Aged Care Fees Income Assessment Request - Australian Department Of Human Services Page 20
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Please read this before answering the following question.
In the last 5 years, have you (and/or your partner) given
away, sold for less than their market value, or surrendered
An income stream product is a regular series of
a right to any cash, financial assets, property or income?
payments which may be made for a lifetime or a fixed
period by:
Include forgiven loans and shares in private companies.
• a financial institution
No
Go to next question
• a superannuation fund
Yes
Give details below
• a Self Managed Superannuation Fund (SMSF)
1
What you gave away or sold for less than its market
• a Small APRA Fund (SAF)
value (e.g. money, car, second home, land, farm)
• an employer subject to Australian prudential
regulations.
Types of income streams include:
Date given or sold
What it was worth
• Allocated Pension (also known as Account Based
$
Pension)
Partner’s
• Market-Linked Pension (also known as Term
What you got for it
Your share
share
Allocated Pension)
%
%
$
• Annuities
• Defined Benefit Pension (e.g. ComSuper pension,
Was this gift to a Special Disability
State Super pension)
Trust (SDT)?
No
Yes
• Superannuation Pension (non-defined benefit).
2
What you gave away or sold for less than its market
Do you (and/or your partner) receive income from any
value (e.g. money, car, second home, land, farm)
income stream products?
No
Go to next question
Date given or sold
What it was worth
Yes
Give details below
$
You (and/or your partner) will need to
Partner’s
attach a completed, Details of income
What you got for it
Your share
share
stream product form (SA330) or a similar
%
%
schedule, for each income stream
$
product. The form or similar schedule
Was this gift to a Special Disability
must be completed by your product
Trust (SDT)?
No
Yes
provider or the trustee of the Self
Managed Superannuation Fund (SMSF)
3
What you gave away or sold for less than its market
or Small APRA Fund (SAF) or the SMSF
value (e.g. money, car, second home, land, farm)
administrator.
If you do not have this form, go to
humanservices.gov.au/forms or call us
Date given or sold
What it was worth
on Freecall™ 1800 227 475.
$
1
Name of institution/fund manager
Partner’s
What you got for it
Your share
share
%
%
$
Name of fund
Was this gift to a Special Disability
Trust (SDT)?
No
Yes
Account balance
$
If you (and/or your partner) have given away or sold for
less than its market value more than 3 items, attach a
Amount of income received
How often (e.g. monthly)
separate sheet with details.
$
per
Partner’s
%
%
Your share
share
12 of 18
SA456.1705
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