STATUTORY RULES
1934. No. 59.
_________
REGULATION
UNDER THE INVALID AND OLD-AGE PENSIONS ACT 1908-1933.
I, THE GOVERNOR-GENERAL in and over the Commonwealth of
Australia, acting with the advice of the Federal Executive Council, hereby make
the following regulation under the Invalid and Old-age Pensions Act 1908-1933.
Dated this sixteenth day of May, 1934.
Governor-General.
By His Excellency’s Command,
for Treasurer.
_______
Amendment of Invalid and Old-age
Pensions Regulations.
(Statutory Rules 1926, No. 178, as amended to this date.)
Form 23.
Form 23 in the Invalid and Old-age
Pensions Regulations is repealed and the following Form inserted in its stead:—
“Commonwealth
of Australia. Form 23.
The Invalid and Old-age Pensions Act 1908-1933.
INCOME AND PROPERTY STATEMENT.
Directions.—The pensioner must answer fully and correctly the questions
contained in this form, and make the declaration before one of the persons
mentioned at the foot of the form.
Where the pensioner is married,
information is required concerning both husband and wife.
The form will be handed to the
pensioner by the Postmaster, and when completed should be returned immediately
to the Postmaster.
A pensioner who wilfully makes a
false statement in reply to any question contained in this form is liable to be
prosecuted in a Court of Law, which may impose a penalty not exceeding One
hundred pounds. In addition his pension may be cancelled.
Important.—All questions must be answered in words. Strokes will not
be accepted.
Should the form not be returned
within four weeks, payment of pension will be stopped.
QUESTIONS. | ANSWERS. |
Information concerning the Pensioner. | Information concerning the Pensioner’s Wife or Husband. |
What is your full name and your present postal
address?..........................................
|
At what
post office is your pension paid?......................................................
|
What is
your pension certificate number?......................................................
|
1788.—6/12.5.1934.—Price
3d.
|
QUESTIONS. | ANSWERS. |
Information concerning the Pensioner. | Information concerning the Pensioner’s Wife or Husband. |
What is your fortnightly rate of
pension?................
|
Are you single, married, widower,
widow, or divorcee?
(State which.) |
If married, is your husband or
wife a pensioner?.....
|
Have you been employed during the
last twelve months?
(If so, state names and addresses of employers.) |
State the amount you earned during
the last twelve months and the rate of wages you are receiving at present.....
|
Do you receive board and lodging
either free or in return for services?......................................................... (State which, for how long and
from whom received.)
|
Are you in receipt of a War
Pension or any other allowance from the Repatriation Department or any other
pension or superannuation allowance?...........................
(If so, give full particulars.) |
Do you keep a shop, lodging-house,
or boarding-house, or conduct a business of any kind, or have you an interest
in any shop or business?....................................... (If so, state nature of same; also
state gross receipts and profit made during the last twelve months.)
|
What other income have you
received during the last twelve months?.......................................................... (Reply should include rents,
dividends, interest, or any other income.)
|
Do you own or have you an interest
in any house or land property? Property includes freehold, leasehold and
property being purchased by instalments...........
(Give situation of each property
and its value.) |
If you own or have an interest in
only one house, do you live in it?...................................................................
|
If you own or have an interest in
more than one house, which do you live in?.................................................
|
Is any of your property subject to
a mortgage or other encumbrance?................................. (If so, state clearly which
property is encumbered; also the name and address of the person to whom the
money is owing, and the amount of the debt.)
|
QUESTIONS | ANSWERS. |
Information concerning the Pensioner. | Information concerning the Pensioner’s Wife or Husband. |
Do you own any horses, cattle,
sheep or other live-stock or any vehicles, implements, &c.?
(If
so, give particulars and value.) |
Have you any interest in a
deceased estate, or under any Settlement, Deed of Gift, or Deed or
Declaration of Trust?.......................................................................
(If
so, give particulars.) |
Is your life insured?.............................................. (If so, state name of company,
number and amount of policy, and when payable.)
|
Have you disposed of any real or
personal property by sale, transfer or Deed of Gift since the pension was
granted?.......................................................................
(If
so, give full particulars.) |
Do you own any Government or other
Bonds or Stock or Industrial shares or have you lent money to any person on
mortgage or in any other manner?.....................
(If
so, give particulars.) |
Have you any real or personal
property not elsewhere disclosed in this Statement?.............................................
(If
so, give particulars.) |
Have you any money in any bank,
savings bank, building society, or other institution, or any money in hand? (If so, give details as to
amounts, name and address of bank, &c.)
|
What are the names and present
addresses of your husband, wife, father, mother, and children over 21 years
of age?
| This information should be
furnished on a sheet of paper which must be returned with this Statement.
|
Declaration.
* Full name of pensioner.
Address and occupation.
I, * of do hereby declare that I am the pensioner whose income and
property are set out in the foregoing Statement, and that the contents of such
Statement are true and correct in every particular.
Declared at the day
of ,
19 , |
(Signature of Pensioner.) |
Before me, ‡
‡Person before whom declaration is
made to add title, such as “Postmaster”, &c.
Note.—The declaration may be made before any of the following
persons:—A postmaster or postmistress or person in charge of a post office, a
permanent officer of the Postmaster-General’s Department whose duties include
the payment of invalid or old-age pensions, a police stipendiary or special
magistrate of the Commonwealth or of a State, a justice of the peace, a
barrister or solicitor, a State school head-teacher, an officer of the Department
of Trade and Customs, a member of the police force of the Commonwealth or of a
State, a legally qualified medical practitioner, a notary public, a
commissioner for affidavits, a commissioner for declarations, a registrar under
the Invalid and Old-age Pensions Act 1908-1933, a minister of religion,
an officer of the Commonwealth Department of the Treasury, a councillor of any
municipality or shire, or a member of the Parliament of the Commonwealth or of
any State.”.
By Authority: L. F. Johnston, Commonwealth Government
Printer, Canberra.