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 and fill them in so they are processed quickly. You can also electronically sign some of our forms. We have help available if you use assistive technology.

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: 3 December 2022.
QC 19996