Claim for Age Pension and Pension Bonus
SA002.1503
Are you of Aboriginal or Torres Strait Islander Australian
origin?
If you are of both Aboriginal and Torres Strait Islander
Australian origin, please tick both ‘Yes’ boxes.
Questions 11 and 12 are optional and will not affect your
payment. If you do answer, the information will help us
to continue to improve services to Aboriginal and Torres
Strait Islander Australians and Australian South Sea
Islanders.
Australian South Sea Islanders are the descendants of
Pacific Islander labourers brought from the Western
Pacific in the 19th Century.
11
Are you of Australian South Sea Islander origin?
12
No
Yes – Aboriginal Australian
Yes – Torres Strait Islander Australian
No
Yes
Do you need an interpreter when dealing with us?
This includes an interpreter for people who have a hearing
or speech impairment.
13
Go to 15
No
Yes
Do you want to authorise another person or organisation to
make enquiries, get Centrelink payments and/or act on
your behalf?
16
Go to next question
No
Yes
You will need to complete and attach an
Authorising a person or organisation
to enquire or act on your behalf
form
(SS313). If you do not have this form or
want more information about nominee
arrangements, go to
www.humanservices.gov.au/nominees
Do you give permission for your partner to make enquiries
with us on your behalf?
You can change this authority at any time.
17
No
Yes
Are you of Aboriginal or Torres Strait Islander Australian
origin?
If you are of both Aboriginal and Torres Strait Islander
Australian origin, please tick both ‘Yes’ boxes.
Questions 11 and 12 are optional and will not affect your
payment. If you do answer, the information will help us
to continue to improve services to Aboriginal and Torres
Strait Islander Australians and Australian South Sea
Islanders.
Australian South Sea Islanders are the descendants of
Pacific Islander labourers brought from the Western
Pacific in the 19th Century.
Are you of Australian South Sea Islander origin?
No
Yes – Aboriginal Australian
Yes – Torres Strait Islander Australian
No
Yes
Do you need an interpreter when dealing with us?
This includes an interpreter for people who have a hearing
or speech impairment.
Go to 15
No
Yes
Do you want to authorise another person or organisation to
make enquiries, get Centrelink payments and/or act on
your behalf?
Go to next question
No
Yes
You will need to complete and attach an
Authorising a person or organisation
to enquire or act on your behalf
form
(SS313). If you do not have this form or
want more information about nominee
arrangements, go to
www.humanservices.gov.au/nominees
Do you give permission for your partner to make enquiries
with us on your behalf?
You can change this authority at any time.
No
Yes
Go to next question Go to next question
What is your preferred spoken language?
14
What is your preferred spoken language?
What is your preferred written language?
15
What is your preferred written language?
11
12
13
16
17
14
15
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You Your partner
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