Verification of Working Life Residence in Australi 2023-2026

Verification of working life residence in Australia OFFICE USE ONLY Return to CSC Customer s name CRN The Australian Government Department of Human Services needs to verify the period you resided in Australia during your working life. Working life means for men between your 16th and 65th birthdays For claiming Survivor Pension working life means details about your deceased partner Please complete this form if you have applied to have your Australian pension paid outside Australia or want to get a pension under a social security agreement with another country. When you have completed this form bring it with your documents to your local Service Centre or return it with your claim* NOTE If claiming a Survivor Pension give details about your deceased partner. Customer details Family name Given name s Date of birth Sex Male Female Surname at birth Place of birth Residential address Postcode Were you born in Australia Yes Go to Question 3 No Date of first arrival Place of arrival Name on arrival Name of ship Airline flight number if known CLK0AUS027 1402 AUS027. 1402 1 of 2 Have you been absent from Australia during your working life for any period greater than 12 months since you first arrived in Australia or since birth if born in Australia Date of departure List all absences of more than 12 months Name of ship/flight number Date of return Do you have any documents which confirm your residence in Australia Yes during your working life deceased partner. Suitable documents are taxation documents education certificates reference from employer showing periods of employment marriage certificate birth certificate birth certificate of any of your children born in Australia naturalisation certificate passport any other document which may help to confirm your residence in Australia during your working life. Please give details of persons who are not related to you and can confirm all or some of your residence in Australia during your working life. e*g* employers neighbours co-workers. Name Address Please attach some documents to confirm your sighted and returned to you by the Department of Human Services. Known for period From To Please list some important personal events that occurred during your residence in Australia e*g* name place and date of birth of children name address and dates of employment details of schools that children attended names addresses of property owned IMPORTANT INFORMATION Privacy and your personal information Your personal information is protected by law including the Privacy Act 1988 and is collected by the Australian Government Department of Human Services for the assessment and administration of payments and services. This information is required to process your application or claim* Your information may be used by the department or given to other parties for the purposes of research investigation or where you have agreed or it is required or authorised by law. You can get more information about the way in which the Department of Human Services will manage your personal information including our privacy policy at humanservices.