STATUTORY RULES
1934. No. 59.
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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.
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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Form 23 in the Invalid and Old-age Pensions Regulations is repealed and the following Form inserted in its stead:—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? |
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At what post office is your pension paid? |
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What is your pension certificate number? |
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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?....... |
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Are you single, married, widower, widow, or divorcee? (State which.) |
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If married, is your husband or wife a pensioner?.. |
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Have you been employed during the last twelve months? (If so, state names and addresses of employers.) |
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State the amount you earned during the last twelve months and the rate of wages you are receiving at present. |
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Do you receive board and lodging either free or in return for services? (State which, for how long and from whom received.) |
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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.) |
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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.) |
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What other income have you received during the last twelve months? (Reply should include rents, dividends, interest, or any other income.) |
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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.) |
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If you own or have an interest in only one house, do you live in it? |
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If you own or have an interest in more than one house, which do you live in? |
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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.) |
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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.) |
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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.) |
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Is your life insured?..................... (If so, state name of company, number and amount of policy, and when payable.) |
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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.) |
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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.) |
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Have you any real or personal property not elsewhere disclosed in this Statement? (If so, give particulars.) |
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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.) |
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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.