Level 7, 120 Collins Street Melbourne, 3000
Postal Address: Locked Bag 3060, Melbourne VIC 3001
Telephone: 1300 884 114
International: +61 3 8635 5580
Website: www.sct.gov.au
Superannuation
Complaints
Tribunal
Ref. No. _________________
STATEMENT OF FINANCIAL DEPENDENCY
This form should be completed if you are claiming to have been wholly or partially
financially dependent on the deceased member at the time of the member’s death.
The level of financial dependency a person had on the deceased member is a relevant
consideration in reviewing a trustee’s decision about how to distribute the death benefit.
The financial support provided to you by the deceased member may include:
- Paying part or all rent/mortgage
- Paying part or all food, clothing, utilities, insurance
- Carrying out or paying part or all repairs and alterations to your home
- Paying part or all education expenses
- Making child support payments
YOUR FINANCIAL DEPENDENCY AT TIME OF DEATH OF THE MEMBER
Payments made by the deceased member until the date of death
Type of support
Frequency
Amount ($)
Eg: rent
fortnight
280.00
Please provide supporting documentation.
Payments jointly made by the deceased member and you until the date of death
Type of support
Frequency
Amount ($)
Please provide supporting documentation.
2
Your occupation at the time of the deceased member’s death: _____________________
Your income at the time of the deceased member’s death: $_______________________
Is there anything else we should consider when looking at your financial dependency
on the deceased member?
STATEMENT
I declare that the information on this form is complete and correct.
_____________________________________
(Name)
_________________________________________ ____/____/_______
(Signature) (Date)
The information you provide will be provided to the other parties to the complaint.
Please refer to the attached Personal Information Collection Notice for further
information.
3
PERSONAL INFORMATION COLLECTION NOTICE
Collection of personal information
We collect your personal information for the purposes of performing our statutory functions
under the Superannuation (Resolution of Complaints) Act 1993 (Complaints Act). These
functions relate to the resolution of complaints made to us about decisions made by
superannuation entities.
We collect personal information about you through your participation in our complaints
handling processes. We also collect personal information about you from other parties to the
complaint. These other parties usually include:
the trustees of the superannuation entities complained about
the person who has made the complaint (complainant)
any relevant insurer
in relation to a complaint about the distribution of a death benefit, other persons who
may claim an entitlement to all or part of the benefit.
If this information is not collected by the Tribunal it may not be able to properly investigate
and resolve the complaint. The Complaints Act may require or authorise the Tribunal to collect
this information.
Disclosure of your personal information
We disclose personal information for the purposes of our statutory functions under the
Complaints Act. This includes disclosures to other parties to a complaint to ensure that we
accord procedural fairness to all parties in our dispute resolution processes.
We may also disclose your personal information to other persons where you consent or there
are other circumstances where disclosure is permitted under the Privacy Act 1988. These
circumstances include disclosure to appropriate persons where:
the disclosure is required or authorised by law
you would reasonably expect that the information is used for that purpose and the
purpose relates to our functions
it will lessen or prevent a serious threat to somebody's life, health or safety, or to
public health or safety
it is reasonably necessary for enforcement related activities of an enforcement body.
In dealing with a complaint it is possible that we may be required to disclose personal
information to a person involved in the complaint who is outside Australia. Disclosure of
personal information to an overseas recipient depends on the facts of the particular
complaint, and this could occur in relation to any foreign country.
Privacy policy
Our Privacy Policy contains information about:
how you can seek access to personal information that we hold about you or request
that we make corrections to that information
how you may make a complaint about our handling of your personal information.
You can read our complete Privacy Policy on our website at www.sct.gov.au or you can
request that we provide you with a copy by contacting us on the Contact Details above.
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