Form Mod Pt – Fill Out and Use This PDF

When to use this form

Online services

Using a tax agent or accountant

What else you will need to provide

For more information

This form is used to work out your share of a private trust’s income and assets.

Use this form, if in the last 5 years, you (and/or your partner):

•have been involved with or have transferred funds or assets to a private trust that has not been vested

•have made any type of gifts involving a private trust (either active or vested).

You do not need to complete this form if it is:

•a Special Disability Trust

•a Complying Self Managed Superannuation Fund

•vested and no gifts need to be declared. However, you will need to provide evidence of the vesting.

You can upload this form, with any supporting documents, online.

For more information about how to access an online account or how to lodge documents online, go to servicesaustralia.gov.au/submitdocumentsonline

Much of the information required on the form is only available from those who know the details of the trust. Services Australia is not able to help you complete the form.

We suggest you talk to the trust tax agent or accountant and consider having them complete the form on your behalf. It is still your responsibility to make sure the form is completed and returned.

If a tax agent or accountant provides information, advice or completes the form, or provides the Income Tax Returns for the trust, we will not reimburse any fees they may charge you for this service.

If you are making a claim, you must return this form and all other supporting documents at the same time you lodge your claim form. If you do not return all documents, your claim may not be accepted. The only exception will be if you are waiting for medical evidence or other documents from a third party.

Go to servicesaustralia.gov.au/trustsandcompanies or visit one of our service centres.

If you need to call us, go to servicesaustralia.gov.au/phoneus

We can translate documents you need for your claim for free.

To speak to us in your language, call 131 202.

Call charges may apply.

If you have a hearing or speech impairment, you can contact the TTY service Freecall™ 1800 810 586. A TTY phone is required to use this service.

Authority to inspect the property

Purpose of this authority

To enable us to correctly assess your entitlement, it may be necessary for a valuation of a property held by the trust to be completed.

In order to continue paying your correct entitlement, we may arrange to have the property professionally valued from time to time, at no cost to you.

Information about having a valuation

Why is a valuation required?

Social security law requires that the value of assets (for example, property, shares in a company, units in a trust) is included when calculating the amount of pension, benefit or allowance payable.

How is the value of a property decided?

The value of real estate is its current market value, less any allowable debts on the property.

The ‘current market value’ is the price the owner could expect to receive if the property was sold.

Through regular updates using relevant market data we will maintain the value of the property.

What happens if there is no permission to inspect the property?

If the value of the property is likely to affect a person’s entitlement to social security payments or the rate of payment, but no permission to inspect the property is provided, the person’s payment may not be granted, payment may be reduced or payment may be stopped.

Definition of primary production

Primary producer means a person whose principal occupation is primary production.

Primary production means:

•production resulting directly from the cultivation of land

•the maintenance of animals or poultry for the purpose of selling them or their bodily produce, including natural increase

•fishing operations

•forest operations

•the manufacture of dairy produce by the person who produced the raw material used in that manufacture.

Special concession for primary producers

There is a special concession for primary producers who meet certain conditions. This concession will allow some primary producers to retain limited appointorship powers without the income and assets of the private trust being attributed to them.

Note: Primary producers taking up this concession after 31 March 2002, will be considered to have made a gift.

The conditions are:

Family member running the farm

As this concession is aimed at farmers wishing to retire and hand control on to the next generation, the concession is limited to circumstances where a family member is operating, or takes over the operation of the primary production enterprise.

This will allow the older generation to retire without the need for the farm to support several generations.

Income and asset limits

The special concession is limited to primary producers who, together with their partners, meet certain income and asset requirements.

Primary production assets include primary production land as well as all other primary production assets such as plant, machinery and livestock.

The value of the primary production enterprise is based on current market values. We may arrange to have the primary production assets valued at no cost to the farmer or the trust.

The net value of the primary production enterprise is determined by deducting the allowable primary production liabilities from the current market value of the primary production assets (less the net value of the principal home of the farmer if that principal home is owned by the trust).

70% rule

More than 70% of the net value of the assets of the trust (excluding the net value of the principal home of the farmer if that principal home is owned by the trust) must relate to assets used wholly or principally for the purposes of carrying on a primary production enterprise.

Special concession for primary producers continued

Limited appointorship

The powers that the appointor can hold must be limited.

This means that an irrevocable clause must be inserted into the trust deed providing that:

•the appointor’s power to appoint a new trustee can only be exercised upon the trustee’s death, resignation or legal disablement

•any power of veto held by the appointor is limited to the power to veto the sale of the primary production land.

The appointor must also make a statutory declaration of their resignation from the trust, stating they will not exert any control over, or benefit in any way from the trust, beyond the limited benefits allowed.

Neither they nor their partner can:

•be the trustee, or be able to be appointed as trustee

•have the power to change the trust deed

•be *capital or income beneficiaries of the trust.

(*A capital beneficiary or income beneficiary is a person who is able to receive either capital or income at any time from the trust).

Loans from appointors

Appointors who have large loans outstanding to the trust may be assessed as still having control over the trust. If you have a large loan to the trust, you should seek advice from us as to the effect on your eligibility to this concession.

Life interest in home

The appointor and their partner can retain a life interest in their home if it is situated on the primary production property.

Incidental fringe benefits

The appointor and their partner can receive some incidental fringe benefits such as food, water, fuel, gas or electricity for personal consumption.

Receiving income from the farm

The appointor and their partner may continue to draw a combined income from the trust(s) during the 5 years after transfer to a limited appointorship if they are affected by the gifting rules.

If there are several primary production trusts, the income limit applies to the combined income from all the trusts.

If the gifting rules do not apply to a person, all income from the trust must cease for the concession to apply.

For more information on the current primary production income and asset concessions, go to

servicesaustralia.gov.au/assets

Attribution to new controller

Usually the family member who takes over the operation of the primary production enterprise would be appointed as the trustee of the trust.

The new controller will have the income and assets of the trust taken into account should they or their partner be receiving an income support payment. This is because, as controller, the income and assets of the trust would be attributed to them.

MOD

PT

Private Trust

Filling in this form

You can complete this form on your computer, print and sign it.

If you have a printed form:

•Use black or blue pen.

•Print in BLOCK LETTERS.

•Use a separate form for each trust.

•If you need more space to answer any questions, provide a separate sheet. Write the trust name and your Centrelink Reference Number (CRN) if known, on each sheet.

•Each form can be used jointly for all our customers and their partners who are involved in the trust. However, for privacy, you may choose to complete your own separate form.

About you

1Your Centrelink Reference Number (if known)

2Your name Family name

First given name

Second given name

3Your date of birth

//

4Do you have a partner?

For the definition of a partner, go to servicesaustralia.gov.au/moc

5Your partner’s name Family name

First given name

Second given name

6Your partner’s date of birth

//

About the private trust

7What is the name of the private trust?

This private trust will be referred to as ‘the trust’ on the rest of this form.

8Trust tax file number (Trust TFN)

Trust Australian Business Number (Trust ABN)

9Are you the person we can contact about details given on this form?

CLK0MOD(PT) 2005

10Provide details of the person we can contact about details given on this form (for example, your tax agent or accountant).

Name

Business name (if applicable)

Position in relation to the trust discussed in this form

Postal address

Postcode

Daytime phone number

11Provide contact person details for future requests for taxation returns and financial statements of the trust, if required for a review (for example, yourself, your tax agent or accountant).

Position in relation to the trust discussed in this form

Postal address

Postcode

Daytime phone number

12In which month are the taxation returns and financial statements for the trust normally completed?

13Is this a testamentary trust?

A testamentary trust is one set up through a will and activated by the death of the testator (the person who makes the will).

Name of testator

Date of death of testator

/ /

Relationship to the beneficiaries

You will need to provide a copy of the will of the testator.

Go to next question

14Is there a surviving partner of the testator?

Name of surviving partner

Date of birth

/ /

Their permanent address

Postcode

Read this before answering the following questions.

For more information about ‘The control test’, refer to the Notes Booklet.

15Does the surviving partner have personal control of the trust?

16Does the surviving partner have an interest and control through an associate?

For more information about ‘Associates’, refer to the Notes Booklet.

17What date was the trust set up (such as the date shown on the trust deed)?

//

18What date did the trust commence trading?

//

19Is the trust still trading?

20What date did the trust cease trading?

//

21Explain why the trust ceased trading

22 Trading name under which the trust conducts business and the type of business

1 Trading name

Type of business (for example, primary production, retail, commercial, investment)

2Trading name

Type of business (for example, primary production, retail, commercial, investment)

3Trading name

Type of business (for example, primary production, retail, commercial, investment)

If there are more than 3 trading names, provide a separate sheet with details.

23Read this before answering the following question.

Only answer questions 24 and 25 if you (and/or your partner) are age pension age or claiming Age Pension otherwise, go to 26

To work out if you (or your partner) are age pension age, use the table below.

From 1 July 2019, the Work Bonus will also apply to self-employment income of age pension age customers if the income earned is a direct result of your actions or effort in a particular task.

This means if you work for financial gain or reward, that involves your personal exertion, you will be eligible to have the Work Bonus applied to that income. For example, book keeping, lawn mowing and/or other tasks where your direct involvement generates that income. We call this active self-employment.

24Does your (and/or your partner’s) role in the business involve personal exertion?

This does not include domestic or household maintenance tasks and management or administration of your place of residence or any financial investment or real property belonging to:

•a member of your family group

•a company that is a family company

•a trustee or trustees of a family trust.

25What percentage of the income is from personal exertion?

If you need more space, provide a separate sheet with details.

26Has the trust had a change in circumstances since the last financial statements were prepared (for example, downturn in trade, business sold, changes in wages paid by the trust to you and/or your partner)?

You will need to provide a copy of the evidence of the change in circumstance. Evidence may include:

•an interim Profit and Loss Statement

•sale documents

•a current Balance Sheet

•an Administrator’s or Liquidator’s Report

•payslips

•payroll reports.

Change in circumstances since last financial statement

27Details of the trustee

The trustee may be a person or company. The name of the trustee appears on the trust Income Tax Return and the Trust Deed.

1Name of trustee

Date of birth (if a person)

/ /

Centrelink Reference Number (if known)

2Name of trustee

Date of birth (if a person)

/ /

Centrelink Reference Number (if known)

3Name of trustee

Date of birth (if a person)

/ /

Centrelink Reference Number (if known)

If there are more than 3 trustees, provide a separate sheet with details.

28Is the trustee a corporate trustee?

If the trustee is a company, this is referred to as a ‘corporate trustee’.

29Does the trust have an appointor?

An appointor may also be known as the guardian. It is generally the person who establishes the trust and who has the power to appoint or dismiss the trustee.

1Name of the appointor

Date of birth

/ /

2Name of the appointor

Date of birth

/ /

If there are more than 2 appointors, provide a separate sheet with details.

30Does any other person have the power to:

•veto a trustee’s decision

•replace the trustee

•control the trustee’s actions

•change the trust deed?

1Name

Date of birth

/ /

Tick one only

This person can exercise control independently This person can exercise control jointly

2Name

Date of birth

/ /

Tick one only

This person can exercise control independently This person can exercise control jointly

If there are more than 2 people, provide a separate sheet with details.

31Is there any person(s) who is or may be instructing any person named in question 29 or question 30?

1Name

Date of birth

/ /

2Name

Date of birth

/ /

If there are more than 2 people, provide a separate sheet with details.

32Does any person have informal control of the trust?

A person has informal control where:

•they are capable of gaining control

•the person with formal control could reasonably be expected to act in accordance with their wishes.

1Name

Date of birth

/ /

2Name

Date of birth

/ /

If there are more than 2 people, provide a separate sheet with details.

33Does any person have use and enjoyment of the income and/or assets of the trust?

1Name

Date of birth

/ /

2Name

Date of birth

/ /

3Name

Date of birth

/ /

If there are more than 3 people, provide a separate sheet with details.

34Have there been any previous trustees and/or appointors since 1 January 2002?

1Name

Reason for change

Trustee

or

Appointor

2Name

Reason for change

Trustee

or

Appointor

3Name

Reason for change

Trustee

or

Appointor

If there are more than 3 previous trustees/appointors, provide a separate sheet with details.

No Yes

Go to next question

Give details of all unitholders and their unitholding

Name

1

2

3

4

5

6

7

8

Name

1

2

3

4

5

6

7

8

9

10

37Read this before answering the following question.

A person may be unable to manage their own affairs because they are:

•under age (a minor) and therefore unable to sign contracts

•unable to understand a contract because of an intellectual disability

•unable to make a decision for themselves because they have a severe physical disability, for example, they are in a coma.

Exclusive benefit means that all income earned by the trust, or distributed assets of the trust, has been used for the sole benefit of the person who is unable to manage their own financial affairs.

Is the trust administered for the exclusive benefit of a person under 18 years of age, or an adult unable to manage their own affairs?

Name of the beneficiary

Date of birth

/ /

38What is the source of funds for the trust?

Source of the funds may include:

•an insurance payment

•a transport accident compensation payment

•an inheritance.

39Date on which the person will be able to access their entitlement directly

The terms of the trust may be that the person who is unable to manage their own financial affairs is able to access the monies held on their behalf when they reach a certain age, for example, 21 years of age.

/ /

Not applicable

40Is your role as a beneficiary only?

•the Resolution to Distribute

•evidence of the Beneficiary Loan account balance.

Go to 98

Trust financials

41Is the trust a fixed trust set up before 7:30 pm AEST on 9 May 2000?

A fixed trust is one where the trust deed:

•names the person who will benefit from the trust

•specifies the income and/or assets they will receive.

42Did the fixed trust entitlements exist before 7:30 pm AEST on 9 May 2000?

43Have the entitlements altered since then?

1Owner of entitlement(s)

What changed?

2Owner of entitlement(s)

What changed?

3Owner of entitlement(s)

What changed?

If there are more than 3 changes, provide a separate sheet with details.

44Have additional contributions been received by the trust since 7:30 pm AEST on 9 May 2000?

A contribution may be in the form of:

•cash

•investments

•services

•real estate.

1Contribution by (name or person or organisation)

What was contributed?

2Contribution by (name or person or organisation)

What was contributed?

3Contribution by (name or person or organisation)

What was contributed?

If there are more than 3 additional contributions, provide a separate sheet with details.

45If this trust is a unit trust, have additional units been issued since 7:30 pm AEST on 9 May 2000?

If there are more than 3 people, provide a separate sheet with details.

46Have there been any other changes to the trust since 7:30 pm AEST on 9 May 2000?

47Has anyone gifted, transferred or sold for less than their market value, any cash, investments, services, real estate or other assets to this trust since 7:30 pm AEST on 9 May 2000?

This is referred to as ‘contribution’.

Include any loans which may have been written off, waived or for any reason decided not to recover.

Market value is the price a willing but not anxious purchaser is prepared to pay a willing but not anxious seller for an item.

The value of:

•cash is the amount contributed

•services is the gross amount normally charged by a qualified person for a similar service

•real estate is the market value at the time the property was transferred to the trust.

Note: If the contribution was in the form of real estate, you must complete the ‘Trust real estate details’ section (questions 57 to 88), about that real estate.

1 Name of contributor

Date of birth

What was contributed?

Amount originally paid for contribution (if applicable)

$

Continued

2 Name of contributor

Date of birth

What was contributed?

Amount originally paid for contribution (if applicable)

$

If there are more than 2 contributors, provide a separate sheet with details.

48Does the trust hold any shares in public companies?

Include:

•futures

•options

•derivatives

•rights or convertible notes

•other securities including those not listed on a securities or stock exchange.

1Name of the public company or ASX code

Number of shares held

2Name of the public company or ASX code

Number of shares held

3Name of the public company or ASX code

Number of shares held

4Name of the public company or ASX code

Number of shares held

5Name of the public company or ASX code

Number of shares held

6Name of the public company or ASX code

Number of shares held

If there are more than 6 public companies, provide a separate sheet with details.

49Does the trust hold any managed investments?

Include:

•investment trusts

•personal investment plans

•life insurance bonds

•friendly society bonds.

Do not include:

•conventional life insurance policies

•funeral bonds

•superannuation or rollover investments

•investments purchased with a margin loan.

APIR code – is commonly used for fund managers to identify individual financial products.

1Name of the fund manager

2Name of the fund manager

3Name of the fund manager

Continued

4Name of the fund manager

If there are more than 4 managed investments, provide a separate sheet with details.

50Does the trust hold any shares or have any other involvement in other private companies?

1 Name of the company

Company ABN or ACN

2Name of the company

Company ABN or ACN

3Name of the company

Company ABN or ACN

If there are more than 3 private companies, provide a separate sheet with details.

51Is the trust a beneficiary of or otherwise involved in another private trust?

1Name of the private trust

Trust

TFN

Trust

ABN

2Name of the private trust

Trust

TFN

Trust

ABN

3Name of the private trust

Trust

TFN

Trust

ABN

If there are more than 3 private trusts, provide a separate sheet with details.

52Does the trust own any other assets?

No Yes

Go to next question

Give details below

You will need to provide a copy of each loan agreement (if available).

A written loan agreement must be signed by all parties to the agreement and witnessed by a genuine third party. Associates are not considered to be genuine third parties.

No Yes

Go to next question

Give details for each liability

Include:

•bank loans

•mortgages

•fully drawn advances

•personal loans not provided in question 54.

Collateral security is fall back security in the event that the primary security is insufficient.

56Did any associate (as defined in the Notes Booklet) or any person named in questions 27, 29, 30, 32 or 36 receive, or were they entitled to receive, any INCOME from the trust in the last financial year?

Include:

•wages

•salaries

•director’s fees

•bonus shares

•an income or capital distribution

•superannuation contributions made on the person’s behalf to a superannuation fund.

1Name

Date of birth

/ /

Value

$

2Name

Financial year of payment

Value

$

3Name

Financial year of payment

No Yes

Go to 91

How many properties does the trust hold?

If the trust owns more than 1 property, complete a separate ‘Trust real estate details’ section (questions 59 to 90) for each property.

Go to next question

59Name of the trust which holds the real estate

Trust CRN – if applicable

Trust ABN

About the property

If you need to complete this section for more than 1 property, copy pages 17 to 21 before you answer the questions.

60Address of the property

Postcode

Country (if not in Australia)

61What date did the property become an asset of the trust?

//

62What type of property is this?

Vacant land Bush block Home office/business House

Self contained flat (part of or provided to a residence)

Units/flats/town house Retail premises Commercial premises Industrial premises Farm (or hobby farm) Market garden

Residential block larger than 2 hectares (5 acres)

63What is the legal description of the property (for example, lot, section or parish. This may appear on the rates notice)?

If the property is made up of more than 1 title, give details for each separate title.

Provide a copy of the latest council rate/ valuation notice.

64What is the estimate of the current market value of the property, including land, buildings and water assets (for example, water rights, allocations or licences)?

You do not need to have the property professionally valued. We may have the property valued at no cost to you.

$

Provide a copy of the water rights, allocation or licence documents, if applicable.

65Is there a residence on the property?

66Does any trustee, appointor, unitholder or beneficiary live on the property?

67Is the property larger than 2 hectares (5 acres)?

68What is the estimate of the value of the residence and surrounding 2 hectares (5 acres)?

$

69Does the property have more than 1 title document?

70What is the estimate of the value of the residence and surrounding title?

$

Provide the legal description and area of the title on which the residence sits.

Provide a copy of each title deed.

71Is the person who lives on the property (or their partner) currently over age pension age and receiving, or claiming:

•Age Pension

•Carer Payment

•Pension Bonus Bereavement Payment

•Department of Veterans’ Affairs Age Service Pension?

72Has the property been their home property for 20 years or more continuously?

75Is the property used to produce an income?

76Is there any reason that prevents the trust from using the property to produce an income?

77Why is the property not being used to produce an income?

Tick all that apply

Rural residential block

Land is not viable for commercial or agricultural use

Caring responsibilities Health reasons Zoning restrictions

Environmental restrictions

78How is the property currently used?

Tick all that apply

73Does the person (and/or their partner) or a family member use the property to support themselves?

74Is there any potential commercial use of the property (for example, subdividing, agistment, hobby farming)?

Do not currently make any use of the property

Primary production Rural residential only Leased

Other commercial or business use (for example, commercial kennels)

Hobby farm Other

Give details below

79Have 2 or more titles been amalgamated after 9 May 2006? No

Yes

80Does the trust have 100% ownership of the property?

81Who else owns the property?

If there are more than 3 owners, provide a separate sheet with details.

82What is the area or dimension of the property? Complete one of these measurements only.

If the property is made up of more than 1 title, provide a separate sheet with details of the area or dimensions for each title.

83Describe all buildings on the property This will help us to value the property.

Type of construction

Exterior (for example, brick, timber)

Interior (for example, plaster, not lined)

Roof (for example, metal, tiles)

General condition (for example, good, fair, poor)

Total number of flats/units in the complex (if applicable)

For residential building, number of bedrooms

Number of other rooms (excluding laundry, bathroom, toilet)

Type of construction

Exterior (for example, brick, timber)

Interior (for example, plaster, not lined)

Roof (for example, metal, tiles)

General condition (for example, good, fair, poor)

Total number of flats/units in the complex (if applicable)

For residential building, number of bedrooms

Number of other rooms (excluding laundry, bathroom, toilet)

If there are more than 2 buildings, provide a separate sheet with details.

Property financial details

84Is the property mortgaged or encumbered?

Name of finance provider

Provide the:

•mortgage or loan agreement(s) showing which assets or properties are held as security against the loan (if applicable)

•latest statement of each loan account.

85Have any other assets or properties been used to secure the loan to purchase this property?

Provide the following documents if this has not already been done:

•mortgage or loan agreement(s) showing which assets or properties are held as security against the loan

•latest statement for each loan account.

Describe the asset or give the address of the property used to secure the loan.

Estimated market value

$

If there is more than 1 asset or property used as security, provide a separate sheet with details.

86Does the trust receive any rental income from the lease of the property?

Gross amount of rent received (before tax and other deductions)

$

87Are there any circumstances affecting the value of the property?

This may include details such as:

•no water on property for grazing livestock

•lack of adequate fencing

•hills

•rocky ground

•natural bushland

•unusual title.

88If the property is hard to locate, give full directions or provide a map.

Privacy notice

89You need to read this

Privacy and your personal information

The privacy and security of your personal information is important to us, and is protected by law. We need to collect this information so we can process and manage your applications and payments, and provide services to you. We only share your information with other parties where you have agreed, or where the law allows or requires it. For more information, go to

servicesaustralia.gov.au/privacy

Authority to inspect the property

90For more information about ‘Authority to inspect the property’, refer to the Notes Booklet.

I hereby authorise a licenced valuer to enter and inspect the property for the purposes of a valuation in relation to the Social Security (Administration) Act 1999.

I understand that if the property to be inspected is not occupied by me, it is my responsibility to give the actual occupant reasonable notice, or such notice as is required by agreement, of the inspection.

This authorisation does not permit the valuer to enter my home, or any dwelling I may own, during the inspection, unless invited to do so. A similar condition applies to the home of any tenant involved.

I further understand that Centrelink or its representative will contact me, or the person noted below, to arrange a mutually convenient time for any inspection of the property.

Name of Trustee

/ /

Second signature (if a corporate trustee) Date

/ /

Person to be contacted by the valuer

Their daytime phone number

When you have completed a ‘Trust real estate details’ section for each real estate property owned by the trust

Go to next question

Special concessions for primary producers

91Read this before answering the following questions.

For more information refer to ‘Information for primary producers’, in the Notes Booklet.

Are you a primary producer who wishes to apply for the special concession?

•a stamped copy of initial trust deed

•a stamped copy of the trust deed amendment or separate deed relinquishing beneficial interest

•a written statement declaring that you will not exert any control over, or benefit in any way, from the trust.

92Are you (and/or your partner) beneficiaries of the trust?

For more information, refer to ‘Special concession for primary producers: Limited appointorship’ in the Notes Booklet.

93Who is operating the farm? Name of operator

Date of birth

/ /

Their relationship to you

94Does your primary production enterprise include a partnership?

You will need to complete and return a Business details (Mod F) form.

If you do not have this form, go to

servicesaustralia.gov.au/forms

Go to next question

95Date appointorship changed to ‘limited’?

//

96What was your (and/or your partner’s) primary production income for the 3 financial years before ‘limited’ appointorship, that is, before the date in question 95?

97Do you (and/or your partner) own other primary production assets that are not part of this trust?

Documents you MUST provide

Tick all that apply

Personal Income Tax Return for you

Personal Income Tax Return for your partner if they are involved with the trust

Latest Income Tax Return for the trust

Profit and Loss Statement for the trust

Depreciation Schedule for the trust

Balance sheet for the trust

Notes to and forming part of the accounts (If applicable)

Trading account details for the trust (If applicable)

A Profit and Loss Statements for all income sources and/or balance sheet for the trust for the current financial year if the most recent completed year is not an accurate reflection of the current circumstances of the trust (if applicable)

If you are not able to lodge any of the required documentation, give an explanation below

Documents you MAY need to provide

If you are not sure, check the question to see if you should provide the documents.

Tick all that apply

A copy of the will of the testator

(if you answered Yes at question 13)

A copy of the evidence the trust has had a change in circumstances

(if you answered Yes at question 26)

Private Company (Mod PC) form

(if you answered Yes at question 28 and/or 50)

A copy of the Resolution to Distribute and evidence of the Beneficiary Loan account balance

(if you answered Yes at question 40)

A copy of the latest statement detailing the shareholding in each company

(if you answered Yes at question 48)

A complete copy of a document which gives current details for each investment

(if you answered Yes at question 49)

Private Trust (Mod PT) form

(if you answered Yes at question 51)

Copies of any written agreements concerning loans from a person or an associate to the trust (if you answered Yes at question 54)

A completed ‘Trust real estate details’ section for each real estate property held by the trust

(if you answered Yes at question 58)

A copy of the council rate/valuation notice for each property held by the trust (at question 63)

A copy of the water rights, allocation or licence documents, if applicable (at question 64)

A copy of each title deed (required at question 70)

The mortgage or loan agreement(s) showing which assets or properties are held as security against the loan (if applicable) and latest statement of each loan account

(if you answered Yes at question 84 or 85)

A stamped copy of the initial trust deed, a stamped copy of the trust deed amendment of separate deed relinquishing beneficial interest, and a written statement declaring you will not exert any control over, or benefit in any way, from the trust

(if you answered Yes at question 91)

Business details (Mod F) form

(if you answered Yes at question 94)

We may request further documents that relate to the trust.

Privacy notice

99You (and your partner) need to read this

Privacy and your personal information

The privacy and security of your personal information is important to us, and is protected by law. We need to collect this information so we can process and manage your applications and payments, and provide services to you. We only share your information with other parties where you have agreed, or where the law allows or requires it. For more information, go to

servicesaustralia.gov.au/privacy

Declaration

100I declare that:

•the information I have provided in this form is complete and correct.

I understand that:

•if submitting this document as part of a claim, the claim may not be accepted unless supporting documents are lodged at the same time as the claim. The only exception will be if I am waiting for medical evidence or other documents from a third party.

•the trust may be reviewed but I must tell Centrelink of any changes to the trust’s circumstances that may impact my payment within 14 days of the change(s) occurring, or within 28 days if I live outside Australia. For example:

–changes in the trust’s income, assets or expenses

–gifts made or received

–distributions made.

•Centrelink can make relevant enquiries to make sure I receive the correct entitlement.

•giving false or misleading information is a serious offence.

Your signature

Date

/ /

Your partner’s signature

Date

/ /

Returning this form

Return this form and any supporting documents:

•online using your Centrelink online account. For more information, go to servicesaustralia.gov.au/submitdocumentsonline

•in person at one of our service centres, if you are not able to use your Centrelink online account.