Claim for Australian Pension - Department of Human Services

Notes for claiming Australian Pension 

Social Security Agreement between Australia and Croatia 

Upute za australsku mirovinu 

Ugovor izmeðu Australije i Republike Hrvatske o socijalnom osiguranju 

Upute na hrvatskom jeziku potraite na stranici 12. 

Purpose of this form 

For more information 

Use this form to claim an Australian pension. 

If you are not sure if you qualify for an Australian pension call Centrelink International Services 

direct on +61 3 6222 3455 (between 0800 and 1700 hours Australian Eastern Standard time, 

Monday to Friday). You may reverse charges through your local operator if they provide this 

service. 

Note: The date from which we start paying you may depend on how soon you contact 

Centrelink International Services. If you call Centrelink to register your intent to claim and return 

your completed claim to Centrelink or the competent District Service of the Croatian Pension 

Insurance Institute within 14 days, Centrelink may treat your claim as being lodged on the day 

you called Centrelink. If you cannot return your claim within 14 days because of a reasonable 

circumstance, you can request an extension, of up to 13 weeks, from Centrelink. 

• Call Centrelink International Services on +61 3 6222 3455. If you call between 0800 and 

1700 hours (Australian Eastern Standard time), Monday to Friday, you may reverse the 

charges through your local operator (if they provide this service) and you will not have to pay 

for the call. 

If you call outside these hours you can leave a message and we will return your call. 

Please leave your name, your Australian Centrelink Reference Number (CRN) and your phone 

number (including country and area code). 

• You can write to us by: 

mail at: Centrelink International Services 

GPO Box 273 

Hobart TAS 7001 

Australia 

email at: international.services@centrelink.gov.au 

fax to: + 61 3 6222 2799 

Please include your phone number (including country and area code), so we can quickly 

respond to your query. 

• Information online – If you would like further information on Centrelink services and 

payments, you can go to our website at www.centrelink.gov.au 

AUS140_CB.1005 

Please keep these Notes for claiming Australian Pension (Part 1), 

pages 1 to 22, for your future reference. 

Notes—1 of 22

Forms in your claim 

pack 

Other form you may 

need to complete 

Your partner 

To claim an Australian 

Pension 

AUS140_CB.1005 

In your claim pack, you should have the following forms: 

PART 1 Notes for claiming Australian Pension 

This part tells you important information about claiming, your rights and obligations. 

You should read this information and keep it for future reference. 

PART 2 Claim for Australian Pension 

You and your partner (if you have one) must answer ALL questions in the claim form. 

Mod (IA) Income and assets 

You and your partner (if you have one) must answer ALL questions in the Income and 

assets form. 

If you are claiming Disability Support Pension, you will need to complete a Job capacity – 

Customer Information form (AUS142CB). 

If you do not have this form, you can download it from www.centrelink.gov.au or contact your 

local Croatian Social Insurance Scheme office or Centrelink International Services. 

For Centrelink purposes a person is considered to be your partner if you and the person are 

living together, or usually live together, and are: 

• married, or 

• in a registered relationship (opposite or same-sex), or 

• in a de facto relationship (opposite or same-sex). 

From 1 July 2009 Centrelink recognises all couples, opposite-sex and same-sex. 

A registered relationship is one that is registered under certain prescribed Australian state and 

territory laws that provide for registration of relationships – opposite or same-sex. 

Same-sex marriages and relationships registered in other countries are not recognised by 

Australian social security law. However, you will be recognised as partnered (de facto) for 

Centrelink purposes. 

A de facto relationship is where two people who are not married are living together – or usually 

live together – and are members of a couple. A de facto relationship can be between people of 

the opposite or same sex. Centrelink considers a couple to be in a de facto relationship from 

the time they commence living together as a member of a couple. 

If you identify yourself as a member of a couple Centrelink will not generally undertake an 

assessment of your relationship. Where an assessment is required, establishing whether two 

people are members of a couple involves consideration of the financial and social aspects of 

the relationship, nature of the household, presence or absence of a sexual relationship, and 

nature of the commitment. Evidence relating to these factors is considered, although not all 

factors need to be present for a decision that a person is in a de facto relationship to be made. 

You can get more information from the factsheet titled Are You a Member of a Couple from our 

website at www.centrelink.gov.au 

The date from which we start paying you depends on how soon you contact us. 

Call Centrelink International Services as soon as possible (between 0800 to 1700 hours 

Australian Eastern Standard time, Monday to Friday). Alternatively, you can leave your contact 

details on the answering machine which will be available outside normal business hours on the 

same telephone number. 

Tell us you wish to claim an Australian Pension and Centrelink International Service staff will 

provide you with advice on the best way for you to proceed with your claim for an Australian 

Pension. 

You can contact Centrelink International Services by telephone, post, email or fax. 


Filling in this form 

Returning your form(s) 

Please use black or blue pen. 

Mark boxes like this with a tick 4 or 8. 

When you see a box like this Go to 5 skip to the question number shown. You do not need 

to answer the questions in between. 

If you need more space for answers, use a separate sheet. 

• Take your completed Claim for Australian Pension form (PART 2), Income and assets 

form (Mod(IA)) and any supporting documentation to the competent District Service of the 

Croatian Pension Insurance Institute. They will copy original documents and return them to 

you. The claim forms do not need to be copied. If you do copy the claim form, please ensure 

you keep the copy , not the original. The competent District Service of the Croatian Pension 

Insurance Institute will forward PART 2, Mod (IA) and any supporting documentation to 

Centrelink International Services in Australia. 

OR 

• Post PART 2, (Mod (IA)) and any supporting documentation to: 

Centrelink International Services 

GPO Box 273 


AUSTRALIA 

If you send original documents Centrelink International Services will copy these and return 

original documents to you. 

If you need advice call Centrelink International Services on +61 3 6222 3455. You may reverse 

charges through your local operator if they provide this service. 

AUS140_CB.1005 


Australian Pension – what you can claim 

Requirements 

If you have never lived in Australia you cannot be paid an Australian pension. 

The amount of pension you get paid will depend on how long you have lived in Australia 

between the ages of 16 and age pension age. 

The amount of pension usually also depends on your (and/or your partner’s) income and assets. 

You should claim Age Pension if: 

• you are male and over 65 years of age, OR 

• you are female and over age pension age (please refer to the table below), AND 

• you have lived in Australia for more than 10 years, OR 

• the period of time you have lived in Australia and the period of time that you contributed to 

the Croatian Social Insurance Scheme adds up to more than 10 years. 

Pension age and claim lodgement rules 

You can lodge your claim for Age Pension up to 13 weeks before you reach age pension 

age. 

A claim lodged more than 13 weeks before you reach age pension age does not meet 

Australian legislation provisions and another claim will be required. 

Date of birth Qualifying age Earliest age claim can 

be lodged 

Males: 65 years 64 years 9 months 

Females: 

Before: 1 January 1946 You are age Lodge immediately 

pension age now 

On or between: 

1 January 1946 and 30 June 1947 64 years 63 years 9 months 

1 July 1947 and 31 December 1948 64 years 6 months 64 years 3 months 

On or after: 

1 January 1949 65 years 64 years 9 months 

AUS140_CB.1005 


Australian Pension – what you can claim • continued 

You should claim Disability Support Pension if: 

• you are aged between 16 and age pension age, AND 

• you are unable to work because of a disability or are permanently blind, AND 

• your disability occured while you were living in Australia, OR 

• you have lived in Australia for more than 10 years, OR 

• the period of time you have lived in Australia and the period of time that you contributed to 

the Croatian Social Insurance Scheme adds up to more than 10 years. 

‘Work’ means any type of work which is over 8 hours per week. This is not limited to your usual 

occupation. 

If you are claiming a Disability Support Pension you may be required to undergo a 

medical examination. We will advise you if an examination is necessary. 

If you are claiming Disability Support Pension, you will need to complete a Job capacity – 

Customer Information form (AUS142CB). 

If you do not have this form, you can download it from www.centrelink.gov.au or contact 

your local Croatian Social Insurance Scheme office or Centrelink International Services. 

AUS140_CB.1005 


Information about claiming Australian Pension 

What you will need 

When claiming an Australian pension you will need to prove your identity. If you, and/or your 

partner, are residents of Croatia, this will normally be done by the Croatian authorities. 

If you, and/or your partner, are not a permanent resident of Croatia or you are going to send 

your claim directly to Centrelink and not take it to your local Croatian Social Insurance Scheme 

office, you must provide documents to show proof of birth in Australia (e.g. Australian birth 

certificate) OR proof of arrival in Australia (e.g. port and date stamp in your passport) AND 

any other documents listed below which add up to 100 points. This list is not complete, other 

documents may be accepted. 

Original documents will be copied and the originals returned to you. 

Note: You cannot use the same documents to make up the 100 points if you are using them for 

Proof of Birth in Australia or Proof of Arrival in Australia. 

Australian documents 

Points 

Passport (current) 70 

Citizenship Certificate 70 

Birth Certificate 70 

Certificate of Evidence of Resident Status 70 

Australian Entry Visa 70 

Driver’s Licence 40 

Marriage Certificate 40 

Divorce Papers 40 

Birth Certificate(s) of any of your child(ren) 40 

Education Examination Certificates 40 

Bank Card or Statements 40 

Mortgage Papers 40 

Certificate of Name Change 40 

Rates Notices 20 

Financial Papers (incl. share or superannuation statements) 10 

Taxation Assessment Notice 10 

Non-Australian documents 

Points 

Passport stamped with an entry into Australia 40 

Identity Card 20 

Other non-Australian documents that match the Australian documents 

listed above (e.g. marriage certificate, birth certificate, driver’s licence etc.) 20 

Note: Only a maximum of 3 non-Australian documents (excluding a current passport) can 

be used. 

AUS140_CB.1005 


Information about claiming Australian Pension • continued 

Your rights 

Your obligations 

If you think we have made a wrong decision, contact us and we will check the facts and 

explain the decision. 

If you still do not agree you may ask for Centrelink’s Authorised Review Officer (ARO) to look 

at it. The ARO is an officer who has no previous involvement in your case and, if the decision 

is wrong, the ARO can correct it. The ARO can also tell you how you can appeal to the Social 

Security Appeals Tribunal (SSAT) if you still do not agree. Both the ARO review and the SSAT 

appeal are free. If you do not ask for the decision to be reviewed within 13 weeks of being told 

about it, you can only get back payment from the date you ask. 

Personal information is treated as confidential and can only be released to someone else in 

special circumstances, where the law requires or where you give permission. If you have 

concerns about your personal information contact us. We will look into the matter and tell 

you about your rights to see and amend your information. If you are still not satisfied, you can 

contact the Privacy Commissioner at GPO Box 5218, Sydney NSW 2001, Australia. 

Australian pension is paid subject to an income and assets test. 

Most forms of income will affect the amount of Australian pension that you can be paid. The 

income test allows you to receive an amount of income before your Australian pension will be 

affected. You are required to tell us about all of the income that you receive and we will work 

out how it affects the amount of Australian pension that you can be paid. 

The assets test allows you to have a certain level of assets before your Australian pension will 

be affected. As with income, you are required to tell us of all of your assets and we will tell you 

how they affect your Australian pension. 

AUS140_CB.1005 


Australian Pension – income and assets 

Income 

The amount of payment you can get from Centrelink may depend on your (and your partner’s) 

total income. 

Income includes money received from employment and money deemed to be earned from 

investments. It also includes money from sources inside and outside Australia. You can have 

income up to certain limits without having your Australian Pension reduced. These income 

limits are known as ‘allowable income limits’. For more information, please contact Centrelink. 

Income can include: 

• gross income from pensions (before tax and other deductions) (e.g. old age, anticipatory, 

disability, survivors, and others) 

• gross money earned from employment (before tax or other deductions) 

• rent (or board) paid to you 

• compensation or damages payments 

• income replacement insurance (personal accident and sickness insurance) 

• profit from withdrawal of money from superannuation or rollover investments 

• income from allocated pensions and allocated annuities 

• income from immediate annuities (including investments in a country other than Australia) 

• income from superannuation pensions 

• income from life interests 

• gratuities, tips, honoraria 

• other payments from Australian government departments (e.g. DVA pensions) 

• other payments from the country you live in 

• income from any other country 

• income from trusts 

• income from a business 

• deemed income – deeming assumes that bank accounts and other financial investments are 

earning a certain amount of income regardless of what income they are actually earning – 

deemed income can include money from financial investments such as: 

– bank accounts – managed investments 

– cash – listed shares, securities, futures 

– term deposits – loans and debentures 

– cheque accounts – shares in unlisted public companies. 

AUS140_CB.1005 


Australian Pension – income and assets • continued 

Assets 

The amount of payment you can get from Centrelink may depend on the total net value of your 

(and your partner’s) assets (inside or outside Australia.) 

Calculating your Australian pension rate is more complicated if you have an interest in a farm, 

a business, a trust or if you own real estate, other than the house in which you live. Generally, 

any debt owing on an asset is deducted from the value of the asset. 

Assets can include: 

• cars 

• boats and caravans (unless it is where you live) 

• real estate other than your home (e.g. holiday homes, land, farms) 

• some of the money you receive from a loan secured against your home (as long as you did 

not use it to purchase your home) 

• home furniture 

• jewellery 

• stamp collections 

• money in the bank 

• shares, bonds or debentures 

• money in trust or insurance accounts 

• money in other financial institutions 

• money you have loaned 

• gold and other bullion. 

Assets DO NOT include: 

• the family home (i.e. the home in which you live and up to 2 hectares of surrounding land – 

on the same title document as the home – that is used for domestic purposes). 

If your home and adjacent land is on a single title block, larger than 2 hectares, the whole 

property may be exempt from the assets test. To be eligible: 

• you must be of age pension age 

• you must qualify for Age Pension, Carer Payment or Service Pension (from the Department of 

Veterans’ Affairs) 

• the pension must be payable 

• you must have a long term (20 years) continuous attachment to the land and the principal 

home, and 

• you must be making effective use of productive land to generate an income, given your 

capacity to do so. 

If you are unsure about what counts as an asset, please check with Centrelink International 

Services. 

The value of your assets should be the MARKET VALUE. This means money that you would get 

if you sold the asset, but not counting any money that you still owe on the asset. 

We use the current market value not the replacement cost or the insurance value. 

AUS140_CB.1005 


Changes you must tell us about 

As soon as you have lodged your claim for Australian pension, you must tell us within 28 days 

if any of these things happen or may happen. You can tell us by writing to us, by telephoning us 

on +61 3 6222 3455 or by contacting us by email at international.services@centrelink.gov.au 

or by facsimile on +61 3 6222 2799. 

Income: 

• if you and/or your partner start to receive a pension from a country, other than Australia, or 

you are already getting one and it increases (e.g. annual reviews) 

• if you and/or your partner claim or receive compensation for work related accidents or 

illnesses 

• if you and/or your partner start work or recommence work, or start any form of profession, 

trade, business or self employment 

• if you and/or your partner receive a private pension or superannuation pension, or the 

private pension or superannuation pension you are already getting increases 

• if you and/or your partner start to receive rent, or the rent you are getting increases 

• if you and/or your partner’s combined income from any source other than investments 

increases 

• if you and/or your partner buy or sell any shares or managed investments 

• if you and/or your partner receive any bonus shares. 

Assets: 

• if you and/or your partner’s combined assets other than financial investments increase 

• if you and/or your partner’s combined financial investments increase by more than $AUS1,000 

• if you and/or your partner open any new accounts 

• if you and/or your partner give away assets or sell them for less than their value. 

Other things you must tell us: 

• if you marry; are in or commence an opposite or same-sex registered or de facto relationship; 

reconcile with a former partner; start living with someone as their partner 

• if you separate from your partner 

• if you divorce 

• if your partner dies 

• if you and/or your partner move into or out of a nursing home, hostel or retirement village 

• if you and/or your partner or any of your dependent children/students are charged with an 

offence and are in custody or remanded in a psychiatric institution or in jail 

• if you and/or your partner sell, rent out or dispose of the home you live in 

• if you and/or your partner leave your home for more than 12 months 

• if you change your address you should tell us straight away. If mail is returned to us because 

you are not at the last address you gave us, payment may stop, or be rejected 

• if you are paid by direct deposit, you must advise us before you close or change your bank 

account 

• if you and/or your partner return to Australia, as your rate will probably change from the date 

you arrive 

• you must also tell us if you and/or your partner leave the country you live in, either 

permanently or temporarily, as your Australian Pension may no longer be payable. 

AUS140_CB.1005 


About the information you give 

Privacy and your 

personal information 

Personal information is protected by law, including the Privacy Act 1988. The authority to collect 

this information is contained in the Social Security (Administration) Act 1999. 

The information you provide on this form will be used to determine your eligibility for, and 

provide payments and services to you, and where relevant, third parties. This information may 

also be used to detect or prevent fraud and/or recover overpayments. 

Centrelink may give some or all of your information to the Department of Families, Housing, 

Community Services and Indigenous Affairs (FaHCSIA), the Department of Education, 

Employment and Workplace Relations (DEEWR) and Job Services Australia providers or service 

providers working on behalf of DEEWR. 

Centrelink may disclose limited information (for example, income and assets) about you to 

other individuals when your circumstances affect their entitlement to payments and services. 

In order to collect relevant immigration records, Centrelink will disclose information needed 

to identify you, and where applicable your partner and child(ren), to the Department of 

Immigration and Citizenship. 

Limited personal information collected from you may be used to conduct customer research 

run by the Department of Human Services, Centrelink, the Department of Families, Housing, 

Community Services and Indigenous Affairs (FaHCSIA), or by research organisations on their 

behalf. Your participation in customer is valued, however, if you do not wish to take part please 

call Centrelink International Services, or refer to the factsheet ‘Market research and you’ for 

more information. 

Centrelink can give your information to other persons, bodies or agencies without your 

permission in circumstances where Commonwealth legislation requires or authorises the 

disclosure. For example, Centrelink usually gives some or all of your information about income 

and taxation matters to the Australian Taxation Office and the Child Support Agency for their 

use. Information is also data matched with other government agencies, and in some cases with 

the social security authorities in countries with which Australia has international social security 

agreements, to ensure you are receiving your correct entitlement. 

You can get more information from the factsheet titled ‘Your right to privacy’ on the Centrelink 

website www.centrelink.gov.au or you can call Centrelink International Services to request a 

copy. 

AUS140_CB.1005 

Please keep these Notes for claiming Australian Pension (Part 1), 

pages 1 to 22, for your future reference. 


Upute za australsku mirovinu 


Èemu slui ovaj obrazac 

Za dodatne informacije 

Ovaj obrazac upotrijebite za podnošenje zahtjeva za australsku mirovinu. 

Ako niste sigurni ispunjavate li uvjete za neku od australskih mirovina, nazovite Centrelinkovu 

meðunarodnu slubu (Centrelink International Services) na +61 3 6222 3455 (od ponedjeljka 

do petka, izmeðu 8.00 i 17.00 sati, po australskom istoènom standardnom vremenu). Od svog 

lokalnog operatera, ukoliko pruaju ovu uslugu, moete zatraiti da nama naplate troškove poziva. 

Napomena: Datum od kojeg Vam poèinjemo isplaæivati isplate ovisi o tome koliko brzo se 

obratite Centrelinkovoj meðunarodnoj slubi. Nazovete li Centrelink, kako biste najavili namjeru 

da podnesete zahtjev za mirovinu, i dostavite li ispunjenu tiskanicu zahtjeva u Centrelink ili u 

podruènu slubu Hrvatskog zavoda za mirovinsko osiguranje u roku od 14 dana, Centrelink æe 

smatrati da ste podnijeli zahtjev na dan na koji ste nazvali Centrelink. Ako, iz opravdanih razloga, 

niste u moguænosti vratiti tiskanicu zahtjeva u roku od 14 dana, moete od Centrelinka zatraiti 

produenje roka do najviše 13 tjedana. 

• Nazovite Centrelink International Services (Centrelinkovu meðunarodnu slubu) na 

+61 3 6222 3455. Ako zovete izmeðu 8 ujutro i 5 poslije podne (po australskom istoènom 

standardnom vremenu) moete od svog lokalnog operatera (ukoliko pruaju tu uslugu) zatraiti 

da nama naplate troškove tog poziva, tako da Vi ne plaæate. 

Ako zovete izvan tog vremena, moete ostaviti poruku na sekretarici i mi æemo Vas nazvati. 

Molimo da ostavite svoje ime, broj svog Centrelinkovog dosjea (CRN) i svoj broj telefona 

(ukljuèujuæi predbroj za dravu i mjesto stanovanja). 

• Pismeno nam se moete obratiti: 

poštom na: Centrelink International Services 

GPO Box 273 


Australia 

Emailom na: international.services@centrelink.gov.au 

faksimilom na: + 61 3 6222 2799 

Molimo navedite svoj broj telefona (ukljuèujuæi predbroj za dravu i mjesto stanovanja) kako 

bismo što prije mogli odgovoriti na Vaš upit. 

• Informacije na Internetu – ako trebate više informacija o Centrelinkovim uslugama i 

isplatama, posjetite našu Internet stranicu www.centrelink.gov.au 

AUS140_CB.1005 

Molimo Vas da saèuvate ove Upute za podnošenje zahtjeva za australsku mirovine 

(DIJELU 1), stranice 1 do 22, kako biste ih mogli upotrijebiti ubuduæe. 


Obrasci u Vašem 

priruèniku za 

potraivanje isplate 

Ostale tiskanice koje 

æete moda trebati 

ispuniti 

VAŠ PARTNER 

Podnošenja zahtjeva za 

australsku mirovinu 

U Vašem kompletu za podnošenje zahtjeva trebale bi se nalaziti sljedeæe tiskanice: 

DIO 1 Upute za podnošenje zahtjeva za australsku mirovinu 

U ovom dijelu se nalaze vane informacije o tome kako podnijeti zahtjev i koja su Vaša 

prava i obveze. Trebali biste proèitati ove informacije i saèuvati ih za ubuduæe. 

DIO 2 Zahtjev za australsku mirovinu 

Vi i Vaš partner (ako ga imate) morate odgovoriti na SVA pitanja u tiskanici zahtjeva. 

Mod (IA) Prihodi i imovina 

Vi i Vaš partner (ako ga imate) morate odgovoriti na SVA pitanja u tiskanici o 

prihodima i imovini. 

Ako podnosite zahtjev za invalidsku mirovinu (Disability Support Pension), morat æete ispuniti 

tiskanicu Sposobnost za rad – podaci o stranci (AUS 142CB). 

Ako nemate ovaj obrazac, moete ga skinuti s Internet stranice www.centrelink.gov.au ili 

kontaktirati svoj mjesni Croatian Social Insurance Scheme office (Hrvatski zavod za socijalno 

osiguranje) ili Centrelink International Services. 

U poslovanju sa Centrelinkom, osoba se smatra Vašim partnerom ako Vi i ta osoba ivite 

zajedno, ili najèešæe ivite zajedno, i 

• vjenèani ste, ili 

• ste u registriranoj vezi (s osobom suprotnog ili istog spola), ili 

• ste u de-facto vezi (s osobom suprotnog ili istog spola). 

Od 1.srpnja 2009. Centrelink priznaje sve parove, bilo suprotnog ili istog spola. 

Registrirana veza je veza registrirana prema zakonima australskih saveznih drava i teritorija, koji 

priznaju registraciju veza suprotnog ili istog spola. 

Veze osoba istog spola, bilo braène ili registrirane u inozemstvu, ne priznaju se prema 

australskom zakonu o socijalnom osiguranju. Meðutim, u poslovanju sa Centrelinkom, smatrat æe 

se da imate partnera (de-facto veza). 

De-facto veza je zajednica dvije osobe koje nisu vjenèane no ive zajedno – ili najèešæe ive 

zajedno – kao par. De-facto veza moe postojati izmeðu osoba suprotnog ili istog spola. 

Centrelink smatra da je osoba u de- facto vezi od onog dana kad s drugom osobom poène ivjeti 

kao par. 

Ako ste prijavljeni kao par, Centrelink najèešæe neæe provjeravati Vašu vezu. Ako je potrebno 

obaviti procjenu kako bi se utvrdilo jesu li te dvije osobe u vezi, uzimaju se u obzir financijski i 

društveni aspekti veze, vrsta kuæanstva, postoji li ili ne postoji seksualni odnos i koliko su partneri 

jedan drugome odani. Razmatraju se dokazi, no procjena radi li se o de-facto vezi se moe izvršiti 

i ako nisu prisutni svi ovi aspekti. 

Više informacija moete naæi u informativnom listiæu Are You a Member of a Couple (Imate li 

partnera) na našoj Internet stranici www.centrelink.gov.au 

Datum od kojeg æemo zapoèeti isplatu ovisi o datumu na koji ste nas kontaktirali. 

Nazovite Centrelink International Services (Centrelinkovu meðunarodnu slubu) èim prije (izmeðu 

08.00 i 17.00 sati po australskom istoènom standardnom vremenu, od ponedjeljka do petka). 

Recite nam da elite podnijeti zahtjev za australsku mirovinu i osoblje Centrelinkove meðunarodne 

slube æe Vam dati savjet kako æete najbolje postupati u vezi Vašeg zahtjeva za australsku 

mirovinu. 

Moete ostaviti Vaše podatke, na telefonskoj sekretarici koja je na raspolaganju izvan redovnog 

radnog vremena na istom telefonskom broju. Ako elite, moete nazvati na raèun primatelja preko 

Vaše mjesne centrale. 

Centrelink International Services (Centrelinkovu meðunarodnu slubu) moete kontaktirati 

telefonom, poštom, preko emaila, ili faksom. 

AUS140_CB.1005 


Ispunjavanje ovog 

obrasca 

Molimo pišite crnom ili plavom kemijskom olovkom. 

Kvadratiæe kao oznaèite kvaèicom 4 ili kriiæem 8. 

Kad vidite kvadratiæ kao ovaj Idite na 5, prijeðite na pitanje koje je naznaèeno. Ne morate 

odgovarati na pitanja izmeðu tih brojeva. 

Ako Vam za odgovore treba više mjesta, priloite posebnu stranicu. 

Vraæanje obrasca 

(obrazaca) 

• Odnesite svoje ispunjene obrasce Claim for Australian Pension - PART 2 (zahtjev za 

australsku mirovinu - DIO 2), Income and assets (Obrazac o prihodu i imovini) (Mod(IA)) 

i svu popratnu dokumentaciju u Podruènu slubu hrvatskog zavoda za socijalno osiguranje. 

Oni æe fotokopirati originalne dokumente i Vama vratiti originale. Molbeni obrazac ne treba 

fotokopirati. Ako fotokopirate molbu, molimo pripazite da sebi ostavite kopiju a ne original. 

Odgovorni ured Hrvatskog zavoda za socijalno osiguranje æe poslati DIO 2, Mod (IA) i svu 

popratnu dokumentaciju u Centrelink International Services u Australiji. 

ILI 

• Pošaljite sami DIO 2 i Mod (IA) i svu popratnu dokumentaciju na adresu: 


GPO Box 273 


AUSTRALIA 

Ako pošaljete originale dokumenata, Centrelink International Services æe ih fotokopirati i vratiti 

Vam originale. 

Trebate li pomoæ u svezi ovoga, nazovite Centrelink International Services na +61 3 6222 3455. 

Od svog lokalnog operatera, ukoliko pruaju ovu uslugu, moete zatraiti da nama naplate troškove 

poziva. 

AUS140_CB.1005 


Australska mirovina – što moete zahtijevati 

Uvjeti 

Ako nikada niste ivjeli u Australiji, ne moete ostvariti pravo na australsku mirovinu. 

Iznos mirovine koji æete ostvariti ovisit æe o tome koliko ste dugo ivjeli u Australiji izmeðu 16-te 

godine i dobi za starosnu mirovinu. 

Iznos mirovine takoðer ovisi o Vašim i/ili partnerovim prihodima i imovini. 

Starosnu mirovinu (Age Pension) biste trebali zatraiti: 

• ako ste muškarac stariji od 65 godina, ILI 

• ako ste ena i stariji od dobi za umirovljenje (molimo pogledajte tablicu u nastavku), I 

• ako ste ivjeli u Australji due od 10 godina, ILI 

• razdoblje ivljenja u Australji i razdoblje uplaæivanja u hrvatski mirovinski fond ukupno iznosi 

više od 10 godina. 

Starosna mirovina i uvjeti za podnošenje zahtjeva 

Svoj zahtjev za starosnu mirovinu moete podnijeti i 13 tjedana prije datuma ispunjavanja uvjeta 

starosne dobi za umirovljenje. 

Zahtjev predat više od 13 tjedana prije navršene dobi za umirovljenje ne ispunjava uvjete 

australskog zakonodavstva, pa æete morati predati novi zahtjev. 

Datum roðenja 

Muškarci: 

ene: 

Prije: 1. sijeènja 1946 

Na ili izmeðu: 

1. sijeènja 1946. i 30. lipnja 1947. 

1. srpnja 1947. i 31. prosinca 1948. 

Na ili poslije: 

1. sijeènja 1949 

Starosna dob za 

umirovljenje 

65 godine 

Sada imate godine starosti 

za starosnu mirovinu 

64 godine 

64 godine i 6 mjeseci 

65 godine 

Najranija dob za 

podnošenje zahtjeva 


Predajte smjesta 




Trebali biste zatraiti invalidsku mirovinu (Disability Support Pension): 

• stari ste izmeðu 16 godina i godina za ostvarivanje prava na starosnu mirovinu, I 

• nesposbni ste za rad zbog invaliditeta ili jer ste trajno slijepi, I 

• do invaliditeta je došlo dok ste ivjeli u Australiji, ILI 

• razdoblje ivljenja u Australiji je due od 10 godina, ILI 

• razdoblje ivljenja u Australiji i razdoblje uplaæivanja u hrvatski mirovinski fond ukupno iznose 

više od 10 godina. 

“Rad” podrazumijeva bilo koji posao preko 8 sati tjedno. To nije ogranièeno samo na Vaše 

uobièajeno zanimanje. 

Ako podnosite zahtjev za invalidsku mirovinu (Disability Support Pension), moda æete trebati 

obaviti lijeènièki pregled. Obavijestit æemo Vas ako to bude potrebno. 

Ako podnosite zahtjev za invalidsku mirovinu (Disability Support Pension), morat æete ispuniti 

tiskanicu Sposobnost za rad – podaci o stranci (AUS 142CB). 

Ako nemate tu tiskanicu, moete je skinuti s www.centrelink.gov.au ili se obratite 

odgovarajuæoj slubi Hrvatskog zavoda za mirovinsko osiguranje ili Centrelinkovoj 

meðunarodnoj slubi. 

AUS140_CB.1005 


Informacija o australskoj mirovini 

Što æe Vam trebati 

Kod podnošenja molbe za australsku mirovinu trebat æete dokazati svoj identitet. Ako Vi i/ili Vaš 

partner ivite u Hrvatskoj, to æe obaviti hrvatske vlasti. 

Ako Vi i/ili Vaš partner niste stalno nastanjeni u Hrvatskoj ili ako æete svoju molbu slati izravno u 

Centrelink, a ne odnijeti u svoj Podruèni ured hrvatskog zavoda za socijalno osiguranje, morate 

dostaviti dokumente koji potvrðuju roðenje u Australiji (npr. australski rodni list) ILI dokaz o 

dolasku u Australiju (npr.ig u putovnici kojim se potvrðuje mjesto i datum ulaska) I sve druge, nie 

navedene dokumente, koji zajedno imaju 100 bodova dokazivanja identiteta. Ovo nije kompletan 

popis, pa i drugi dokumenti mogu biti prihvatljivi. 

Originali æe biti fotokopirani i Vama vraæeni. 

Napomena: Ne moete upotrijebiti iste isprave da skupite 100 bodova ako ste ih upotrijebili za 

dokaz o roðenju u Australiji ili dokaz o dolasku u Australiju. 

Australske isprave 

vaeæa australska putovnica 

isprave od dravljanstvu 

rodni list 

potvrda o stalnom boravku 

australska ulazna viza 

vozaèka dozvola 

vjenèani list 

rješenje o razvodu braka 

rodni list(ovi) Vašeg djeteta (djece) 

školske svjedodbe ili potvrde o ispitima 

bankovna kartica ili izvješæe 

isprava o pravu vlasništva na nekretninama 

potvrda o promjeni imena 

potvrda o opæinskim pristojbama 

financijska izvješæa (ukljuèujuæi dionice i mirovinski fond) 

izvješæe o plativom porezu 

Bodovi 

70 bodova 

70 bodova 

70 bodova 

70 bodova 

70 bodova 

40 bodova 

40 bodova 

40 bodova 

40 bodova 

40 bodova 

40 bodova 

40 bodova 

40 bodova 

20 bodova 

10 bodova 

10 bodova 

Inozemne isprave 

putovnica sa igom o ulasku u Australiju 

osobna iskaznica 

ostale inozemne isprave koje odgovaraju gore navedenim 

ispravama (vjenèani list, rodni list, vozaèka dozvola, itd.) 

Bodovi 

40 bodova 

20 bodova 

20 bodova 

Napomena: Moete upotrijebiti najviše 3 inozemne isprave (osim putovnice). 

AUS140_CB.1005 


Informacija o australskoj mirovini • nastavak 

Vaša prava 

Ukoliko smatrate da smo donijeli pogrešnu odluku, kontaktirajte nas i mi æemo provjeriti èinjenice 

i objasniti odluku. 

Ako još uvijek niste suglasni, moete zatraiti da je pogleda ovlašteni slubenik Centrelinka za 

reviziju (ARO). ARO je slubenik koji prethodno nije bio ukljuèen u Vaš sluèaj, i ako je odluka 

pogrešna, on je moe ispraviti. ARO Vas takoðer moe uputiti na koji naèin se moete aliti 

Prizivnom sudu za sporove socijalnog osiguranja (SSAT) ako se još uvijek ne slaete s odlukom. 

Revizija od strane ovlaštenog slubenika za reviziju i alba Prizivnom sudu za sporove socijalnog 

osiguranja su besplatni. Ne zatraite li reviziju odluke u roku od 13 tjedana od obavijesti, povrat 

isplate moete dobiti samo od datuma kada ste istu zatraili. 

S osobnim podacima se postupa povjerljivo i oni se mogu prenijeti drugima samo u posebnim 

sluèajevima predviðenima zakonom ili uz Vaše odobrenje. Ako brinete zbog svojih osobnih 

podataka, kontaktirajte nas. Mi æemo ispitati stanje i obavijestiti Vas o Vašim pravima da 

pogledate i ispravite podatke. Ukoliko još uvijek niste zadovoljni, moete kontaktirati povjerenika 

za zaštitu osobnih podataka na GPO Box 5218, Sydney NSW 2001, Australia. 

Vaše obveze 

Australska mirovina se ostvaruje ovisno o visini prihoda i imovine. 

Veæina vrsta prihoda æe utjecati na iznos australske mirovine koji moete ostvariti. Prema 

prihodovnom cenzusu dozvoljeno je primati odreðenu visinu prihoda koji neæe utjecati na visinu 

Vaše australske mirovine. Od Vas se trai da nas izvijestite o svim prihodima koje primate, a mi 

æemo odrediti u kojoj mjeri utjeèu na iznos australske mirovine koji bi Vam pripadao. 

Prema imovinskom cenzusu dozvoljeno je posjedovati imovinu do odreðene vrijednosti koja neæe 

utjecati na visinu Vaše australske mirovine. Kao i kod prihoda, od Vas se trai da nas izvijestite 

o Vašoj ukupnoj imovini, a mi æemo Vas izvijestiti o mjeri u kojoj ona utjeèe na Vašu australsku 

mirovinu. 

AUS140_CB.1005 


Australska mirovina – prihod i imovina 

Prihod: 

Iznos isplata koje moete ostvariti kod Centrelinka moe ovisiti o Vašem (i partnerovom) ukupnom 

prihodu. 

Prihod ukljuèuje novac koji ste zaradili na poslu kao i pretpostavljenu zaradu iz investicija. 

Ukljuèuje i novac iz inozemnih izvora i Australije. Moete imati prihod do odreðene granice a da 

Vam se ne umanji australska mirovina. Ta ogranièenja prihoda se nazivaju “dozvoljene granice 

prihoda”. Za više informacija, izvolite se obratiti u Centrelink. 

Prihod ukljuèuje: 

• bruto prihod od mirovina (prije odbitka poreza i drugih odbitaka) (npr. starosna, prijevremena, 

invalidska, obiteljska i druge) 

• bruto zarada od zaposlenja (prije odbitka poreza ili drugih odbitaka) 

• najamnina (ili naknada za hranu) koju primate 

• kompenzacije ili naknade štete 

• rentno osiguranje (osiguranje za sluèaj nesreæe ili bolesti) 

• dobit od podizanja novca od štednje za starost ili prijenosa ulaganja 

• prihod od doznaèenih mirovina i godišnjih isplata 

• prihodi iz trenutaènih anuiteta (ukljuèujuæi investicije u inozemstvu) 

• prihod od mirovine za zajamèenu štednju za starost 

• prihod od doivotnog uivanja prihoda od imovine 

• otpremnine, napojnice, honorari 

• druga primanja od australskih dravnih tijela (npr. DVA mirovine) 

• druga primanja od drave u kojoj ivite 

• prihod iz bilo koje druge drave 

• prihod od trustova 

• prihod od poduzetništva 

• pretpostavljeni prihod – tu se pretpostavlja da bankovni raèuni i druga financijska ulaganja 

donose odreðeni prihod bez obzira na stvarnu zaradu – pretpostavljeni prihod moe ukljuèiti 

novac od financijskih ulaganja kao što su: 

– bankovni raèuni 

– gotovina 

– oroèena štednja 

– èekovni raèuni 

– ulaganja kojima se upravlja 

– dionice koje kotiraju na burzi, vrijednosni papiri, trgovanje 

vrijednosnim papirima 

– zajmovi i obveznice 

– dionice društava èije dionice ne kotiraju na burzi. 

AUS140_CB.1005 


Australska mirovina – prihod i imovina • nastavak 

Imovina: 

Iznos isplata koje moete ostvariti kod Centrelinka moe ovisiti o ukupnoj neto vrijednosti Vaše 

(i partnerove) imovine (u ili izvan Australije). 

Obraèunavanje Vaše australske mirovine je kompliciranije ako imate farmu, poslovnu djelatnost, 

trust ili nekretninu, osim kuæe u kojoj ivite. Opæenito, svaki dug na imovinu se oduzima od 

vrijednosti imovine. 

Imovina moe ukljuèivati: 

• automobile 

• brodove i kamp kuæicu (osim ako u njoj ivite) 

• nekretninu koja nije Vaš dom (npr. kuæu za odmor, zemljište, farme) 

• dio novca koji dobivate od hipotekarnog kredita (ako ga niste upotrijebili za kupnju Vašeg 

doma) 

• kuæni namještaj 

• nakit 

• filatelistièke zbirke 

• novac u banci 

• dionice, obveznice ili zadunice 

• novac na povjerljivim raèunima ili raèunima osiguranja 

• novac u drugim financijskim institucijama 

• novac koji ste pozajmili 

• zlatne ili druge poluge. 

Imovina NE ukljuèuje: 

• Obiteljski dom (npr. kuæa u kojoj ivite i do 2 hektara okuænice – a pod istim posjedovnim listom 

pod kojim je kuæa koja se koristi kao kuæanstvo za ivljenje). 

Ako se Vaša kuæa i okuænica nalaze na jednoj parceli veæoj od 2 hektara, cijelo imanje bi moglo biti 

izuzeto od provjere vrijednosti imovine. Za ostvarivanje tog prava: 

• morate biti u dobi za starosnu mirovinu 

• morate imati pravo na starosnu mirovinu, isplatu za skrbnika (Carer Payment) ili vojnu mirovinu 

(Service Pension) od Ministarstva za pitanja vojnih veterana (Department of Veterans’ Affairs) 

• mirovina mora biti isplativa 

• morate biti dugotrajno (20 godina) povezani sa zemljom i glavnom kuæom, i 

• morate nastojati uèinkovito upotrebljavati plodnu zemlju kako biste ostvarili prihod, ako ste 

sposobni za to. 

Ako niste sigurni što se smatra imovinom, provjerite u Centrelinkovoj meðunarodnoj slubi. 

Vrijednost Vaše imovine treba biti TRIŠNA VRIJEDNOST. To znaèi novac koji biste dobili kad biste 

prodali imovinu, ne raèunajuæi novac koji još dugujete za imovinu. 

Koristimo sadašnju trišnu vrijednost, a ne zamjensku nabavnu vrijednost ili vrijednost osiguranja. 

AUS140_CB.1005 


Promjene o kojima nas morate izvijestiti 

Kad podnesete zahtjev za australsku mirovinu, morate nas u roku od 28 dana izvijestiti ako se 

dogodi ili se oèekuju sljedeæi dogaðaji. Moete nas pismeno izvijestiti ili nas nazvati na telefon 

+61 3 6222 3455 ili nas kontaktirati e-mailom na international.services@centrelink.gov.au ili 

faksom na broj +61 3 6222 2799. 

Prihod: 

• ako Vi ili Vaš partner poènete primati mirovinu iz neke drave, koja nije Australija, ili je veæ 

primate i ona se poveæava npr. godišnje usklaðivanje 

• ako Vi i/ili Vaš partner potraujete ili primate odštetu zbog povrede na radu ili bolesti 

• ako Vi ili Vaš partner poènete raditi ili se nanovo zaposlite ili zapoènete bilo koju profesionalnu, 

trgovaèku, poslovnu ili samostalnu djelatnost 

• ako Vi ili Vaš partner primate privatnu mirovinu ili mirovinu iz zajamèene štednje za starost ili ako 

veæ dobivate poveæanja 

• ako Vi ili Vaš partner poènete primati najamninu ili se poveæa najamnina koju primate 

• ako se Vaš i partnerov zajednièki prihod poveæa iz bilo kojeg izvora osim od ulaganja 

• ako Vi ili Vaš partner kupite ili prodate dionice ili ulaganja kojima se upravlja 

• ako Vi ili Vaš partner primite dodatne dionice. 

Imovina: 

• ako se Vaša i partnerova zajednièka imovina, osim financijskih ulaganja, poveæa 

• ako se Vaša i partnerova zajednièka financijska ulaganja poveæaju za više od $A 1,000 

• ako Vi ili Vaš partner otvorite nove raèune 

• ako Vi ili Vaš partner poklonite imovinu ili je prodate za manje od njene vrijednosti. 

Druge stvari o kojima nas 

trebate izvijestiti: 

• ako stupite u brak: ako ste sada ili ako poènete ivjeti s osobom suprotnog ili istog spola 

u registriranoj ili de-facto vezi: ako se pomirite s bivšim partnerom: ako poènete ivjeti s 

partnerom 

• ako se rastavite od partnera 

• ako se razvedete 

• ako Vaš partner umre 

• ako se Vi ili Vaš partner selite u ili iz staraèkog doma, doma ili sela za umirovljenike 

• ako ste Vi ili Vaš partner ili Vaše dijete/student koje uzdravate optueni zbog prijestupa i u 

pritvoru ili vraæeni u psihijatrijsku ustanovu ili zatvor 

• ako Vi ili Vaš partner prodate, iznajmite ili otuðite dom u kojem ivite 

• ako Vi ili Vaš partner napustite Vaš dom na due od 12 mjeseci 

• ako promijenite adresu, trebate nam odmah javiti. Ako nam se pošta vrati jer niste na 

posljednjoj adresi koju ste naveli, isplata se moe obustaviti ili uskratiti 

• ako primate isplatu putem direktne uplate na bankovni raèun, morate nas izvijestiti prije no što 

zatvorite ili promijenite taj bankovni raèun 

• morate nas izvijestiti o tome da li se Vi ili Vaš partner vraæate u Australiju jer æe se Vaša svota 

mirovine vjerojatno promijeniti od datuma Vašeg povratka 

• takoðer nas morate izvijestiti napuštate li dravu u kojoj ivite, bilo trajno ili privremeno, jer 

moete ostati bez australske mirovine. 

AUS140_CB.1005 


O informacijama koje nam date 

Povjerljivost i Vaši osobni 

podaci 

Osobni podaci su zaštiæeni zakonom, ukljuèujuæi Privacy Act 1988 (Zakon o èuvanju povjerljivosti 

podataka iz 1988). Ovlast za prikupljanje informacija se navodi u Social Security (Administration) 

Act 1999 (Administrativni postupci u zakonu o socijalnom osiguranju iz 1999). 

Informacije koje navodite na ovom obrascu se primjenjuju kod procjene Vašeg prava na isplate 

i usluge, a kad je potrebno bit æe ustupljene i treæim licima. Ove informacije æe se koristiti i za 

otkrivanje i spreèavanje prijevara i/ili utjerivanje dugova. 

Centrelink ima pravo dati neke ili sve Vaše informacije ovim agencijama – Department of Families, 

Housing, Community Services and Indigenous Affairs (FaHCSIA) (Ministarstvo za pitanja obitelji, 

stanovanja, društvene usluge i aboridanska pitanja - FaHCSIA), Department of Education, 

Employment and Workplace Relations (DEEWR) (Ministarstvo za prosvjetu, zapošljavanje i radne 

odnose – DEEWR) i pruateljima Job Services Australia (mrea pruatelja usluga za traenje 

posla), kao i pruateljima usluga pod pokroviteljstvom DEEWR-a. 

Centrelink moe objaviti neke Vaše podatke (npr. o prihodima ili imovini) drugim pojedincima, kad 

Vaše okolnosti utjeèu na njihovo pravo na isplate i usluge. 

Kako bi se prikupili odgovarajuæi podaci o useljavanju, Centrelink æe Department of Immigration 

and Citizenship (Ministartsvu za useljavanje i dravljanstvo) dati informaicje o Vama, i ako je 

primjenjivo, o Vašem partneru i djetetu (djeci). 

Neke, od Vas prikupljene informacije, se mogu primjeniti u svrhu istraivanja stranaka, koje 

provodi Department of Human Services (Ministarstvo za društvene usluge), Centrelink, 

Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA), ili 

organizacije koje to istraivanjeje vrše umjesto njih. Vaše sudjelovanje u tom istraivanju se cijeni, 

meðutim, ako ne elite sudjelovati, molimo nazovite Centrelink International Services ili za više 

podataka pogledajte informativni listiæ ‘Market research and you’ (Ispitivanje trišta i Vi). 

Centrelink moe Vaše podatke dati drugim osobama, tijelima ili agencijama, bez Vašeg pristanka, 

ako to zahtijeva ili ovlašæuje Savezni zakon. Na primjer, Centrelink otkriva neke ili sve Vaše 

informacije o prihodima i porezu, Australian Taxation Office-u (Australskom poreznom uredu) i 

Child Support Agency (Agenciji za ubiranje alimentacije za djecu), za njihove potrebe. Informacije 

se isto take usporeðuju s drugim dravnim agencijama,a u nekim sluèajevima i sa socijalnim 

osiguranjima u dravama s kojima je Australija potpisala internacionalni sporazum o socijalnom 

osiguranju, kako bi se osiguralo da primate toène isplate. 

Više informacija moete naæi u informativnom listiæu ‘Your right to privacy’ (Vaše pravo na 

povjerljivost podataka) na Centrelinkovoj Internet stranici www.centrelink.gov.au ili ako 

nazovete Centrelink International Services i zatraite primjerak listiæa. 

AUS140_CB.1005 


This page has been left blank intentionally. 

Ova stranica je namjerno ostavljena prazna 

AUS140_CB.1005 

Molimo Vas da saèuvate ove Upute za podnošenje zahtjeva za australsku mirovine 

(DIJELU 1), stranice 1 do 22, kako biste ih mogli upotrijebiti ubuduæe. 


Claim for Australian Pension 

Social Security Agreement between Australia and Croatia 

Zahtjev za australsku mirovinu 


OFFICE USE ONLY/SAMO ZA SLUBENU UPOTREBU 

Date customer made a written request for a claim form: 

Datum kad je stranka pismeno zatraila zahtjevni 

obrazac: 

Date customer lodged this completed claim form at 

Croatian Pension Insurance Institute service. 

Datum primitka ispunjenog zahtjevnog obrasca u 

slubi Hrvatskog zavoda za mirovinsko osiguranje. 

Day/Dan Month/Mjesec Year/Godina 


Stamp 

Peèat 

You/ Vi 

1 If Centrelink needs to contact you what is your preferred 

language 

Ako bi Vam se trebao obratiti Centrelink, na kojem jeziku 

biste najradije komunicirali 

1 

Your partner/ Vaš Partner 

If your partner is now deceased, please fill in 

‘Your partner’ details at questions 5, 6, 7, 8 , 13 and 20 

ONLY. 

Ako je Vaš partner preminuo/la, molimo popunite SAMO 

‘Your partner’ podatke u pitanjima 5,6,7,8,13 i 20. 

2 

2 Is your partner also claiming an Australian pension 

Podnosi li i Vaš partner zahtjev za australsku mirovinu 

No 

Ne 

Yes 

Da 

You must still answer all the questions about 

them. 

Još uvijek morate odgovoriti na sva pitanja o 

svom partneru. 

Go to next question 

Prijeðite na sljedeæe pitanje 

3 Is your partner using this form or a separate form for a 

claim or to provide their details 

Koristi li Vaš partner ovaj isti ili posebni obrazac za 

podnošenje zahtjeva ili navoðenje podataka 

This form 

Ovaj obrazac 

Separate form 

Posebni 

obrazac 

4 What type of payment do you wish to claim 

Za koju vrstu isplate elite podnijeti zahtjev 

Age Pension 

Starosna mirovina 

Disability Support Pension 

Invalidska mirovina za 

uzdravanje teških invalida 

What type of payment do you wish to claim 

Za koju vrstu isplate elite podnijeti zahtjev 

Age Pension 

Starosna mirovina 

Disability Support Pension 

Invalidska mirovina za 

uzdravanje teških invalida 

CLK0AUS140CB 1005 

AUS140_CB.1005 

1 of 22

You/ Vi 


5 Your name 

Vaše ime 

Your name 

Vaše ime 

Mr 

Gosp. 

Mrs 

Gða 

Miss 

Gða 

Ms 

Gða 

Other 

Ostalo 

Mr 

Gosp. 

Mrs 

Gða 

Miss 

Gða 

Ms 

Gða 

Other 

Ostalo 

Family name 

Prezime 

Family name 

Prezime 

First given name 

Prvo ime 

First given name 

Prvo ime 

Second given name 

Srednje ime 

Second given name 

Srednje ime 

6 Have you ever used or been known by any other names 

(e.g. name at birth, maiden name, previous married name, 

Aboriginal or tribal name, alias, adoptive name, foster name) 

Jeste li ikada upotrebljavali neko drugo ime (npr. ime kod 

roðenja, djevojaèko prezime, prijašnje braèno prezime, 

aboridansko ili plemensko ime, pseudonim, usvojeno ili 

posvojeno ime) 

No 

Ne 

Yes 

Da 

1 

Other name 

Drugo ime 



Give details below 

U nastavku navedite pojedinosti 

Have you ever used or been known by any other names 

(e.g. name at birth, maiden name, previous married name, 

Aboriginal or tribal name, alias, adoptive name, foster name) 

Jeste li ikada upotrebljavali neko drugo ime (npr. ime kod 

roðenja, djevojaèko prezime, prijašnje braèno prezime, 

aboridansko ili plemensko ime, pseudonim, usvojeno ili 

posvojeno ime) 

No 

Ne 

Yes 

Da 

1 

Other name 

Drugo ime 





Type of name (e.g. name at birth) 

Vrsta imena (npr. ime kod roðenja) 

Type of name (e.g. name at birth) 

Vrsta imena (npr. ime kod roðenja) 

2 Other name 

2 

Drugo ime 

Other name 

Drugo ime 

Type of name (e.g. maiden name) 

Vrsta imena (npr. djevojaèko prezime) 

Type of name (e.g. maiden name) 

Vrsta imena (npr. djevojaèko prezime) 

If you have more than 2 other names, attach a separate 

sheet with details. 

Ako imate više od 2 imena, molimo priloite dodatnu 

stranicu s detaljima. 

If you have more than 2 other names, attach a separate 


Ako imate više od 2 imena, molimo priloite dodatnu 

stranicu s detaljima. 

AUS140_CB.1005 


You/ Vi 

7 Your sex 

Vaš spol 

Male 

Muško 

Female 

ensko 

8 Your date of birth 

Vaš datum roðenja 



Your sex 

Vaš spol 

Male 

Muško 

Female 

ensko 

Your date of birth 

Vaš datum roðenja 


9 Your permanent address 

Vaša stalna adresa 

Your permanent address 

Vaša stalna adresa 

Country 

Drava 

Country 

Drava 

10 Your postal address (if different to above) 

Vaša poštanska adresa (ako se razlikuje od gore navedene 

adrese) 

Your postal address (if different to above) 

Vaša poštanska adresa (ako se razlikuje od gore navedene 

adrese) 

Country 

Drava 

Country 

Drava 

AUS140_CB.1005 


You/ Vi 

11 Your contact details 

Vaši kontakt podaci 

It is important that you include the complete number 

(including the country and area codes) as Centrelink 

may need to contact you on these numbers. 

Vano je da ukljuèite sve brojeve (ukljuèujuæi predbroj 

za dravu i mjesto) jer æe Vas Centrelink moda trebati 

kontaktirati na te brojeve. 


Your contact details 

Vaši kontakt podaci 

It is important that you include the complete number 

(including the country and area codes) as Centrelink 

may need to contact you on these numbers. 

Vano je da ukljuèite sve brojeve (ukljuèujuæi predbroj 

za dravu i mjesto) jer æe Vas Centrelink moda trebati 

kontaktirati na te brojeve. 

Home phone number 

Vaš kuæni broj telefona 

Country 

Drava 

Home phone number 

Vaš kuæni broj telefona 

( ) ( ) 

( ) 

Mobile phone number 

Broj mobitela 

Area code 

Mjesni predbroj 

Country 

Drava 

Mobile phone number 

Broj mobitela 

Area code 


( ) 

Fax number 

Broj telefaksa 

Country 

Drava 

Fax number 

Broj telefaksa 

( ) ( ) 

( ) 

Area code 


Alternative phone number 

Alternativni broj telefona 

Country 

Drava 

Email 

Email 

Area code 


Country 

Drava 

Area code 


Alternative phone number 

Alternativni broj telefona 

( ) ( ) 

( ) 

Country 

Drava 

Email 

Email 

Area code 


( ) 

( ) 

@ 

@ 

12 Are you currently receiving an Australian pension 

12 

Primate li sada neku australsku mirovinu 

No 

Ne 

Yes 

Da 





What payment are you receiving 

Koju vrstu isplate primate 

Are you currently receiving an Australian pension 

Primate li sada neku australsku mirovinu 

No 

Ne 

Yes 

Da 





What payment are you receiving 

Koju vrstu isplate primate 

Your Customer Reference Number (if known) 

Vaš broj Centrelinkovog dosjea (ako ga znate) 



Name payments are made in 

Na koje ime se isplaæuju isplate 

Name payments are made in 

Na koje ime se isplaæuju isplate 

Go to 14 

Idite na 14 

Go to 14 

Idite na 14 

AUS140_CB.1005 


You/ Vi 


13 Have you claimed or received an Australian pension or 

benefit in the last 10 years 

Jeste li zatraili ili primili neku australsku mirovinu ili 

beneficiju u posljednjih 10 godina 

No 

Ne 

Yes 

Da 





What payments did you last claim or receive 

Koju vrstu isplate ste posljednji put zatraili ili primili 

Have you claimed or received an Australian pension or 

benefit in the last 10 years 

Jeste li zatraili ili primili neku australsku mirovinu ili 

beneficiju u posljednjih 10 godina 

No 

Ne 

Yes 

Da 





What payments did you last claim or receive 

Koju vrstu isplate ste posljednji put zatraili ili primili 





Name claim was made in 

Na koje ime ste podnijeli zahtjev 

Name claim was made in 

Na koje ime ste podnijeli zahtjev 

AUS140_CB.1005 


14 What is your CURRENT relationship status 

Koje je Vaše SADAŠNJE braèno stanje 

15 

Please read this before answering the question. 

Prije nego što odgovorite na pitanja, molimo proèitajte ovaj 

dio. 

From 1 July 2009, Centrelink recognises both oppositesex 

and same‐sex relationships. This includes de facto 

relationships and relationships registered under Australian 

state or territory laws. If you and your same-sex partner 

have married or had your relationship registered outside 

Australia, please indicate your relationship as ‘partnered’ 

in the list below. 

Selection ONE option below that best describes your 

current relationship status. 

Od 1. srpnja 2009. Centrelink priznaje veze izmeðu osoba 

suprotnog i istog spola. To ukljuèuje de-facto veze kao i 

veze registrirane prema zakonima australskih saveznih 

drava i teritorija Ako imate partnera koji je istog spola 

kao i Vi, ako ste vjenèani ili je Vaše veza registrirana izvan 

Australije, trebate u listu nie navesti da imate partnera 

(‘partnered’). 

To ukljuèuje de-facto Izaberite JEDNU od nie navedenih 

opcija, koja najbolje odgovara Vašem sadašnjem 

braènom stanju. 

Married 

Oenjen-udana 

Registered relationship 

(opposite-sex or same-sex relationship 

registered under Australian state or 

territory laws) 

Registrirana veza 

(veza osoba suprotnog ili istog spola 

registrirana prema zakonima australskih 

saveznih drava ili teritorija) 

Partnered 

(living together in an opposite-sex or same-sex 

relationship, including de facto) 

S partnerom 

(zajednièki ivot s osobom suprotnog ili istog 

spola, ukljuèujuæide-facto vezu) 

Separated 

(previously lived with an opposite-sex or 

same-sex partner, including in a marriage, 

registered or de facto relationship) 

Rastavljeni 

(prethodno ste ivjeli s osobom suprotnog ili 

istog spola u braku, registriranoj vezi ili defacto 

vezi) 

Divorced 

Razveden(a) 

Widowed 

(previously partnered with an opposite-sex 

or same-sex partner, including in a marriage, 

registered or de facto relationship) 

Udovac/udovica 

(prethodno se ivjeli s osobom suprotnog 

ili istog spola u braku, registriranoj ili 

de-facto vezi) 

Never married or lived with a partner 

Nikada ranije bili u braku ili ivjeli s 

partnerom 

AUS140_CB.1005 

Go to 15 

Idite na 15 

Go to 15 

Idite na 15 

Go to 16 

Idite na 16 

Go to 21 

Idite na 21 

Go to 21 

Idite na 21 

Go to 20 

Idite na 20 

Go to 25 

Idite na 25 

6 of 22 

What is your date of marriage or relationship registration 

Datum kad ste se vjenèali ili registrirali vezu 


Country where you married 

Drava u kojoj ste se vjenèali 

Go to 17 

Idite na 17 

16 When did you and your partner start living together as a 

member of a couple 

Kada ste poèeli ivjeti s partnerom kao par 


17 Do you currently live in the same home as your partner 

ivite li sada s partnerom u istom domu 

No 

Ne 

Yes 

Da 

18 Why are you not living with your partner 

Zašto ne ivite s partnerom 

Partner’s illness 

Bolest partnera 

Your illness 

Vaša bolest 

Partner in prison 

Partner je u zatvoru 

Partner’s employment 

Podaci o partnerovom zaposlenju 

Other 

Ostalo 

19 Period not living with your partner. 

Razdoblje u kojem ne ivite s partnerom. 

From 

Od 

To 

Do 

Day/Dan 

Day/Dan 

Month/Mjesec 

Month/Mjesec 

Year/Godina 

Year/Godina 

OR 

ILI 



Go to 23 

Idite na 23 

Indefinite 

Neodreðeno 


U nastavku navedite 

pojedinosti 

Go to 23 

Idite na 23

20 Please give the following details about your deceased 24 

partner. 

Molimo navedite sljedeæe podatke o pokojnom partneru. 

Does your partner give permission for you to make 

enquiries on their behalf with Centrelink 

Daje li Vam Vaš partner dozvolu da u njegovo/njezino ime 

obavljate poslove sa Centrelinkom 

Date of death 

Datum smrti 


Country were partner died 

Drava u kojoj je partner umro 

Go to 25 

Idite na 25 

21 Do you live in the same home as your former partner 

ivite li u istom domu u kojem je ivio Vaš bivši partner 

No 

Ne 

Yes 

Da 

22 Please give the following details about your former partner. 

Molimo navedite sljedeæe podatke o svom bivšem 

partneru. 

Full name 

Puno ime i prezime 

Date of birth 


Current address (if known) 

Sadašnja adresa (ako je znate) 

Date relationship ended 

Datum prestanka veze 

Day/Dan Month/Mjesec Year/Godina Day/Dan Month/Mjesec Year/Godina 

No 

Ne 

Yes 

Da 

25 Do you live with anyone else, other than members of your 

family 

ivite li s nekim drugim tko nije èlan Vaše obitelji 

No 

Ne 

Yes 

Da 

Q 

26 Do you (and/or your partner): 

• own your own home, 

• have a life interest in your home, 

or 

are you (and/or your partner): 

• buying your own home 

Da li ste Vi (i/ili Vaš partner): 

• vlasnici kuæe 

• ivotno zainteresirani za svoju kuæu, ili 

da li Vi (i/ili Vaš partner): 

• kupujete vlastitu kuæu 

No 

Ne 

Yes 

Da 

Country 

Drava 

Go to 25 

Idite na 25 

23 Do you give your partner permission to make enquiries on 

your behalf with Centrelink 

Dajete li pristanak da se Vaš partner u Vaše ime raspituje u 

Centrelinku 

You can change this authority at any time. 

Ovu punomoæ moete promijeniti kad god to zaelite. 

No 

Ne 

Yes 

Da 

AUS140_CB.1005 


Dependent children 

Zavisna djeca 

27 

Continued 

Nastavak 

27 

Do you (and/or your partner) have any dependent children 

or students 

Imate li Vi (i/ili Vaš partner) djecu koju uzdravate koji su 

uèenici/studenti 

A dependent child is a young person under age 16 or 

a full-time student under age 22 who is in your care 

and has limited income. A young person cannot be 

dependent if they are not studying full-time or are 

earning income. 

Zavisno dijete je osoba mlaða od 16 godina ili redoviti 

student mlaði od 22 godine o kojem Vi skrbite a ima 

ogranièen prihod. Ne smatra se zavisnom mlada osoba 

koja nije redoviti student ili koja zaraðuje. 

No 

Ne 

Yes 

Da 





AND 

I 

If any child is in full-time study, you 

should provide a statement from the 

educational institution confirming their 

enrolment. 

Ako je bilo koje dijete redoviti student, 

trebate podnijeti izjavu o upisu od 

obrazovne ustanove koju pohaðaju. 

2 

3 

Child’s name 

Ime djeteta 




Is the child in full-time study 

Je li dijete redoviti ðak 

Does the child live with you 

ivi li dijete s Vama 

Has the child lived in Australia 

with you OR been an Australian 

resident 

Je li dijete ivjelo s Vama u 

Australiji ILI bilo stanovnik 

Australije 

Child’s name 

Ime djeteta 




No 

Ne 

No 

Ne 

No 

Ne 

Yes 

Da 

Yes 

Da 

Yes 

Da 

1 Child’s name 

Ime djeteta 





No 

Ne 

No 

Ne 

Yes 

Da 

Yes 

Da 






No 

Ne 

Yes 

Da 



resident 



Australije 

No 

Ne 

Yes 

Da 





resident 



Australije 

No 

Ne 

No 

Ne 

Yes 

Da 

Yes 

Da 

If you have more than 3 children, attach a separate 


Ako imate više od 3-je djece, dodajte posebnu stranicu s 

podacima. 

AUS140_CB.1005 


Residence details 

Podaci o prebivalištu 

Please read this before answering the questions. 

Prije nego što odgovorite na pitanja, molimo proèitajte ovaj dio. 

To claim an Australian Pension, a period of Australian residence must be proved. 

‘Permanent’ means you lived in Australia on a long-term basis, with a permanent residence visa or as an Australian 

citizen. Holidays in Australia are not included. Holidays or short trips outside Australia while you were living in Australia 

are included as part of your residence in Australia. 

A list of suitable documents is shown in PART 1 for proof of identity and proof of residence in Australia. If you have no 

documents to confirm your residence in Australia a benefit may not be granted. 

Please attach to your claim certified copies of any documents which verify your residence in Australia. 

Kod podnošenja zahtjeva za australsku mirovinu, treba podnijeti dokaz o stalnom boravku u Australiji. 

Pod izrazom ‘Permanent’ (stalni) se misli da ste dugoroèno ivjeli u Australiji, s vizom za stalni boravak ili kao australski 

dravljanin. Ne odnosi se na vrijeme provedeno u Australiji na odmoru. Odmor ili kraæi boravak izvan Australije, dok ste 

stalno nastanjeni u Australiji, se ubrajaju u vrijeme stalnog boravka u Australiji. 

U DIJELU 1 je naveden popis odgovarajuæih dokumenata kojima se dokazuje identitet i stalni boravak u Australiji. Ako 

nemate dokumente kojima se potvrðuje Vaš stalni boravak u Australiji, moda neæete ostvariti pravo na isplatu. 

Molimo da uz svoju molbu priloite ovjerene kopije dokumenata koji potvrðuju Vaš stalni boravak u Australiji. 

You/ Vi 

28 What is your country of birth 

U kojoj zemlji ste roðeni 


What is your country of birth 

U kojoj zemlji ste roðeni 

29 What are your countries of citizenship or nationality 

Èije dravljanstvo ili narodnost imate 

Australia 

Australija 

Date of grant 

Datum odobrenja 

What are your countries of citizenship or nationality 

Èije dravljanstvo ili narodnost imate 

Australia 

Australija 

Date of grant 

Datum odobrenja 


Other 

Ostalo 

Please list all other countries where 

you have citizenship or nationality. 

Molimo navedite sve ostale drave 

èiji ste dravljanin ili èiju narodnost 

imate. 

Other 

Ostalo 

Please list all other countries where 

you have citizenship or nationality. 

Molimo navedite sve ostale drave 

èiji ste dravljanin ili èiju narodnost 

imate. 

AUS140_CB.1005 


You/ Vi 

30 Give details of all countries (including Australia) where 

you have lived since birth. 

Navedite sve zemlje (ukljuèujuæi i Australiju) u kojima ste 

ivjeli od svog roðenja. 

‘Lived’ means you lived permanently or long term in 

that country (don’t include holidays or short trips.) 

“ivjeli” podrazumijeva ivjeti u nekoj zemlji za stalno ili 

na dulje vrijeme (nemojte ukljuèiti provedeni odmor ili 

kraæe putovanje) 


Give details of all countries (including Australia) where 

you have lived since birth. 

Navedite sve zemlje (ukljuèujuæi i Australiju) u kojima ste 

ivjeli od svog roðenja. 

‘Lived’ means you lived permanently or long term in 

that country (don’t include holidays or short trips.) 

“ivjeli” podrazumijeva ivjeti u nekoj zemlji za stalno ili 

na dulje vrijeme (nemojte ukljuèiti provedeni odmor ili 

kraæe putovanje) 

1 Country of residence 

1 

Zemlja boravka 

Country of residence 


From 

To 

From 

To 

Od 

Do 

Od 

Do 

Day/Dan Month/Mjesec Year/Godina Day/Dan Month/Mjesec Year/Godina Day/Dan Month/Mjesec Year/Godina Day/Dan Month/Mjesec Year/Godina 

Time worked in the country 

Razdoblje koje ste 

proveli radeæi u toj zemlji 

Year/Godina 

Month/Mjesec 


2 







Year/Godina 

Month/Mjesec 

From 

Od 


To 

Do 


From 

Od 


To 

Do 





Year/Godina 

Month/Mjesec 


3 







Year/Godina 

Month/Mjesec 

From 

Od 


To 

Do 


From 

Od 


To 

Do 





Year/Godina 

Month/Mjesec 




Year/Godina 

Month/Mjesec 

If you have more than 3 countries, attach a separate 


Ako imate više od 3 drave, pridodajte posebnu stranicu 

s podacima. 

If you have more than 3 countries, attach a separate 


Ako imate više od 3 drave, pridodajte posebnu stranicu 

s podacima. 

AUS140_CB.1005 


You/ Vi 

31 For each of the arrivals in, and departures from Australia 

identified in Question 30, please provide the following details. 

Za svaki ulaz u i napuštanje Australije, kao što je navedeno 

u Pitanju 30, molimo navedite sljedeæe podatke. 

Be as accurate as possible, even if you can only 

remember the year you first arrived in Australia. 

Budite što precizniji, èak i ako se samo sjeæate godine 

kad ste prvi put došli u Australiju. 


For each of the arrivals in, and departures from Australia 

identified in Question 30, please provide the following details. 

Za svaki ulaz u i napuštanje Australije, kao što je navedeno 

u Pitanju 30, molimo navedite sljedeæe podatke. 

Be as accurate as possible, even if you can only 

remember the year you first arrived in Australia. 

Budite što precizniji, èak i ako se samo sjeæate godine 

kad ste prvi put došli u Australiju. 

1 Arrival date 

Ship or Airline 

1 

Datum ulaza 

Brod ili avion 


Arrival date 

Datum ulaza 




Place of arrival/Mjesto dolaska 


Visa details on arrival 

Podaci o ulaznoj vizi 

Visa sub-class 

Podklasa vize 

Date visa granted 

Datum izdavanja vize 




Podklasa vize 




Departure date 

Datum odlaska 




Datum odlaska 




Place of departure/Mjesto odlaska 


2 Arrival date 


2 

Datum ulaza 


Arrival date 

Datum ulaza 









Podklasa vize 






Podklasa vize 





Datum odlaska 




Datum odlaska 






If you require more space, attach a separate sheet with 

details. 

Ako trebate više prostora, priloite podatke na posebnom 

listu. 

If you require more space, attach a separate sheet with 

details. 

Ako trebate više prostora, priloite podatke na posebnom 

listu. 

AUS140_CB.1005 


32 

You/ Vi 

If Centrelink is unable to verify your Australian 

residence Centrelink will need to contact people who 

knew you in Australia. 

Ako Centrelink ne bude u moguænosti potvrditi Vaše 

razdoblje prebivanja u Australiji, morat æe se obratiti 

ljudima koji su Vas poznavali u Australiji. 

Give the names, addresses and telephone numbers of 

3 people, not related to you, who are currently living in 

Australia and can confirm your residence in Australia. 

Navedite imena, adrese i telefonske brojeve 3. osoba, koje 

nisu s Vama u rodbinskoj vezi, a koje trenutaèno ive u 

Australiji i mogu potvrditi Vaš stalni boravak u Australiji. 


If Centrelink is unable to verify your Australian 

residence Centrelink will need to contact people who 

knew you in Australia. 

Ako Centrelink ne bude u moguænosti potvrditi Vaše 

razdoblje prebivanja u Australiji, morat æe se obratiti 

ljudima koji su Vas poznavali u Australiji. 

Give the names, addresses and telephone numbers of 

3 people, not related to you, who are currently living in 

Australia and can confirm your residence in Australia. 

Navedite imena, adrese i telefonske brojeve 3. osoba, koje 

nisu s Vama u rodbinskoj vezi, a koje trenutaèno ive u 

Australiji i mogu potvrditi Vaš stalni boravak u Australiji. 

1 Full name 

1 


Full name 


Address 

Adresa 

Address 

Adresa 

Contact phone number 

Kontakt broj telefona 

Area code 


( ) 

Postcode 

Poštanski broj 



Area code 


( ) 

Postcode 


2 Full name 

2 


Full name 


Address 

Adresa 

Address 

Adresa 



Area code 


( ) 

Postcode 




Area code 


( ) 

Postcode 


3 Full name 

3 


Full name 


Address 

Adresa 

Address 

Adresa 



Postcode 




Postcode 


Area code 


( ) 

Area code 


( ) 

AUS140_CB.1005 


Bank account details 

Podaci o prihodu i imovini 



Centrelink will need your bank account details to pay your Australian pension. 

The nominated account must be in US dollars. Payment will be issued by wire transfer from Australia in US dollars via an 

intermediary bank in the USA and then on to your bank and account in Croatia. 

Please note that as payments will be made in US dollars, lifting fees may be levied by your bank and/or intermediary banks. 

Where lifting fees are levied, such fees must be paid by you. 

Please confirm with your bank or financial institution that your account is capable of receiving wire payments in USD 

currency. 

Centrelinku su potrebni podaci o Vašem bankovnom raèunu kako bi Vam mogao isplaæivati australsku mirovinu. 

Navedeni bankovni raèun mora biti u amerièkim dolarima. Isplate æe se doznaèivati elektronskim putem iz Australije u amerièkim 

dolarima u posrednièku banku u SAD-u i onda u Vašu banku i na Vaš raèun u Hrvatskoj. 

Skreæemo pozornost da zbog toga što su isplate u amerièkim dolarima, bilo Vaša bilo posrednièka banka mogu naplaæivati 

naknadu kod podizanja uloga. U tom sluèaju Vi snosite troškove za naknadu. 

Molimo Vas provjerite u svojoj banci ili financijskoj ustanovi jesu li u banci, ili u financijskoj ustanovi osposobljeni za primanje 

isplata elektronskim putem u US dolarima. 

33 

You/ Vi 

Is your bank account capable of receiving US Dollar wire 

payments 

Mogu li se vršiti uplate u US dolarima na Vaš bankovni 

raèun 


Is your bank account capable of receiving US Dollar wire 

payments 

Mogu li se vršiti uplate u US dolarima na Vaš bankovni 

raèun 

No 

Ne 

If you are granted an Australian pension you 

will have to open a suitable account before you 

can receive any payments. 

Ako Vam bude odobrena australska mirovina, 

trebat æete otvoriti odgovarajuæi bankovni raèun 

prije nego što isplate poènu. 

No 

Ne 

If you are granted an Australian pension you 

will have to open a suitable account before you 

can receive any payments. 

Ako Vam bude odobrena australska mirovina, 

trebat æete otvoriti odgovarajuæi bankovni raèun 

prije nego što isplate poènu. 

Yes 

Da 

Please complete your bank details on the next 

page and ask your bank to verify the details on 

page 14. 

Na sljedeæoj stranici, molimo popunite podatke 

o Vašoj banci i zamolite ih da to ovjere na 14. 

stranici. 

AND 

I 

Yes 

Da 

Please complete your bank details on the next 

page and ask your bank to verify the details on 

page 14. 

Na sljedeæoj stranici, molimo popunite podatke 

o Vašoj banci i zamolite ih da to ovjere na 14. 

stranici. 

AND 

I 

Please attach a copy of a bank 

statement or other document that shows 

your bank details including your account 

Molimo priloite kopiju bankovnog 

izvješæa ili neki drugi dokument koji sadri 

Vaše bankovne podatke, ukljuèujuæi broj i 

ime/na raèuna. 

Please attach a copy of a bank 

statement or other document that shows 

your bank details including your account 

Molimo priloite kopiju bankovnog 

izvješæa ili neki drugi dokument koji sadri 

Vaše bankovne podatke, ukljuèujuæi broj i 

ime/na raèuna. 

AUS140_CB.1005 


33 

You/ Vi 

Continued 

Nastavak 

Name of bank – Write the full name of the bank, building 

society or other financial institution. 

Naziv banke — Napišite puni naziv banke ili financijske 

ustanove. 


Continued 

Nastavak 

Name of bank – Write the full name of the bank, building 

society or other financial institution. 

Naziv banke — Napišite puni naziv banke ili financijske 

ustanove. 

Name of bank branch – Write the full name of the bank, 

building society or other financial institution branch. 

Naziv podrunice banke — Napišite puni naziv podrunice 

banke ili financijske ustanove. 

Name of bank branch – Write the full name of the bank, 

building society or other financial institution branch. 

Naziv podrunice banke — Napišite puni naziv podrunice 

banke ili financijske ustanove. 

Address of bank branch 

Adresa podrunice banke 

Number/Street 

Ulica i broj 

Address of bank branch 

Adresa podrunice banke 

Number/Street 

Ulica i broj 

Town/City/Postcode 

Grad/Mjesto/Predbroj 


Grad/Mjesto/Predbroj 

Country 

Drava 

Country 

Drava 

Bank SWIFT Code — Write the SWIFT code of the bank or 

other financial institution. 

Bankovni SWIFT/Identifikacijski broj banke — Upišite SWIFT 

banke ili neke druge financijske ustanove. 

Bank SWIFT Code — Write the SWIFT code of the bank or 

other financial institution. 

Bankovni SWIFT/Identifikacijski broj banke — Upišite SWIFT 

banke ili neke druge financijske ustanove. 

IBAN (International Bank Account Number) 

IBAN (broj meðunarodnog bankovnog raèuna) 

H R 

IBAN (International Bank Account Number) 

IBAN (broj meðunarodnog bankovnog raèuna) 

H R 

Name of account holder – Write the exact name(s) in 

which the account is held. 

Ime vlasnika raèuna — Upišite toèno ime/imena pod kojim 

se vodi raèun. 

Name of account holder – Write the exact name(s) in 

which the account is held. 

Ime vlasnika raèuna — Upišite toèno ime/imena pod kojim 

se vodi raèun. 

AUS140_CB.1005 


33 

Continued / Nastavak 

Bank use only / Samo za slubenu upotrebu banke 

Intermediary bank details—you MUST get your bank to complete the following details. Because the wire is in 

US dollars, it must be sent through the bank in the USA with which your bank in Croatia deals. This is called an 

intermediary bank. 

Podaci o posrednièkoj banci—MORATE zatraiti u svojoj banci da ispune sljedeæe podatke. S obzirom da su doznake elektronskim 

putem u amerièkim dolarima moramo ih poslati u amerièku banku s kojom suraðuje Vaša banka u Hrvatskoj. To se naziva 

posrednièka banka. 

To the Bank/Financial Institution: 

We are asking you to complete the following details to: 

1. confirm that the customer account can receive deposits by electronic means in US Dollars. 

2. verify that the customer account details shown at question 33 are correct. 

3. complete details of the intermediary bank. 

Upute bankama/financijskim ustanovama: 

Molimo Vas ispunite sljedeæe podatke, radi njihovog utvrðivanja: 

1. potvrdite moe li bankovni raèun Vaše stranke primati doznake elektronskim putem u amerièkim dolarima. 

2. provjerite jesu li podaci pod pitanjem 33 toèni. 

3. ispunite podatke o posrednièkoj banci. 

You/ Vi 

Name of intermediary bank in USA — Write here the full 

name of the intermediary bank or financial institution. 

Naziv posrednièke banke u SAD-u — Upišite ovdje puni 

naziv posrednièke banke ili financijske ustanove. 


Name of intermediary bank in USA — Write here the full 

name of the intermediary bank or financial institution. 

Naziv posrednièke banke u SAD-u — Upišite ovdje puni 

naziv posrednièke banke ili financijske ustanove. 

Address of bank branch in USA 

Adresa podrunice banke u SAD-u 

Number/Street 

Broj/Ulica 

Address of bank branch in USA 

Adresa podrunice banke u SAD-u 

Number/Street 

Broj/Ulica 


Grad/Mjesto/Poštanski broj 

USA 


Grad/Mjesto/Poštanski broj 

USA 

Bank Sort Code/Routing Code of intermediary bank in 

USA — Write here the sort/routing code for the branch of 

the intermediary bank or financial institution. 

Note: This is not the SWIFT or Bank Identifier Code (BIC) 

code. 

Šifra “Bank Sort”/”Routing Code” posrednièke banke u 

SAD-u — Upišite ovdje Sort /Routing Code podrunice 

posrednièke banke ili financijske ustanove 

Napomena: To nije bankovni SWIFT niti identifikacijski broj 

banke - BIC. 

Federal Reserve 

routing address 

“Routing” adresa 

Savezne Rezerve 

ABA Institution ID 

Identifikacijski ABA 

(australski poslovni 

broj) ustanove 

Check 

digit 

Brojka za 

provjeru 

Bank Sort Code/Routing Code of intermediary bank in 

USA — Write here the sort/routing code for the branch of 

the intermediary bank or financial institution. 

Note: This is not the SWIFT or Bank Identifier Code (BIC) 

code. 

Šifra “Bank Sort”/”Routing Code” posrednièke banke u 

SAD-u — Upišite ovdje Sort /Routing Code podrunice 

posrednièke banke ili financijske ustanove 

Napomena: To nije bankovni SWIFT niti identifikacijski broj 

banke - BIC. 

Federal Reserve 

routing address 

“Routing” adresa 

Savezne Rezerve 

ABA Institution ID 

Identifikacijski ABA 

(australski poslovni 

broj) ustanove 

Check 

digit 

Brojka za 

provjeru 

AUS140_CB.1005 


33 

Continued 

Nastavak 

You/ Vi 

Bank/Financial institution stamp 

Peèat banke/financijske ustanove 

Continued 

Nastavak 


Bank/Financial institution stamp 

Peèat banke/financijske ustanove 

Person permitted to enquire 

Osoba koja se smije raspitivati 

Please read this before answering the questions. 


Completing this section allows a person to make enquires ONLY, not to change your personal details or receive payments 

from Centrelink. If you wish a person to receive payments or change your personal details on your behalf, you will have 

to complete a Authorising a person or organisation to enquire or act on your behalf form (SS313). This form can be 

downloaded from www.centrelink.gov.au, or contact Centrelink International Services. 

Ispunjavanjem ovog dijela u tiskanici dozvoljavate osobi SAMO da se raspituje, a ne i da mijenja Vaše podatke ili prima Vašu 

isplatu od Centrelnika. Ako elite da ova osoba u Vaše ime prima isplate ili mijenja Vaše podatke, morat æete ispuniti tiskanicu 

Opunomoæivanje osobe ili organizacije da se raspituje ili da djeluje u Vaše ime (SS313). Tu tiskanicu moete skinuti s naše intenet 

stranice www.centrelink.gov.au ili se obratite Centrelinkovoj meðunarodnoj slubi. 

34 

You/ Vi 

Do you wish to nominate a person to make enquiries on 


• You do not have to nominate a person to enquire. 

• The person you nominate to enquire on your behalf 

can be living in Australia. 

• You can change this arrangement at any time. 

elite li imenovati osobu koja æe Vas zastupati (netko tko se 

u Vaše ime moe raspitivati) kod Centrelinka 

• Ne morate imenovati zastupnika, tj. osobu koja æe se u 

Vaše ime raspitivati 

• Osoba koju imenujete moe ivjeti u Australiji. 

• Bilo kada moete promijeniti zastupnika 


Do you wish to nominate a person to make enquiries on 


• You do not have to nominate a person to enquire. 

• The person you nominate to enquire on your behalf 

can be living in Australia. 

• You can change this arrangement at any time. 

elite li imenovati osobu koja æe Vas zastupati (netko tko se 

u Vaše ime moe raspitivati) kod Centrelinka 

• Ne morate imenovati zastupnika, tj. osobu koja æe se u 

Vaše ime raspitivati 

• Osoba koju imenujete moe ivjeti u Australiji. 

• Bilo kada moete promijeniti zastupnika 

No 

Ne 

Yes 

Da 



Give details on the next page 

Navedite podatke na sljedeæoj stranici 

No 

Ne 

Yes 

Da 



Give details on the next page 

Navedite podatke na sljedeæoj stranici 

AUS140_CB.1005 


35 

You/ Vi 

Continued 

Nastavak 

Person’s full name 

Puno ime i prezime osobe 


Continued 

Nastavak 

Person’s full name 

Puno ime i prezime osobe 

Person’s date of birth 

Datum roðenja osobe 


Person’s date of birth 

Datum roðenja osobe 


Person’s relationship to you 

Veza te osobe s Vama 

Person’s relationship to you 

Veza te osobe s Vama 

Person’s address 

Adresa osobe 

Person’s address 

Adresa osobe 

Country 

Drava 

Country 

Drava 

Person’s contact phone number 

Kontakt telefonski broj osobe 

Country 

Drava 

Person’s fax number 

Broj telefaksa osobe 

Country 

Drava 

Person’s Email 

Email adresa osobe 

Area code 


Person’s contact phone number 

Kontakt telefonski broj osobe 

( ) ( ) ( ) ( ) 

Country 

Drava 

Person’s fax number 

Broj telefaksa osobe 

Country 

Area code 

( ) ( ) 

Area code 

( ) ( ) 


Drava 

Person’s Email 

Email adresa osobe 

Area code 



@ 

Person’s preferred language when dealing with Centrelink 

Na kojem jeziku zastupnik eli komunicirati s Centrelinkom 

@ 

Person’s preferred language when dealing with Centrelink 

Na kojem jeziku zastupnik eli komunicirati s Centrelinkom 

Period of authorisation 

Razdoblje davanja ovlasti 

Indefinite 

Neodreðeno 



Period of authorisation 

Razdoblje davanja ovlasti 

Indefinite 

Neodreðeno 



Set Period 

Odreðeno 

vrijeme 



Set Period 

Odreðeno 

vrijeme 



From 

To 

From 

To 

Od 

Do 

Od 

Do 

Day/Dan Month/Mjesec Year/Godina Day/Dan Month/Mjesec Year/Godina Day/Dan Month/Mjesec Year/Godina Day/Dan Month/Mjesec Year/Godina 

AUS140_CB.1005 


37 

Other information 

Druge informacije 

36 Are you (and/or your partner) claiming Age Pension 

Podnosite li Vi (i/ili Vaš partner) zahtjev za starosnu mirovinu 

No 

Ne 

Yes 

Da 

Go to 38 

Idite na 38 





dio. 

Age Pension (blind) may be paid if you are legally 

blind. For Centrelink purposes this means that your 

visual acuity: 

• after correction by suitable lenses, is less then 6/60 

on the Snellen Scale in both eyes, OR 

• has a field of vision constricted to 10 degrees or 

less of arc around central fixation in the better eye 

irrespective of corrected visual acuity (equivalent to 

1/100 white test object), OR 

• has a combination of visual defects resulting in the 

same degree of visual impairment as that occurring 

in the above points. 

Age Pension (blind) may be paid at a higher rate than 

Age Pension, depending on your circumstances. 

Ako ste trajno slijepi, moda moete dobiti starosnu 

mirovinu za slijepe. U poslovanju sa Centrelinkom, pod 

time se smatra da Vam je vid: 

• uz korekciju odgovarajuæim leæama, manji od 6/60 

po Snellen skali u oba oka, ILI 

• u vidom polju ogranièen na 10 stupnjeva ili manje na 

osi oko centralne fiksacije u boljem oku, bez obzira 

na korekciju vida (ekvivalent od 1/100, test bijelog 

oblika), ILI 

• pokazuje kombinaciju poremeæaja vida, èija je 

posljedica gubitak vida, kao što je navedeno u 

gornjim toèkama. 

Starosna mirovina za slijepe se moe isplaæivati po višoj 

stopi od starosne mirovine, ovisno o Vašim okolnostima. 

38 



dio. 

Australian Pension News is sent every six months 

to Centrelink customers living outside Australia. It 

contains important Centrelink information and articles 

of interest to Australians living away from Australia. It 

is mailed to customers in April and October each year 

Australian Pension News se šalje svakih šest mjeseci 

strankama Centrelinka u inozemstvu. Sadri vane 

obavijesti iz Centrelinka i èlanke koji mogu zanimati 

Australce koji ive izvan Australije. Šalje se strankama u 

travnju i listopadu svake godine. 

What is your preferred language to receive Australian 

Pension News 

Na kojem jeziku elite primati kopije brošure Australian 

Pension News (Australske vijesti za umirovljenike) 

Australian Pension News is published in Arabic, Croatian, 

Dutch, English, German, Greek, Italian, Macedonian, 

Portuguese, Serbian, Spanish and Turkish. 

Australian Pension News se tiska na arapskom, hrvatskom, 

nizozemskom, engleskom, njemaèkom, grèkom, 

talijanskom, makedonskom, portugalskom, srpskom, 

španjolskom i turskom jeziku. 

Do you (and/or your partner) meet the definition of legal 

blindness as stated above 

Smatrate li da Vi (i/ili Vaš partner) zadovoljavate gore 

navedene uvjete za mirovinu za slijepe 

No 

Ne 

Yes 

Da 



Please attach an ophthalmologist 

report confirming that you (and/or your 

partner) meet the Australian definition of 

legal blindness as stated above. 

Molimo priloite izvješæe oftamologa, 

kojim se potvrðuje da Vi (i/ili Vaš 

partner) zadovoljavate australske uvjete 

koji se odnose na trajno sljepilo, kao što 

je gore navedeno. 

AUS140_CB.1005 


Statement 

Izjava 

39 Statement 

I declare that: 

• the information I have given on this form is correct. 

• I have read and I understand the ‘Your rights’ and ‘Your 

obligations’ sections in PART 1 of this claim. 

I authorise: 

• Centrelink to make enquiries necessary to establish 

my correct entitlement to pension or allowance. 

• the Croatian Pension Insurance Institute to release any 

information or evidence in its possession which relates 

or could relate to my application for pension. 

I understand that: 

• giving false or misleading information is a serious 

offence. 

Izjava 

Izjavljujem: 

• da su podaci koje sam naveo/la u ovoj tiskanici toèni. 

• da sam proèitao/la i razumio/mjela odjeljke “Vaša 

prava” i “Vaše obveze” u DIJELU 1 ovog zahtjeva. 

Ovlašæujem: 

• Centrelink da se moe raspitivati za potrebe toènog 

utvrðivanja mojih prava na mirovinu ili doplatak. 

• Hrvatski zavod za mirovinsko osiguranje da dostavi 

svaki podatak ili dokaz koji ima, a koji se odnosi ili bi se 

mogao odnositi na moj zahtjev za mirovinu. 

Razumijem: 

• da se kanjava namjerno davanje netoènih i lanih 

podataka. 

Your signature 

Vaš potpis 

- 

Date 

Datum 


Your partner’s signature 

Potpis Vašeg partnera 

- 

Date 

Datum 


What to do now 

Što treba sada uèiniti 

1 Keep the Notes for claiming Australian pension 

(PART 1) for your future reference. 

Saèuvajte ove Upute za potraivanje australske mirovine 

(DIJELU 1) kako biste ih mogli upotrijebiti ubuduæe. 

2 • Take your completed Claim for Australian Pension 

form (PART 2), Income and assets form (Mod(IA)) 

and any supporting documentation to the competent 

District Service of the Croatian Pension Insurance 

Institute. They will copy original documents and 

return them to you. The claim forms do not need 

to be copied. If you do copy the claim form, please 

ensure you keep the copy , not the original. The 

competent District Service of the Croatian Pension 

Insurance Institute will forward PART 2, Mod (IA) 

and any supporting documentation to Centrelink 

International Services in Australia. 

OR 

• Post PART 2, (Mod (IA)) and any supporting 

documentation to: 


GPO Box 273 


AUSTRALIA 

If you send original documents Centrelink 

International Services will copy these and return 

original documents to you. 

If you need advice call Centrelink International Services 

on +61 3 6222 3455. 

• Odnesite svoje ispunjene obrasce Claim for 

Australian Pension (PART 2), Income and assets 

(Mod(IA)) i svu popratnu dokumentaciju u Podruènu 

slubu hrvatskog zavoda za socijalno osiguranje. Oni 

æe fotokopirati originalne dokumente i Vama vratiti 

originale. Molbeni obrazac ne treba fotokopirati. Ako 

fotokopirate molbu, molimo pripazite da sebi ostavite 

kopiju a ne original. Odgovorni ured Hrvatskog zavoda 

za socijalno osiguranje æe poslati DIO 2, Mod IA i svu 

popratnu dokumentaciju u Centrelink International 

Services u Australiji. 

ILI 

• Pošaljite sami DIO 2 i Mod (IA) i svu popratnu 

dokumentaciju na adresu: 


GPO Box 273 


AUSTRALIA 

Ako pošaljete originale dokumenata, Centrelink 

International Services æe ih fotokopirati i vratiti Vam 

originale. 

Trebate li pomoæ u svezi ovoga, nazovite Centrelink 

International Services na +61 3 6222 3455. 

AUS140_CB.1005 


Checklist—Office use only 

Kontrolni list—samo za slubenu upotrebu 

This checklist is to be completed by your Central 

Service of the Croatian Pension Insurance 

Institute (authorities under the agreed Administrative 

Arrangement). 

Ovaj kontrolni list treba ispuniti Središnja sluba Hrvatskog 

zavoda za mirovinsko osiguranje (prema ugovorenom 

Administrativnom sporazumu). 

Checklist 

Kontrolni list 

All relevant questions on the form have been 

answered (PART 2) 

Odgovoreno je na sva potrebna pitanja na tiskanici 

(DIO 2) 

Claim has been signed and dated (PART 2) 

Zahtjev ima potpis i datum (DIO 2) 

The claimant is a resident of Croatia and his/her 

identity has been verified 

Podnositelj zahtjeva je stanovnik Hrvatske i njegov / 

njezin identitet je potvrðen 

OR 

ILI 

Proof of Identity for a non-resident of Croatia has been 

verified by (indicate appropriate proof below): 

Dokaz o identitetu za ne-stanovnika Hrvatske je 

potvrðen od strane (nie navedite odgovarajuæi dokaz): 

Supporting documentation (authenticated copies 

attached) 

Popratna dokumentacija (ovjereni primjerci priloeni) 

1 

2 

3 

Croatian Pension Insurance Institute records 

Podaci Hrvatskog zavoda za mirovinsko osiguranje 

Reference number 

Oznaka spisa 

Entitlement to pension in Croatia 

Prava na mirovinu u Hrvatskoj 

Applicant / Podnositelj Zahtjeva 

Type of benefit / Vrsta isplate 

Benefit status / Stanje beneficije 

Decision is pending Date claim lodged 

Odluka u toku Datum predaje zahtjeva 

Claim rejected 

Zahtjev je odbijen 

Claim granted 

Zahtjev je odobren 


Reason 

Razlog 

Date 

Datum 


Gross rates (before tax deductions) of Croatian pension 

from the date the Australian claim was received at HZMO 

to the date of this notification: 

Bruto stope (prije odbitaka za porez) hrvatske mirovine od 

datuma primitka zahtjeva za australsku mirovinu u HZMO 

do datuma ove obavijesti: 

Pension Rate 1 

Iznos mirovine 1 

From (date) 

Od (datuma) 

Monthly Pension Rate 

Mjeseèna isplata mirovine 

Total Gross Monthly 

Amount 

Ukupni bruto iznos 

mjeseèno 

Protective Allowance 

Dodatak za zaštitu 

Australian Medical Assessment Report (DSP only) 

Australsko izvješæe o zdravstvenom pregledu (samo za 

primatelje invalidske mirovine – DSP) 

Attached 

U dodatku se nalazi 

To follow 

Slijedi 

Allowance for Assistance 

and Care 

Dodatak za pomoæ i njegu 

Allowance for Children 

Dodatak za djecu 

Cash Allowance for 

Physical Damage 

Dodatak u gotovini za 

tjelesno ošteæenje 

Other 

Ostalo 

AUS140_CB.1005 




From (date) 

Od (datuma) 




Amount 


mjeseèno 



Applicant’s partner / Partner podnositelja zahtjeva 

Type of benefit / Vrsta isplate 

Benefit status / Stanje beneficije 

Decision is pending 

Odluka u toku 

Date claim lodged 

Datum predaje zahtjeva 



and Care 






Claim rejected 

Zahtjev je odbijen 

Reason 

Razlog 



Other 

Ostalo 



From (date) 

Od (datuma) 




and Care 



Amount 


mjeseèno 







Claim granted 

Zahtjev je odobren 

Date 

Datum 


Gross rates (before tax deductions) of Croatian pension 

from the date the Australian claim was received at HZMO 

to the date of this notification: 

Bruto stope (prije odbitaka za porez) hrvatske mirovine od 

datuma primitka zahtjeva za australsku mirovinu u HZMO 

do datuma ove obavijesti: 



From (date) 

Od (datuma) 


Amount 


mjeseèno 



Other 

Ostalo 






and Care 








Other 

Ostalo 

AUS140_CB.1005 




From (date) 

Od (datuma) 




Amount 


mjeseèno 



Details of Croatian periods of contributions confirmed 

Potvrðeni podaci o hrvatskim razdobljima osiguranja 

No 

Ne 

Yes 

Da 

Period from 

Razdoblje od 




To 

Do 



and Care 














Other 

Ostalo 

Signature 

Potpis 



From (date) 

Od (datuma) 


Amount 


mjeseèno 

- 

Date 

Datum 






Printed name 

Štampano ime 


and Care 






Contact details 

Podaci za kontakt 



Other 

Ostalo 

AUS140_CB.1005

Claim for Australian Pension - Department of Human Services

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