Claim for Disability Pension and/or Application for Increase in ...

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PART JOther paymentsIf you lodge a claim for any other pension, benefit or allowance while this claim is being processed, you MUST advisethe Department of Veterans’ Affairs.31 Do you receive, or have youapplied for, any payment (e.g.the age pension fromCentrelink), other thansuperannuation?(Family Allowances are notrequired but other Centrelinkpayments must be included).NoYesGive details belowType of benefit or pensionName and address of sourceDate of claimReference No.(if known)If insufficient space, please attach a separate sheet.PART KCompensation32 Have damages/compensationbeen claimed or received fromany other source for any of thedisabilities you are now claiming(e.g. Comcare, Department ofDefence, third party accidentinsurance)?NoYesGive details belowNature of injury or diseaseName and address of sourceDate of claimReference No.(if known)If insufficient space, please attach a separate sheet.12
PART L33 Do you currently receive apension from the Department ofVeterans’ Affairs?Pension payment detailsNo Go to Question 34Yes Go to Question 35IMPORTANT - If a pension is granted, it will be paid fortnightly into an account at an Australian bank, credit union orbuilding society.34 Provide details of the Australianaccount you want your pensionto be paid intoName of bank, credit union or building societyBranchAddressAccount in the name ofPOSTCODEAccount numberBSB numberAccount type (e.g. savings)Please complete Part M and Part N over page.13
Page 1 and 2: Claim for Disability Pensionand/orA
Page 3 and 4: Proving your identity to DVAWhen yo
Page 6 and 7: PART B continuedVETERAN’S DETAILS
Page 8 and 9: PART E continuedDETAILS OF NEW DISA
Page 10 and 11: PART HDetails of your medical treat
Page 14 and 15: PART MDeclarationsComplete (a) OR (

Claim for Disability Pension and/or Application for Increase in ...

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