Fillable Interdependency Relationship Form Blank Template - Address Details Only

Fill Online, Printable, Fillable, Blank Interdependency Relationship Form Blank Template - Address Details Only Form

Use Fill to complete blank online DEPARTMENT OF THE TREASURY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Interdependency Relationship Form Blank Template - Address Details Only

On average this form takes 23 minutes to complete

The Interdependency Relationship Form Blank Template - Address Details Only form is 3 pages long and contains:

  • 0 signatures
  • 14 check-boxes
  • 85 other fields

Country of origin: AUSTRALIA
File type: PDF

Use our library of forms to quickly fill and sign your Department of the Treasury forms online.

BROWSE DEPARTMENT OF THE TREASURY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Level 7, 120 Collins Street, Melbourne VIC 3000
Postal Address: Locked Bag 3060, Melbourne VIC 3001
Telephone: 1300 884 114
International: +61 3 8635 5580
Fax: (03) 8635 5588
Website: www.sct.gov.au
Superannuation
Complaints
Tribunal
Death Benefit complaints
Information Request – Interdependency Relationships
With some exceptions, two persons (whether or not related by family) have an interdependency
relationship if:
• t
hey have a close personal relationship; and
• they live together; and
• one or each of them provides the other with financial support; and
• one or each of them provides the other with domestic support and personal care.
The Superannuation Industry (Supervision) Regulations 1994 ('SIS Regulations') provide further
guidance as to what factors should be taken into account to establish whether two persons have a
'close personal relationship'. These factors include:
• the duration of the relationship; and
• whether or not a sexual relationship exists; and
• the ownership, use and acquisition of property; and
• the degree of mutual commitment to a shared life; and
• the care and support of children; and
• the reputation and public aspects of the relationship; and
• the degree of emotional support; and
• the extent to which the relationship is one of mere convenience; and
• any evidence suggesting that the parties intend the relationship to be permanent.
I
f you claim to be a person who had an interdependency relationship with the deceased please
answer the questions below. In addition to answering the questions below, please provide a
written
statement
a
ddressing each of the factors (where relevant) listed above. This information will help
us determine whether or not you had an interdependency relationship with the deceased person.
1 Did you have a close personal relationship with the deceased? Yes No
(a) What is your relationship with the deceased?
Parent Grandparent Uncle Aunt Child Sibling Partner
Friend Other (please describe) __________________________________________
(b) Why do you think that you had a close personal relationship with the deceased?
The duration of our relationship _______ years
Our shared life Yes No
The reputation and public aspects of our relationship Yes No
Provide some evidence of these indicators – for example, of the intended permanence of
the relationship, the shared acquisition, ownership and use of property, affidavits provided by
friends, family, associates etc. Note that the absence or presence of any indicators is not
necessarily conclusive evidence of the absence or presence of an interdependency relationship.
2
2 Were you living together at the time of death of the member? Yes No
(a) If 'Yes', for how long? ________________________________
Where did you live together? (address) ________________________________
________________________________
If renting, in whose name was the property rented? ________________________________
If owned, in whose name is the title held? ________________________________
(b) Why were you living together?
Because of our special relationship? Yes No
Sharing accommodation for convenience (e.g. flatmates)? Yes No
Providing a paid carer service (e.g. assistance with mobility,
personal hygiene to the deceased? Yes No
Other reasons? (please describe) ________________________________
________________________________
(c) If you were not living together at the time of death (although you did so previously) what was
the reason for not living together?
Holiday Visiting relatives Work commitments (since ___/___/______)
Disability (complete Question 5) Other (describe) _________________________
(d) If you were not living together at the time of death (although you did
so previously), did both of you intend to resume living together? Yes No
If 'Yes', when did you expect to be re-united? _________________________
Is there any evidence to support that both of you intended to resume
living together? (e.g. letters written by the deceased or given by close
associates etc.) If so, please provide copies or affidavits. Yes No
3 Did one or each of you provide the other with financial support? Yes No
(a) If 'Yes', what financial support was provided, and by whom?
The deceased contributed financial support by paying part or all of the
rent / mortgage / rates / other expenses of living together? Yes No
You contributed financial support by paying part or all of the rent /
mortgage / rates / other expenses of living together? Yes No
(If yes, attach documents to support this – eg rent receipts, bank statements)
If either the deceased or you provided financial support to each other in other ways, state
what that financial support was and attach any supporting documents.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(b) If 'No', what was the reason for not providing financial support?
Because one or each of us suffered from a disability? Yes No
(Provide details of the disability under Question 5 below)
Other reasons? (please describe) Yes No
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
3
4 Did one or each of you provide the other with domestic support
and personal care? Yes No
(a) If 'Yes', what domestic support and personal care was provided, and by whom?
Specify any domestic support and personal care activities carried out by the deceased (e.g.
cooking, cleaning, shopping, laundry, childcare, caring for animals etc.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Specify any domestic support and personal care activities carried out by you.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(b) If 'No', what was the reason for not providing domestic support and personal care?
Because one or each of us suffered from a disability? Yes No
(Provide details of the disability under Question 5 below)
Other reasons? (please describe) Yes No
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
5 Did one or each of you suffer from any disability? Yes No
If 'Yes', what is the nature of the disability/ies?
__________________________________________________ since ___/___/_____
If the disability/ies were the reason why you were not living together at the time of death,
explain how those disability/ies affected your ability to live together (include any evidence of
special medical and physical care needs such as doctor's reports)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Note – If you have answered 'Yes' to Question 5, ensure you have also answered
Questions 3(b) and 4(b).
STATEMENT I declare that the information on this form is complete and correct.
_____________________________________
(Name)
_____________________________________ ___/___/_____
(Signature) (Date)
4
SUPERANNUATION INDUSTRY (SUPERVISION) ACT 1993
- SECT 10A
Interdependency relationship
(1) Subject to subsection (3), for the purposes of this Act, 2 persons (whether or not
related by family) have an interdependency relationship if:
(a) they have a close personal relationship; and
(b) they live together; and
(c) one or each of them provides the other with financial support; and
(d) one or each of them provides the other with domestic support and personal
care.
(2) Subject to subsection (3), for the purposes of this Act, if:
(a) 2 persons (whether or not related by family) satisfy the requirement of
paragraph (1)(a); and
(b) they do not satisfy the other requirements of an interdependency
relationship under subsection (1); and
(c) the reason they do not satisfy the other requirements is that either or both
of them suffer from a physical, intellectual or psychiatric disability;
they have an interdependency relationship.
(3) The regulations may specify:
(a) matters that are, or are not, to be taken into account in determining under
subsection (1) or (2) whether 2 persons have an interdependency
relationship; and
(b) circumstances in which 2 persons have, or do not have, an
interdependency relationship.
5
SUPERANNUATION INDUSTRY (SUPERVISION) REGULATIONS 1994 –
Interdependency relationships (Act s 10A)
(1) For paragraph 10A (3) (a) of the Act, the following matters are to be taken into
account in determining whether 2 persons have an interdependency relationship, or
had an interdependency relationship immediately before the death of 1 of the
persons:
(a) all of the circumstances of the relationship between the persons, including
(where relevant):
(i) the duration of the relationship; and
(ii) whether or not a sexual relationship exists; and
(iii) the ownership, use and acquisition of property; and
(iv) the degree of mutual commitment to a shared life; and
(v) the care and support of
children
; and
(vi) the reputation and public aspects of the relationship; and
(vii) the degree of emotional support; and
(viii) the extent to which the relationship is one of mere convenience; and
(ix) any evidence suggesting that the parties intend the relationship to
be permanent;
(b) the existence of a statutory declaration signed by one of the persons to
the effect that the person is, or (in the case of a statutory declaration made
after the end of the relationship) was, in an interdependency relationship with
the other person.
(2) For paragraph 10A (3) (b) of the Act, 2 persons have an interdependency
relationship if:
(a) they satisfy the requirements of paragraphs 10A (1) (a) to (c) of the Act;
and
(b) one or each of them provides the other with support and care of a type
and quality normally provided in a close personal relationship, rather than by a
mere friend or flatmate.
Examples of care normally provided in a close personal relationship rather than by a friend
or flatmate
1. Significant care provided for the other person when he or she is unwell.
6
2. Significant care provided for the other person when he or she is suffering emotionally.
(3) For paragraph 10A (3) (b) of the Act, 2 persons have an interdependency
relationship if:
(a) they have a close personal relationship; and
(b) they do not satisfy the other requirements set out in subsection 10A (1)
of the Act; and
(c) the reason they do not satisfy the other requirements is that they are
temporarily living apart.
Example for paragraph (3) (c)
One of the persons is temporarily working overseas or is in gaol.
(4) For paragraph 10A (3) (b) of the Act, 2 persons have an interdependency
relationship if:
(a) they have a close personal relationship; and
(b) they do not satisfy the other requirements set out in subsection 10A (1)
of the Act; and
(c) the reason they do not satisfy the other requirements is that either or
both of them suffer from a disability.
(5) For paragraph 10A (3) (b) of the Act, 2 persons do not have an
interdependency relationship if 1 of them provides domestic support and personal
care to the other:
(a) under an employment contract or a contract for services; or
(b) on behalf of another person or organisation such as a government
agency, a body corporate or a benevolent or charitable organisation.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Interdependency Relationship Form Blank Template - Address Details Only

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 18 February 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document