Form D0563a - Request For Information - Comsuper Defined Benefit Income Stream Schedule Page 2
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1
2ComSuper Defined Benefit Income Stream Schedule
for Veterans’ Affairs Assessment Purposes
Privacy notice
Your personal information is protected by law, including the Privacy Act 1988. Your personal information may be collected by the Department
of Veterans’ Affairs (DVA) for the delivery of government programs for war veterans, members of the Australian Defence Force, members of the
Australian Federal Police and their dependants.
Read more: How DVA manages personal information
Details of client
1.
Name
2.
DVA Reference
3.
Date of Birth
4.
Address
Please ensure client details above match your records (amend if different)
Details of product
5.
ComSuper Reference Number
.
6
Type of Pension (tick one)
CSS
PSS
DFRDB
MSBS
7.
Commencement Date
Spouse
(if payee is Eligible Spouse, enter
/
/
/
/
original superannuant’s start date)
8.
Current Gross Fortnightly amount of
.
$
p/f
Effective from
/
/
payment
9.
Current Gross Fortnightly amount of
$
.
p/f
Effective from
/
/
payment in respect of children
Details of Tax Free Component
(known as Deductible Amount for Veterans’ Affairs assessment purposes as defined
under VEA s.5J(1))
10.
Does the superannuant have a Tax
Go to Question 13
No
Free Component?
Yes
11.
Is the Tax Free Component
No
calculated using the
Current amount of Tax Free Component per fortnight
Yes
NEW proportional method under:
• subdivision 307-C of the Income
$
.
p/f
Tax Assessment Act 1997 for
pensions commencing on or after
DVA staff - record the Tax Free Component as a Deductible Amount per
1 July 2007; or
fortnight unless the saving provision applies.
• subsection 307-125(6) of the
Income Tax (Transitional
Provisions) Act 1997 due to the
occurrence of a trigger event for
pensions commencing prior to 1
July 2007?
12.
Is the Tax Free Component
No
calculated using the
Yes
Undeducted Purchase Price (Total UPP at Commencement Date)
OLD method based on UPP for
pensions which commenced prior to
$
.
1 July 2007 as defined in subsection
307-125(2) of the Income Tax
Current amount of Tax Free Component per fortnight
(Transitional Provisions) Act 1997?
$
.
p/f
DVA staff - record the Total UPP and relevant number to derive the Deductible
Amount per fortnight.
Comsuper staff details
13.
Name
[
]
14.
Phone number
/
/
15.
Date
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D0563A - 03/14 - p2 of 2
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