Aged Care Fees Income Assessment Request - Australian Department Of Human Services Page 19
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Do you (and/or your partner) have any funeral bonds/
Do you (or your partner) have any money invested in
funeral investments?
superannuation where the fund is still in accumulation
phase and not paying a pension?
No
Go to 31
Include:
Yes
Give details below
• approved deposit funds
1
Name of company
• deferred annuities
• retirement savings accounts
Name of product
• Self Managed Superannuation Funds (SMSF) and
Small APRA Funds (SAF) if the funds are complying.
No
Go to next question
Purchase price incl.
APIR code (if known)
instalments but not interest
Yes
Give details below
$
Attach the latest statement for each
superannuation investment, including
Current value
Partner’s
latest council rates notices for any real
as per latest statement
Your share
share
estate held by SMSF and SAF
%
%
$
1
Name of institution/fund manager
2
Name of company
Name of fund
Name of product
Amount (if any) that can be
withdrawn as a lump sum
Account balance
Purchase price incl.
instalments but not interest
APIR code (if known)
$
$
$
Amount of income received
How often (e.g. monthly)
Current value
Partner’s
$
per
as per latest statement
Your share
share
Owned by:
You
Your partner
%
%
$
2
Name of institution/fund manager
If you (and/or your partner) have more than 2 funeral
bonds/funeral investments, attach a separate sheet
Name of fund
with details.
Amount (if any) that can be
30
Have you (and/or your partner) a contract to have funeral
withdrawn as a lump sum
Account balance
services provided for which an agreed sum has already
$
$
been paid to the provider or used to buy funeral bonds
Amount of income received
How often (e.g. monthly)
assigned to the provider?
$
per
No
Go to next question
Yes
Owned by:
You
Your partner
Attach a copy of each contract.
3
Name of institution/fund manager
Name of fund
Amount (if any) that can be
Account balance
withdrawn as a lump sum
$
$
Amount of income received
How often (e.g. monthly)
$
per
Owned by:
You
Your partner
If you (and/or your partner) have more than 3 superannuation
products, attach a separate sheet with details.
11 of 18
SA456.1705
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