payments and/or act on
your behalf?
16
Go to next question
No
Yes
You will need to complete and attach an
Authorising a person or organisation
to enquire or act on your behalf
form
(SS313). If you do not have this form or
want more information about nominee
arrangements, go to
www.humanservices.gov.au/nominees
Do you give permission for your partner to make enquiries
with us on your behalf?
You can change this authority at any time.
17
No
Yes
Are you of Aboriginal or Torres Strait Islander Australian
origin?
If you are of both Aboriginal and Torres Strait Islander
Australian origin, please tick both ‘Yes’ boxes.
Questions 11 and 12 are optional and will not affect your
payment. If you do answer, the information will help us
to continue to improve services to Aboriginal and Torres
Strait Islander Australians and Australian South Sea
Islanders.
Australian South Sea Islanders are the descendants of
Pacific Islander labourers brought from the Western
Pacific in the 19th Century.
Are you of Australian South Sea Islander origin?
No
Yes – Aboriginal Australian
Yes – Torres Strait Islander Australian
No
Yes
Do you need an interpreter when dealing with us?
This includes an interpreter for people who have a hearing
or speech impairment.
Go to 15
No
Yes
Do you want to authorise another person or organisation to
make enquiries, get Centrelink payments and/or act on
your behalf?
Go to next question
No
Yes
You will need to complete and attach an
Authorising a person or organisation
to enquire or act on your behalf
form
(SS313). If you do not have this form or
want more information about nominee
arrangements, go to
www.humanservices.gov.au/nominees
Do you give permission for your partner to make enquiries
with us on your behalf?
You can change this authority at any time.
No
Yes
Go to next question Go to next question
What is your preferred spoken language?
14
What is your preferred spoken language?
What is your preferred written language?
15
What is your preferred written language?
11
12
13
16
17
14
15
5 of 25
You Your partner
SA002.1503
6 of 25
You Your partner
‘Permanently’ means you normally live in Australia on
a long-term basis. Holidays or short trips outside
Australia would not affect this.
Please read this before answering the following question.
18
Are you living in Australia permanently?
No
Yes
Go to 29
Are you an Australian citizen who was born in Australia?
20
What is your country of birth?
21
You will need to provide proof of your
Australian residence status
(e.g. citizenship papers, passport or
other documentation).
Go to next question
No
Yes
Go to next question
Give details below
Have you EVER lived or travelled outside Australia,
including short trips and holidays?
19
No
Yes
Passport number
Country of issue
Go to next question
Give details below
Did you start living in Australia before 1965?
23
No
Yes
Name of the ship or airline on which you arrived
Name of the place where you first arrived/disembarked
What was your name when you first arrived in Australia?
When did you start living in Australia?
22
/ /
‘Permanently’ means you normally live in Australia on
a long-term basis. Holidays or short trips outside
Australia would not affect this.
Please read this before answering the following question.
Are you living in Australia permanently?
No
Yes
Go to 29
Are you an Australian citizen who was born in Australia?
What is your country of birth?
You will need to provide proof of your
Australian residence status
(e.g. citizenship papers, passport or
other documentation).
Go to next question
No
Yes
Go to next question
Give details below
Have you EVER lived or travelled outside Australia,
including short trips and holidays?
No
Yes
Passport number
Country of issue
Go to next question
Give details below
Did you start living in Australia before 1965?
No
Yes
Name of the ship or airline on which you arrived
Name of the place where you first arrived/disembarked
What was your name when you first arrived in Australia?
When did you start living in Australia?
/ /
This question assists us to verify your Australian residence. This question assists us to verify your Australian residence.
18
20
21
19
23
22
Year you last entered Australia Year you last entered Australia
SA002.1503
7 of 25
You Your partner
Date granted
/ /
Country of citizenship
What is your country of citizenship?
24
Australia
Other
Are you a refugee or former refugee?
28
No
Yes
Date granted
/ /
Are you a refugee or former refugee?
No
Yes
What type of visa did you arrive on?
25
Permanent
Temporary
Unknown (e.g. arrived
on parent’s passport)
Your visa details on arrival
26
Date visa grantedVisa sub class
Most recent visa details
Has your visa changed since you arrived in Australia?
27
Date visa grantedVisa sub class
Go to next question
Go to next question
Go to 27
Go to next question
No
Yes
/ /
/ /
What type of visa did you arrive on?
Permanent
Temporary
Unknown (e.g. arrived
on parent’s passport)
Your visa details on arrival
Date visa grantedVisa sub class
Most recent visa details
Has your visa changed since you arrived in Australia?
Date visa grantedVisa sub class
Go to next question
Go to next question
Go to 27
Go to next question
No
Yes
/ /
/ /
What is your country of citizenship?
Australia
Country of citizenshipOther
New Zealand passport
(special category visa)
Go to 27
New Zealand passport
(special category visa)
Go to 27
Go to 25 Go to 25
24
28
25
26
27
SA002.1503
8 of 25
From
29
Country of residence
1
To
/ // /
Go to next question
No
Yes
From
Country of residence
2
To
/ // /
From
Country of residence
3
To
/ // /
From
Country of residence
4
To
/ // /
If you require more space, attach a separate sheet with
details.
Except for short trips or holidays, have you EVER lived
outside Australia?
List ALL countries, INCLUDING AUSTRALIA, you
have lived in SINCE BIRTH.
If you were born outside Australia, include the
country where you were born.
Include the periods you have lived in each
country.
Do NOT include short trips or holidays.
From
Country of residence
5
To
/ // /
You Your partner
From
Country of residence
6
To
/ // /
From
Country of residence
1
To
/ // /
Go to next question
No
Yes
From
Country of residence
2
To
/ // /
From
Country of residence
3
To
/ // /
From
Country of residence
4
To
/ // /
Except for short trips or holidays, have you EVER lived
outside Australia?
List ALL countries, INCLUDING AUSTRALIA, you
have lived in SINCE BIRTH.
If you were born outside Australia, include the
country where you were born.
Include the periods you have lived in each
country.
Do NOT include short trips or holidays.
From
Country of residence
5
To
/ // /
From
Country of residence
6
To
/ // /
If you require more space, attach a separate sheet with
details.
29
We need to know if you have lived in any countries other
than Australia from birth through to the present. ‘Lived’
means where you/your family made your home or spent
a long period of time – it does not include places you
visited.
Please read this before answering the following question.
We need to know if you have lived in any countries other
than Australia from birth through to the present. ‘Lived’
means where you/your family made your home or spent
a long period of time – it does not include places you
visited.
Please read this before answering the following question.
SA002.1503
Where do you want your payment made?
The bank, building society or credit union account must be
in your name. A joint account is acceptable.
30
Name of bank, building
society or credit union
Branch where the
account is held
Account number (this may
not be your card number)
Account held in the name(s) of
Where do you want your payment made?
The bank, building society or credit union account must be
in your name. A joint account is acceptable.
Branch number (BSB)
Only give details if you are also claiming Age Pension
on this form.
Note: Payments cannot be made into an account used
exclusively for funding from the National Disability
Insurance Scheme.
9 of 25
You Your partner
Name of bank, building
society or credit union
Branch where the
account is held
Account number (this may
not be your card number)
Account held in the name(s) of
Branch number (BSB)
31
How often do you wish to receive the minimum pension
supplement amount?
Fortnightly
Quarterly
Please read this before answering the following
question.
The pension supplement helps you to meet the costs
of your daily household and living expenses. It is
automatically paid each fortnight with your regular
pension.
You have the option to receive part of the pension
supplement on a quarterly basis. This component/part
is known as the minimum pension supplement amount.
You may find this option useful for budgeting purposes.
If you choose this option, the minimum pension
supplement amount accrues daily during the quarter and
is paid as soon as possible after 20 March, 20 June,
20 September and 20 December with your fortnightly
pension payment.
The option to get the minimum pension supplement as a
fortnightly payment or quarterly payment can be changed
at any time.
Please read this before answering the following
question.
Only give details if you are also claiming Age Pension
on this form.
The pension supplement helps you to meet the costs
of your daily household and living expenses. It is
automatically paid each fortnight with your regular
pension.
You have the option to receive part of the pension
supplement on a quarterly basis. This component/part
is known as the minimum pension supplement amount.
You may find this option useful for budgeting purposes.
If you choose this option, the minimum pension
supplement amount accrues daily during the quarter and
is paid as soon as possible after 20 March, 20 June,
20 September and 20 December with your fortnightly
pension payment.
The option to get the minimum pension supplement as a
fortnightly payment or quarterly payment can be changed
at any time.
How often do you wish to receive the minimum pension
supplement amount?
Fortnightly
Quarterly
30
31
Note: Payments cannot be made into an account used
exclusively for funding from the National Disability
Insurance Scheme.
SA002.1503
10 of 25
Amount
(must be in whole dollars)
$
.00 per fortnight
OR
Percentage (%)
of taxable payment
% per fortnight
Do you want tax taken out of your payment?
If your only income for this financial year is the payment
you are now claiming, you may not have to pay any tax.
However, you may have to pay tax if you get any other
income this financial year, such as salary or wages.
If you think you will have to pay tax this year, you can
ask us to deduct tax instalments from your payment.
You can change this at any time.
If you are not sure how much tax to have taken out of
your payment, contact the Australian Taxation Office.
Please read this before answering the following question.
34
Go to next question
No
Yes Enter the amount OR percentage of tax you want
taken out per fortnight.
You Your partner
Amount
(must be in whole dollars)
$
.00 per fortnight
OR
Percentage (%)
of taxable payment
% per fortnight
Do you want tax taken out of your payment?
Only answer this question if you are also claiming
Age Pension on this form.
If your only income for this financial year is the payment
you are now claiming, you may not have to pay any tax.
However, you may have to pay tax if you get any other
income this financial year, such as salary or wages.
If you think you will have to pay tax this year, you can
ask us to deduct tax instalments from your payment.
You can change this at any time.
If you are not sure how much tax to have taken out of
your payment, contact the Australian Taxation Office.
Please read this before answering the following question.
Go to next question
No
Yes Enter the amount OR percentage of tax you want
taken out per fortnight.
Have you given us your tax file number before?
Go to 34
Go to next question
Not sure
Yes
You are not breaking the law if you do not give us your
tax file number, but if you do not provide it to us, or
authorise us to get it from the Australian Taxation Office,
you may not be paid.
In giving us your tax file number in relation to this claim
you authorise us to use your tax file number for other
social security payments and services in future where
necessary.
Please read this before answering the following
questions.
Go to next question
No
32
33
Please call us on 132 300.No
Yes
Do you have a tax file number?
Your tax file number
Have you given us your tax file number before?
Go to 34
Go to next question
Not sure
Yes
You are not breaking the law if you do not give us your
tax file number, but if you do not provide it to us, or
authorise us to get it from the Australian Taxation Office,
you may not be paid.
In giving us your tax file number in relation to this claim
you authorise us to use your tax file number for other
social security payments and services in future where
necessary.
Please read this before answering the following
questions.
Go to next question
No
Please call us on 132 300.No
Yes
Do you have a tax file number?
Your tax file number
34
32
33
Widowed
(previously partnered with an opposite-sex
or same-sex partner, including in a
marriage, registered or de facto relationship)
SA002.1503
What is your CURRENT relationship status?
35
11 of 25
SS293
Do you live in the same home as your former partner?
42
No
Yes
Full name
Date of birth Date relationship ended
Please give the following details about your former partner.
43
Go to next question
/ / / /
Current address (if known)
Postcode
Do you currently live in the same home as your partner?
When did you and your partner start living together as a
member of a couple?
/ /
37
Full name
Partner’s illness
Give details belowOther
Your illness
Partner in prison
Partner’s employment
From
To
Date of birth Date of death
38
Go to 47
Go to next question
No
Yes
Why are you not living with your partner?
39
Period not living with your partner
/ /
40
/ /
OR indefinite
Go to 45
Please give the following details about your deceased
partner.
41
Go to 44
/ / / /
What is your date of marriage or relationship registration?
/ /
36
Please read this before answering the following question.
We recognise both opposite-sex and same-sex
relationships. This includes de facto relationships and
relationships registered under state or territory law.
Select ONE option below that best describes your current
relationship status.
Married
Partnered
(living together in an opposite-sex or
same-sex relationship, including de facto)
Go to 36
Go to 37
Registered relationship
(opposite-sex or same-sex relationship
registered under state or territory law)
Go to 36
Separated
(previously lived with an opposite-sex or
same-sex partner, including in a marriage,
registered or de facto relationship)
Go to 42
Divorced
Go to 42
Go to 41
Never married or lived with a partner
Go to 45
Have you re-married, entered into a new registered
relationship or re-partnered (including de facto)?
44
Go to 47
Go to next question
No
Yes
Do you share your accommodation with anyone other than
an immediate member of your family?
45
Go to 47
Go to next question
No
Yes
Your living arrangements
Go to 38
Go to 44
Go to next question
