Claim for Age Pension and Pension Bonus
SA002.1503
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Age Pension
Do you have a partner?
1
Go to 4
We require your partner’s details to assess your
claim.
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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).
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Your partner can claim on this form or on a
separate claim form.
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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
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Give details below
No
Yes
Go to next question
Give details below
No
Yes
4
5
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