Completing the Income and Assets Mod iA 106-07110040

• Yes, indicate:
• Partner's CRN (if known)
• Partner's name and
• date of birth

Note: the Mod iA asks questions relating to the income and assets of both the customer and their partner (if applicable). If the customer and/or their partner wish to give this information separately, a Mod iA should be issued to each member of the couple for completion.

Customers should indicate the following details:

• Whether it is the customer or their partner working for the employer
• Employers name, address, phone number and Australian Business Number (ABN)
• Employment status
• Personnel, service or clock-card number
• Number of hours worked and amount earned per fortnight (before tax and deductions)
• Whether they receive the same amount each pay day, i.e. is this a regular wage
• Two most recent payslips are to be attached

Yes, attach a copy of a document that shows the details of the fringe benefit, the value and whether that figure is grossed up or not.

Note: this question will only need to be answered if directed at question 10.

Yes, the customer will need to complete and attach a Seasonal, Contract and Intermittent Work Details form (SU496).

Note: these questions will only need to be answered if directed at question 12.

Yes to any of these questions, the customer will need to attach an Employment Separation Certificate form (SU001), letter from the employer or, in the case of ceasing self-employment, documents to confirm their business has ceased trading.

This is not for businesses run through a trust or company structure (they will be addressed in the following questions).

This question is to determine if the customer and/or partner are involved in the following types of business:

• farming
• sole trader
• partnership
• subcontractor

Yes, complete and attach a Business Details form (MOD F) and if the business owns real estate a Real Estate Details form (MOD R).

Yes, Q18 to 22 will determine in any further information is required.

Private trusts also include:

• bank accounts held in trust (for example bank accounts held as trustee for Grandchildren or others ) see Trusts for further information
• non-complying Self Managed Superannuation Funds
• non-complying Small APRA Funds

Customer and/or partner may be or have been:

• a trustee
• an appointor
• a beneficiary
• a member

Customers may also have:

• made a loan to a private trust
• made a gift of cash, assets or property to a private trust in the last 5 years
• relinquished control of a private trust in the last 5 years
• a private annuity
• a life interest
• an interest in a deceased estate

If the customer indicates their or their partner's current or previous involvement in a private trust they may need to complete and attach a Module PT - Private Trusts if it is not a Special Disability Trust (SDT). If the private trust is a SDT a Module SDT is to be completed. A separate form is to be completed for each trust.

Note: a module PT will not be needed for bank accounts in trusts.

Yes, Q24 to 27 will determine in any further information is required.

• Customer and/or partner may be or have been a director or a shareholder in the last 5 years
• Customers may have:
• made a loan to a private company in the last 5 years
• transferred shares in a private company in the last 5 years
• made a gift of cash, assets or property to a private company in the last 5 years

If the customer indicates they are or their partner's current or previous involvement in a private company they may need to complete and attach a Module PC - Private Companies. A separate form must be completed for each company, except where the Private Company is already deregistered and the customer's record is not already linked to the Private Company CRN.

Yes and details have not previously been advised, complete and attach a Compensation and damages form (MOD C).

Yes, attach a copy of the policy.

• This includes:
• Payments for retirement or old age
• Payments for disability or invalidity
• Payments for widowhood or survivorship
• Payments for children
• Superannuation and annuity payments
• Payments for war injury
• Payments for war service
• Payments as a war widow
• War restitution payments
• Compensation payments
• Other overseas pensions, benefits or allowances
• Yes, attach documents which show the payment details (e.g. pension certificate) and indicate for each payment type:
• The type of payment (as per above list)
• Whose name it is paid in
• Country paying it
• Authority paying it
• Reference number (if known)
• Amount of usual payment
• Currency of payment

Note: if more space is needed, attach details on a separate sheet.

• This includes boarders/lodgers who live with the customer (and/or their partner) or in accommodation at the property of the customer (and/or their partner) (e.g. granny flat)
• Yes, indicate:
• Name of boarder/lodger
• Relationship to customer (e.g. friend, son, cousin)
• Number of meals the customer (and/or their partner) provide each day
• Amount paid for board/lodging each fortnight
• Date boarder/lodger started paying
• Share of the money as a %

Note: if more space is required, attach details on a separate sheet.

Yes, the customer will need to complete a Real estate details form (Mod R).

Do not include funding from the National Disability Insurance Scheme, compensation, insurance or damages lump sum payments.

• Yes, indicate:
• Type of lump sum
• Who paid it
• Amount paid
• Date paid
• Whether paid to customer and/or their partner

Customers must include all accounts including online only institutions.

Any compulsory member shares the customer has, need to be recorded in the shares section and not in the balance of the account advised here.

• The estimate should be the current market value
• House hold contents include all normal furniture such as soft furnishings (e.g. curtains), electrical appliances other than fixtures such as stoves and built-in items. Personal effects include jewellery for personal use and hobby collections (e.g. stamps, coins). Note: antiques and works of art are valued and assessed separately

The customer's and their partner's percentage share of the total needs to be declared.

Yes, indicate:

• Type of asset
• Make
• Model
• Year
• Current market value
• Amount owing
• Percentage owned by the customer and their partner

Note: if more space is needed, attach details on a separate sheet.

Customers to indicate not only if they are homeowners, but if they are living in accommodation in which they have a life interest.

Yes, a Real Estate Details form (MOD R) will need to be completed.

This does not include income from boarders and lodgers. This will be entered in another section of the MOD iA.

Yes, a Real Estate Details form (MOD R) will need to be completed.

Yes, a Real Estate Details form (MOD R) will need to be completed for each property.

This question should only be answered if the customer and their partner (if applicable) are over Age Pension Age. Currently, the Age Pension age for both males and females is 65 and 6 months. Details are only to be included of the Self-Managed Super Fund (SMSF) or Small APRA Fund (SAF) if the funds are complying.

• Yes, indicate:
• Name of institution/fund manager
• Name of fund
• Product Reference number
• Date of joining/investment
• Account Balance
• Owned by the customer or partner

The latest statement for each superannuation fund or if the fund is an SMSF or SAF, the latest financial returns and member statement for the fund is to be attached to the Module iA.

An income stream is a regular series of payments which may be made for a lifetime or fixed period by a financial institution, retirement savings account, superannuation fund, SMSF or SAF.

• Yes:
• Attach the latest schedule of information or Details of Income Stream product form (SA330) for each income stream product currently held (A schedule is a document usually given to a customer by the product provider showing details of the investment purchased such as purchase price, commencement date, gross income, payment frequency etc.)
• Indicate which type of income streams are received, the name of the income stream provider, product reference number, commencement date and who owns it
• Types include: Allocated pension, or Account-based pension, Lifetime, Life Expectancy, Pooled lifetime income stream or Term annuity, Superannuation pension (defined benefit), Allocated annuity, Market-linked income stream or Term Allocated pension (brief description required)

Note: if more space is needed, attach details on a separate sheet.

This includes shares traded in exempt stock markets. Do not include products purchased with a margin loan. Details of Margin Loan investments will be collected in Q50.

• Yes, indicate:
• Name of company
• ASX code (if known)
• Number of shares or other securities
• Country - if share is not listed on Australian stock exchange)
• Percentage owned by the customer and their partner

Note: if more space is needed, attach details on a separate sheet.

Do not include products purchased with a margin loan. Details of Margin Loan investments will be collected in Q50.

• Yes, indicate:
• Name of company
• Type of shares
• Number of shares
• Current market value
• Percentage owned by the customer and their partner

Note: if more space is needed, attach details on a separate sheet.

This includes investment trusts, unit trusts, life insurance bonds and friendly society bonds. Do not include products purchased with a margin loan. Details of Margin Loan investments will be collected in Q50.

• Yes, indicate:
• Name of company
• Name of product (e.g. split trust, growth)
• For unit based investments, the number of units
• Asia Pacific Investment Register (APIR) code (if known). APIR is a commonly used code for fund managers to identify individual financial products
• Current market value of investment
• Currency if not AUD
• Percentage owned by the customer and their partner

Note: if more space is needed, attach details on a separate sheet.

• Yes, indicate:
• Name of margin loan company
• Current portfolio value
• APIR code (if known). APIR is a commonly used code for fund managers to identify individual financial products
• Percentage owned by the customer and their partner

Note: if more space is needed, attach details on a separate sheet.

This includes Australian and overseas investments. Do not include friendly society bonds or life insurance bonds as these are dealt with in Q49.

• Yes, indicate:
• Name of the company
• The type of investment/loan
• Name of the company
• Current amount invested/lent
• Currency if not AUD
• Percentage owned by the customer and their partner

Note: if more space is needed, attach details on a separate sheet.

• This includes all loans, whether made to family members, other people or organisations or trusts
• Yes, indicate:
• Who the money was lent to
• Date and amount lent
• Current balance on the loan
• Percentage lent by the customer and their partner

Attach a document giving details of each loan (if applicable)

Do not include a mortgage taken out to purchase the customer's (and/or their partner's) home

Yes, attach a copy of the arrangement contract and indicate the name of the organisation the agreement is with.

• This includes selling something for less than its value
• Yes, indicate:
• What the customer and/or their partner gave away or sold for less than its value (e.g. money, car, second home, land, farm)
• Date given or sold
• What it was worth
• What the customer and/or their partner got for it
• Whether the gift was made by the customer or their partner
• Whether the gift was to a Special Disability Trust

Note: if more space is needed, attach details on a separate sheet.

This includes funeral bonds and investments. Including pre-paid funerals.

• Yes, indicate:
• Name of the company
• Name of the product
• Purchase price including instalments but not interest
• Current value
• Percentage owned by the customer and their partner

Note: if more space is needed, attach details on a separate sheet.

Yes, a copy of the contract will be required.

Do not include details of life insurance bonds or friendly society insurance bonds as these are dealt with in Q49.

• Yes, indicate:
• Name of Insurance company
• Policy number
• Surrender value
• Whether the policy is in the name of the customer or their partner

Note: if more space is required, attach details on a separate sheet.

For example, Department of Veterans' Affairs (DVA) payment or Self-Employment Allowance.

Yes, attach a document providing a reference number and details of each payment

• This includes income from:
• Life interests
• Gratuities
• Match or sporting payments
• Other payments from overseas
• Private annuities (e.g. Regular payments between family members)
• Any other source not included elsewhere on this form
• Income includes any payment in kind, such as non-monetary payments for services
• Yes, indicate:
• Type of payment
• Who pays it
• Amount received per fortnight
• Date commenced (if known)
• Whether it is paid to the customer or their partner

Note: if more space is needed, attach details on a separate sheet.

• This includes gold bullion, race horses, taxi plates, fishing licences, time share, investment, collections such as art, books, antiques, stamps or jewellery, overseas managed investments
• Yes, give details
• Description of asset
• Current market value
• Balance of loan(s) to purchase the asset
• Currency if not AUD
• Whether it is owned by the customer and/or their partner