Do you have any income stream investments? Yes No
Personal Details:
Single
Couple
Couple (where only one partner is eligible to apply)*
* Use couple combined Income and Assets when completing the Income and Assets fields
Homeowner      Non-Homeowner
Non Income Stream Assets / Income: Asset Value
Personal Assets
(eg. home contents, car, boat, jewellery etc.)
Financial Investments
(eg. unit trusts, bank accounts, shares etc.)
Superannuation
Other Assets
(eg. real estate, private company shares etc.)
Income
Other Income
(eg. employment, rental income, trust distributions etc.)
Income Streams Assets / Income:
Non-Complying Income Streams
Assessable Asset Value
Annual Income Payments
Annual Deductible Amount
Complying Income Streams
Assessable Asset Value
Annual Income Payments
Annual Deductible Amount

Income Test Assets Test
Total Income / Assets* $ $
Amount above Threshold $ $
Pension Reduction $ $
Pension Payable $ $
Annual Per Fortnight
Maximum Age Pension # $ $
Age Pension Entitlement # $ $
# Includes Pharmaceutical Allowance
* Total assets are rounded down to the nearest $250 (singles) and $500 (couples).
Personal Details:
Single
Couple
Couple (where only one partner is eligible to apply)*
* Use couple combined Income and Assets when completing the Income and Assets fields
Homeowner      Non-Homeowner
Non Income Stream Assets / Income: Asset Value
Personal Assets
(eg. home contents, car, boat, jewellery etc.)
Financial Investments
(eg. unit trusts, bank accounts, shares etc.)
Superannuation
Other Assets
(eg. real estate, private company shares etc.)
Income
Other Income
(eg. employment, rental income, trust distributions etc.)

Income Test Assets Test
Total Income / Assets* $ $
Amount above Threshold $ $
Pension Reduction $ $
Pension Payable $ $
Annual Per Fortnight
Maximum Age Pension # $ $
Age Pension Entitlement # $ $
# Includes Pharmaceutical Allowance
* Total assets are rounded down to the nearest $250 (singles) and $500 (couples).