External

Departmental Instruction

DATE OF ISSUE: 18 December 1992

REVISED FORM D2663 - (CLAIM FOR PENSION BY A WIDOW, WIDOWEROR OTHER DEPENDANT OF A DECEASED VETERAN)

The purpose of this instruction is to advise Branches on the introduction of the revised Form D2663 and the associated processing procedures.

2. The new Form D2663 (Claim for Pension by a Widow, Widower or other Dependant of a Deceased Veteran) is to be introduced on 1 January 1993.

3. Attached for information is a copy of the new Form D2663.

ABSENCE OF A DEATH CERTIFICATE.

4. A claim is valid if it has been signed by the claimant, or an authorised third party on behalf of the claimant. If a death certificate is absent, the claim should still be processed normally.

CMS ATTRIBUTE

5. An attribute is in place on the CMS to record whether a death certificate has been provided with the claim. Although the attribute does not become mandatory until the EATERS stage, it should be recorded as early as possible after receipt of the claim.

AUTOMATIC GRANT OF BENEFITS TO THE SPOUSE OF A DECEASED POW

6. The revised Form D2663 contains a section where a widow or widower of a deceased veteran who was a POW can claim for pension. The automatic grant of pension to this class of claimant becomes effective 1 January 1993.

7. Arrears of pension for a widow of a POW can be paid from three months prior to the date of receipt, or 1 January 1993, or the day after the veterans death, whichever is the later.

8. As a cause of death is not an issue in this type of claim, there is no requirement for a death certificate. A POW attribute is on the CMS to record such claims.

ISSUE

9. Requests for issues of the current Form D2663 should not be actioned. Stocks of the new form will be in Branch Offices by the end of December 1992.

10. National and state offices of all major ex-service organisations, including all organisations that deal with war widows, will be contacted and asked to destroy any stocks they may have of the old form D2663 and to ensure that any new claims are lodged on the revised form. They will be told to contact the Branch Offices for stocks of the new form.

Contact Officer: Jeff Kelly (06) 2896569.

PETER HAWKER

NATIONAL PROGRAM DIRECTOR

BENEFITS

ATTACHMENT TO THIS INSTRUCTION

(Note: This attachment has been rekeyed to enable it to be included on the General)

Commonwealth Department of

Veterans' Affairs

CLAIM FOR PENSION BY A

WIDOW, WIDOWER OR

OTHER DEPENDANT OF A

DECEASED VETERAN

A claim may be made by:

.a widow - a woman who was legally married to, or was a partner of, a deceased veteran immediately before his death;

·a widower - a man who was legally married to, or was a partner of, a deceased veteran immediately before her death;

. another dependant - in certain circumstances, a child who was dependent on a deceased veteran immediately before his or her death;

. another person on behalf of the widow, widower or other dependant.

Claims for children aged less than 18 years must be made by the child's parent or

guardian, or by another person authorised by the parent or guardian.

D2663 (p1) Nov 92

The information sought on this form is required to assess your eligibility for a benefit under the Veterans' Entitlements Act 1986. The Act requires that a claim be made on this form, approved by the Repatriation Commission.

The Act provides that the Secretary may obtain information requested for the purposes of the legislation.

Information contained in the form may be provided to another Agency or body. These Agencies or bodies

.the Department of Social Security and the Australian Taxation Office for the purposes of matching information;

.the Health Insurance Commission for treatment account payments;

·the various State or Local Government authorities to verify your eligibility for rebates or concessions relating to rates, electricity, transport, motor vehicles and ambulance;

·doctors and/or hospitals to provide treatment.

Once you apply for a pension as a widow, widower, or other dependant of a deceased veteran, the Department may make any enquires necessary to establish eligibility.

There are penalties for making false statements.

If any of the details you give in this form change, you must tell the Department within 14 days.

If you need more information please ring the Department of Veterans' Affairs:

.Metropolitan residents

Sydney 213 7777Adelaide213 2611

Melbourne 284 6000Perth125 8222

Brisbane 223 8333Hobart 21 6666

.Country residents - free call

Nth NSW (Brisbane Office)008 777 634

NSW all other country locations008 257 251

Northern Territory (incl. Darwin)008 888 121

Tasmania008 00 l211

Nth Qld (incl. Townsville)008 019 304

Australian Capital Territory008 046 088

all other country locations008 113 304

The addresses of the Department of Veterans' Affairs offices are:

Branch Offices:Regional Offices:

Sydney AdelaideCanberraDarwin

Centennial Plaza Tower B Blackburn House — Ground Floor l0 Moore Street — Shop 8 Cascom Centre

280 Elizabeth Street — 199 Grenfell Street — Cnr Moore & Rudd Streets — 15 Scaturchio Street

GPO Box 3994 — GPO Box 1652 — GPO Box 802 — PO Box 42496

Sydney NSW 2001 — Adelaide SA 5001 — Canberra City ACT 2601 — Casuarina NT 0810

Phone (06) 267141 1 — Phone (089) 27 0044

MelbournePerthNewcastleTownsville

300 Latrobe Street — Hyatt Centre — The GIO Building — Commonwealth

Government Centre

GPO Box 87A — 20 Terrace Road — 400 Hunter Street — Cnr Walker and Stanley

Streets

Melbourne Vic 3001 — GPO Box F352 — GPO Box 617 — PO Box 2050

Penh WA 6001 — Newcastle NSW 2300 — Townsville Qld 4810

Phone (049) 26 2733 — Phone (077) 223333

Brisbane — Hobart — Wollongong — Ballarat

133 Mary Street — 21 Kirksway Place — Commonwealth Offices — 12 Dawson Street South

GPO Box 651 — Cnr Gladstone Street — Burelli Street — Ballarat Vic 3350

Brisbane Qld 4001 — GPO Box 481E — PO Box 755 — Phone (053) 31 3844

Hobart Tas 7001 — Wollongong East NSW 2520

Phone (042) 26 0190

D2663(p2) Nov 92

____________________________________________________________________________

Claim for pension by a widow or widower of a deceased veteran

____________________________________________________________________________

You may wish to seek help with this form from a family member, a friend, or an ex-service organisation welfare officer. You may choose to have such a person act on your behalf in matters relating to this claim. If so, that person must complete the Authority at the end of this form.

____________________________________________________________________________

Please write in BLOCK LETTERS

____________________________________________________________________________

Deceased veteran's personal details

1. Veterans' Affairs _________________

File No. (if known)

2.Surname__________________________________

3.Given names___________________________________

4.Date of birth____/____/____

5.Date of death____/____/____

6.Place of death___________________________________

7.Cause of death___________________________________

Important Please attach a copy of the Death Certificate.

8.Was a Post Mortem held? No Yes Not sure

9.Service number(s)Service No.Branch (e.g. Army)

and Branch of service______________________________

Service No.Branch (e.g. Army)

______________________________

____________________________________________________________________________

Claimant's details

10.Surname__________________________

11.Given names__________________________

12.Address____________________________________

__________________ — Postcode _________

13.Date of birth____/____/____

14.Telephone numbers: Home(____)__________

Work(____)__________

15.Your relationship to the

veteran at the time of ______________________

death

Please attach a copy of your marriage certificate or evidence of your

Importantrelationship with the deceased veteran, unless you have previously supplied this material to the Department.

16.Have you married since No Yes Date of marriage

the veteran died.____/____/____

____________________________________________________________________________

Continued overleaf

D2663 (p3) Nov 92

Dependant children's details (under 5 years of age)

17.Give details of dependant children under 25 years of age

Is full-time

Full name(s)(s)Date of — Present address — education

birth — undertaken?

____________________________________________________________

________________ __/__/__ ______________________ No__Yes__

If insufficient space, please attach a separate sheet giving the required details.

____________________________________________________________________________

Important Please attach a Certified extract of birth certificate showing names of both parents or adoption order in respect of each child named in this claim. If the deceased veteran was not the father or mother, attach evidence that the children were wholly or substantially dependent on the veteran immediately before the veteran's death.

____________________________________________________________________________

Prisoners of War

Important This applies to Widows or Widowers of deceased Veterans

who were prisoners of war.

18.Was the deceased veteran aNo Go to Question 19

prisoner of war?

Yes Give details of detention and then go straight to Question 25

___________________________________________________________

Place of detention — Period of detention

___________________________________________________________

From / /To / /

___________________________________________________________

____________________________________________________________________________

Veteran's medical details

19.Name of the veteran's ____________________________________

local doctor

20.Telephone number(___)__________

21.Address____________________________________

____________________Postcode_________

D2663 (p4) Nov 92

Veteran's medical details (continued)

22.Give the names of doctors and/or hospitals who provided treatment for any disease or injury that was related to the veteran's death.

_____________________________________________________________________

Treatment type

Condition treated(e.g. GP/Specialist/Date of — Name

(diagnosis if known)in-patient)treatment — of doctor/hospital etc

_____________________________________________________________________

_____________________________________________/___/____________________

If insufficient space, please attach a separate sheet giving the required details.

____________________________________________________________________________

Veteran's service history

23.Provide details of the veteran's service. (If the deceased veteran has claimed a disability or service pension from this Department you do not need to complete this question. Go straight to question‑l 24 below.)

Period served

Place and country of service(show approx dates)Nature of duties

________________________________/__/__ to __/__/________________________

If insufficient space, please attach a separate sheet giving the required details.

24.How did the veteran's service cause, or contribute to his or her death?

_________________________________________________________________

If insufficient space, please attach a separate sheet giving the required details.

____________________________________________________________________________

Continued overleaf--

D2663 (p5) Nov

Compensation

25.Have damages/compensation been

claimed in respect of the veteran's death?No Yes Give details below

Name and address of compensation source — Date of — Reference no.

claim

___________________________________________________________________

__________________________________________/___/_____________________

If insufficient space, please attach a separate sheet giving the required details.

____________________________________________________________________________

Other benefits or pensions

26.Have any of the dependants named in this

claim received or claimed any payments

from the Department of Social Security or

any other source? (Family Allowances are

not required but other Social Security

benefits, damages or compensation

claims, education,or youth allowances,

etc. must be included .)No — Yes — Give details below

___________________________________________________________________

Name of person — Name of Source — Type of — Date of — Reference no.

paid — payment — claim

___________________________________________________________________

___________________________________________________/___/____________

___________________________________________________________________

If insufficient space, please attach a separate sheet giving the required details.

____________________________________________________________________________

Pension payment details

27.Do you currently receive a pension Yes Go straight to Declaration

from the Department of No Complete details below

Veterans' Affairs?

If a pension is granted, it will be paid fortnightly into an account at a bank, credit union or building society.

28.Name of bank, credit__________________________

union or building society

29Branch___________________________

30.Address____________________________________

_______________________Postcode______

31Account in the name of ____________________________

32.Account number______________________

____________________________________________________________________________

D2663 (p6) Nov 92

Declaration

.I declare that the details I have given in this claim are complete and correct.

.I am aware that there are penalties for making false statements.

.I authorise the Repatriation Commission and the Department of Veterans' Affairs to obtain medical or other information needed to process, determine or review this claim.

.I consent to the release of medical, clinical or other information to the department by any medical practitioner, hospital, clinic, insurance company, the Department of Social Security or other organisation, in relation to this claim or its review.

.I consent to the release of medical, clinical or other information to the person or organisation named in the Authority below, who is acting on my behalf in relation to this claim or its review.

CLAIMANT'S SIGNATURE*

_______________________________

Date _____/____/____

* If the widow, widower or other dependant is unable to sign this form:

.sign the form on behalf of the widow, widower or other dependant; and

.complete the authority below for you to act on behalf of the widow, widower, or other dependant.

____________________________________________________________________________

Authority to act on behalf of a widow, widower or other dependant

The widow, widower or other dependant may elect to have a friend or relative, or an ex-service organisation (or its representative) act on her or his behalf in relation to this claim. If so, this authority must be completed by that person.

I declare that I am authorise by ____________________________________

to act on her/his behalf in matters relating to this claim.

Your full name — __________________________________________

Address — __________________________________________

__________________________ Postcode ________

Telephone numbers — Home (___)___________

Work (___)___________

Your relationship to the

widow, widower, or — ___________________________________________

other dependant

SIGNATURE

______________________________________

Date ____/____/____

____________________________________________________________________________

D2663 (p7) Nov 92