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B33/1995 CLEARANCE FORM FOR USE IN VERIFYING REFUGEE/HUMANITARIAN STATUS FOR NEW SERVICE PENSION CLAIM PURPOSES.

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DATE OF ISSUE:  9 MAY 1995

CLEARANCE FORM FOR USE IN VERIFYING REFUGEE/HUMANITARIAN STATUS FOR NEW SERVICE PENSION CLAIM PURPOSES.

The clearance form (overleaf) has been prepared for use by Income Support new claims examiners where a claimant for service pension does not meet residency requirements and states that he/she is a refugee or former refugee.  It will not be necessary to use this clearance form in all cases as such claimants are likely to possess adequate information concerning their migration details.

2.The form is based upon one currently in use by the Departments of Social Security and Immigration and Ethnic Affairs.  The form will not be printed and released through the Central Office Forms Unit as usage is expected to be minimal.

3.If you have any enquiries about the use of the form or clearance procedures concerning the processing of new claims for refugees and former refugees please telephone Nigel Parmenter on (03) 284-6361.

NEIL BAYLES

ASSISTANT SECRETARY

INCOME SUPPORT

REQUEST FOR VERIFICATION OF REFUGEE/HUMANITARIAN STATUS

This form is for clarification of whether the person holds, or has held, a refugee or humanitarian program visa for the purpose of determining the eligibility for benefits from this Department.  This information is not usually disclosed to any body or agency.

TO:         FROM:

INTERNATIONAL MOVEMENT RECORDS UNIT

Department of Immigration and Ethnic Affairs

PO Box 25

Belconnen ACT 2616

Fax: (06) 264 3752

DEPARTMENT of VETERANS' AFFAIRS

Position No                Telephone No

Reference No

Signature....................................         /     /

  • Please verify/supply client details

  • Tick to verify correct details

  • Cross for incorrect details and/or overwrite with amendments

Instructions for DVA staff

  • Use BLOCK letters.

  • All sections must be completed

Family Name

Given Names

Maiden Name

Male

  Female

Name on initial arrival..................................................................................

Date of initial arrival..................................................................................

Date of birth..................................................................................

Country of birth..................................................................................

Marital status..................................................................................

Visa number..................................................................................

Refugee visa code/class..................................................................................

Client authorisation:

I consent for the Department of Immigration and Ethnic Affairs to disclose the above information to Department of Veterans' Affairs.

Signature:  ...................................................................................                  Date:  ..................

Checked by:  Name (please print)     Phone No:           Position             Signature                   Date: