Aged Care Fees Income Assessment Request - Australian Department Of Human Services Page 22
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38
Please read this before answering the following
Do you (and/or your partner) have any other assets (in or
question.
outside Australia) that you have not already advised us
about on this form?
You are considered to have an interest in a private trust
if any of the following apply.
Include cash, gold or other bullion.
You (and/or your partner) are:
Do NOT include an account used for funding from the
National Disability Insurance Scheme (NDIS).
• the appointor
• a guardian or principal of the trust, or
No
Go to next question
• a trustee
Yes
Give details below
OR
Attach supporting documentation.
• are a shareholder or director of the trustee company
• are a beneficiary or included amongst the categories
1
Description of asset
• of beneficiaries of the trust
• are a unit holder
• are owed money by the trust
Current market value
Amount owed
• are able to benefit from the trust, or
• can expect the trustee or appointor of a trust to act
Partner’s
in accordance with your wishes.
share
Currency if not AUD
Your share
Are you or have you (and/or your partner) been involved
%
%
in a private trust in any of the ways detailed above, in the
2
last 5 years?
Description of asset
Go to 37
No
Yes
Amount of income received in the last financial
Current market value
Amount owed
year (this is available from your personal income
PT
tax returns)
Partner’s
$
Currency if not AUD
Your share
share
%
%
36
Is the private trust a Special Disability Trust (SDT)?
No
If you (and/or your partner) have more than 2 other
Yes
financial assets or investments, attach a separate sheet
with details.
37
Please read this before answering the following
question.
You are considered to have an interest in a private
company if any of the following apply.
You (and/or your partner):
• are a shareholder of the private company
• are a director or other office holder of the company
• are owed money by the company
• are able to benefit from the company
• can expect the director of a company to act in
accordance with your wishes, or
• can expect the governing director or majority
shareholder to act in accordance with your wishes.
Are you or have you (and/or your partner) been involved
in a private company in any of the ways detailed above,
in the last 5 years?
No
Go to next question
Yes
Amount of income received in the last financial
year (this is available from your personal income
PC
tax returns)
$
14 of 18
SA456.1705
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