Relationship details - Separated under one roof form (SS293)

Use this form if you’re separated but live under the same roof as your ex-partner. This is so we can assess whether to pay you as a single person or as a member of a couple.

You must download our forms to fill them in. We have help available if you use assistive technology or if you need a translator or interpreter. Find out how to use our forms.

You and your ex-partner will each need to complete a form.

If it puts you at risk, they don’t need to complete this form.

Download and complete the Relationship details - Separated under one roof form.

You can send the link of the form to your ex-partner. They need to return their completed form to you, so you can submit it with yours.

Page last updated: 22 July 2025.
QC 19996