Income and Assets form (MOD IA)
Use this form to provide information about any additional income and assets you have.
Download and complete the Income and Assets form.
If you are claiming an Australian Pension while overseas, select your agreement country below to get the form you need for your claim:
- Austria (German)
- Belgium (Dutch)
- Belgium (French)
- Canada (French)
- Chile (French)
- Cyprus (Greek)
- Cyprus (Turkish)
- Czech Republic
- Korea, Republic of
- North Macedonia
- Slovak Republic
- Switzerland (French)
- Switzerland (German)
- United States - letter
- United States - A4
This form accompanies the Claim for Australian Pension from an agreement country form.
This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.
If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.
Page last updated: 7 December 2020
This information was printed 17 June 2021 from https://www.servicesaustralia.gov.au/individuals/forms/mod-ia. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.