Form MO014 at a glance
What it is: This is the Early Release of Superannuation on Specified Compassionate Grounds form for Medical, Dental or Transport.
Where and when to file: Send the completed form and all supporting documentation to: Department of Human Services ERSB Programme PO Box 1001 TUGGERANONG DC ACT 2901 or Scan and email: ERSBenquiries@humanservices.gov.au
Use this form to advise the Australian Government Department of Human Services (Human Services) if you need an early release of your superannuation to pay for medical treatment, dental treatment or transport expenses. You may be eligible if: you or your dependant suffers from a life threatening illness or injury, acute or chronic pain or an acute or chronic mental illness, and you need assistance to meet the costs of medical treatment which is not readily available through the public health system or covered by insurance, and/or you need assistance to meet the costs of transport to access medical treatment, and you lack the financial capacity to pay for the expenses without accessing your superannuation.
What to bring and attach to Form MO014
You must prove your identity by providing 100 points of certified identification. All documents supplied need to be clearly certified copies. Do not send originals. Each identification document has a different point value and you need to provide documents which add up to 100 points. For examples of who can certify documents and a list of acceptable forms of identification and their point value go to www.humanservices.gov.au/earlysuper
In addition to your application you must provide 2 separate reports of the Early Release of Superannuation on Specified Grounds - Report by Medical or Dental Practitioner and/or Specialist form (MO017). One report must be completed by a registered medical practitioner, and the other report must be completed by the relevant registered medical specialist. Reports need to be signed, dated and be no older than 6 months from the date of this application.
You must provide evidence of all of the medical expenses that you are applying for. Any medical expenses which are not supported by quotes or unpaid invoices from service providers will not be considered. Quotes and/or invoices need to be provided if you are applying for either medical or transport.
Unpaid invoices can be no older than 30 days from the date of this application.
Where you are applying for early release of superannuation to meet expenses for another person, you must prove that they are dependent on you for financial, domestic, personal or medical care. If they are your partner or child, they are considered your dependant.
A filled-in Form MO014 example: a checklist for treatment costs
How to fill out Form MO014, box by box
Superannuation fund(s)
The exact details relating to your superannuation fund(s) are required in order to process your application.
The best way to obtain the correct details is to contact your fund(s) directly.
The amount you want to withdraw from this fund.
This amount is a guide to assist with the assessment of your application.
This amount is not an indication of how much may be released if your application is approved.
If additional superannuation funds need to be listed, attach a separate sheet with details.
A release of superannuation from an Exempt Public Sector Superannuation Scheme (EPSSS) cannot be approved.
Medical or dental treatment, and transport
Are you claiming for medical or dental treatment expenses? No: Go to 61. Yes: Who requires the medical or dental treatment for which you are applying?
Do you or your dependant have an existing worker's compensation claim relating to this condition? Yes: Please attach claim details that show which treatment expenses are, or are not, covered by the worker's compensation claim.
Do you have private health cover which will assist with any or all of these costs? Yes: Please attach health cover rebate details.
Are you applying for the cost of transport to access treatment? No: Go to 67. Yes: Who needs the treatment for which you are claiming transport costs?
63 Yes: Please attach claim details that show which transport expenses are or are not covered by the worker's compensation claim.
Are you applying to purchase a vehicle to access medical treatment? No: Go to 67. Yes: Do you or your dependant have a motor vehicle? Yes: Please explain why the existing vehicle cannot be used.
You must attach evidence of the trade in value of your existing vehicle(s).
If you ticked No to both questions 56 and 61 your application could be declined.
Supporting documents you are attaching
If you do not provide the relevant supporting documents, your application may be declined.
Indicate which supporting documents you are attaching with your application.
Superannuation fund details (make sure you have completed question 8).
A Power of Attorney if appropriate (refer to question 70).
If any person(s) or organisation(s) listed hold a Power of Attorney, attach a certified copy.
73 I declare that the information I have provided in this form is complete and correct. I have attached the relevant supporting documentation and certified copies of evidence of identity for this application.
I understand that giving false or misleading information is a serious offence.
More rules for Form MO014
Read all the information provided with this application. Complete this application. Sign and date this application. Provide 100 points of certified identification. Provide information listed in the checklist on page 10. If you do not provide proof of identity and all relevant supporting documents, your application may be declined. The final decision to release your superannuation early, rests with the trustee of your superannuation fund(s). You must contact your superannuation fund(s) to confirm they will release your superannuation if this application is approved.
Australian and New Zealand citizens, permanent residents of Australia or holders of a retirement visa (subclass 405 or 410) are eligible to apply for an early release of superannuation on compassionate grounds.
If you are visiting Australia on a temporary visa (excluding subclasses 405 and 410), you may not be eligible for the early release of your superannuation on compassionate grounds.
Contact the Australian Taxation Office for further information.
Please use black or blue pen
Print in BLOCK LETTERS
Mark boxes like this with a ✓ or 7
Where you see a box like this Go to 5 skip to the question number shown. You do not need to answer the questions in between.
For assistance completing this form call 1300 131 060 Monday to Friday, between 9.00 am and 5.00 pm Australian Eastern Standard Time.
If your situation is different
You are applying for medical or dental treatment
Your medical/dental practitioner and medical/dental specialist each need to confirm in writing that you or your dependant require treatment for a life threatening illness or injury, or an acute or chronic pain, or an acute or chronic mental illness, and that the treatment required is not readily available through the public health system.
The maximum release that can be considered is 12 months of medical treatment.
After this period, you can re-apply.
You are applying for medical transport
Your medical practitioner and medical specialist each need to confirm in writing that you or your dependant require treatment for a life threatening illness or injury, or an acute or chronic pain, or an acute or chronic mental illness.
One of your medical practitioners needs to also confirm in writing that you or your dependant require transport to access treatment, the type of transport required, how often you or your dependant must attend treatment, the location(s) where the treatment is provided, and how long you or your dependant expect to require the treatment.
If you are applying to purchase a vehicle for medical transport purposes you need to provide a quote for the type of vehicle you need to buy to access medical treatment.
If you already have a vehicle, you need to provide confirmation of the trade in value from a relevant service provider or online vehicle pricing service.
You are making a joint application
If you are making a joint application, each person will need to complete and submit their application forms.
Both applications need to be submitted at the same time.
You believe the wrong decision was made
If you believe that the wrong decision was made on your application, you can request a review.
You will need to complete an Early Release of Superannuation on Specified Compassionate Grounds - Request for review of a decision form (MO019).
Common questions about Form MO014
Is there a deadline?
The 28 days apply to requesting a review of a decision: reviews must be requested within 28 days from the date on your decision letter.
Where do I file it?
Send the completed form and all supporting documentation to the Department of Human Services ERSB Programme, or scan and email it.
Sources
[1] Form MO014, Early Release of Superannuation on Specified Compassionate Grounds, Medical, Dental or Transport (the Official source link on this page).