Once you have determined your assets level, please complete either:

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Cornelia Chapman
6 years ago
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ASSETS DECLARATION In order for Alwyndor to process your application for permanent residency, you are required to provide information regarding your financial assets.

There are several options available to you when providing this information, depending on the value of your assets.

1 ASSETS DECLARATION In order for Alwyndor to process your application for permanent residency, you are required to provide information regarding your financial assets. The information provided will enable us to make an accurate assessment of any Accommodation Payment that may be required. There are several options available to you when providing this information, depending on the value of your assets. We have provided a simple template on the reverse side of this letter to assist you in determining your asset level. This is designed for your personal use and should not be returned to Alwyndor. Once you have determined your assets level, please complete either: Schedule A For asset levels of less than $400,000 you are required to sign and date Schedule A only. OR Schedule B For asset levels that exceed $400,000 you may choose from the two options available in Schedule B, by signing and dating the relevant box. Please return your completed Schedule(s) and any other documentation described within them to: Administration Assistant Alwyndor Aged Care 52 Dunrobin Road HOVE SA 5048

2 The value of your assets is the net value of all your funds, belongings and property, including assets outside of Australia. If you have a spouse, please declare all assets; however note that when your spouse is remaining at home, the home is exempt from the assessment and only one half of the remaining assets will be considered. MY TOTAL ASSET VALUE IS AS FOLLOWS:- ASSETS Have you owned a Private House/Unit/Land in the last two years? YES NO If YES please indicate current assessed value $... Is a Spouse/Dependent Child residing in this House/Unit? Has a Carer/Close Relative eligible for a pension or benefit resided in this House/Unit for the last five years? YES YES Value of Household Contents and Personal Effects $... Value of Motor Vehicles/Boats/Caravan $... Value of Personal Interests in other Real Estate Business/Farms/Family Trust $... Cash at Banks/Building Societies/Credit Unions including Interest Free Accounts $... Value of Investments held in Property Trusts/Friendly Societies/Equity Trusts/Mortgage Trusts/Bond Trusts/Unit Trusts $... Value of Investments held in Fixed Deposits/Interest Bearing Deposits/Bonds/Debentures/Shares $... Maturity of Superannuation/Annuities/Life Insurance Policies $... Value of Collectible Investment (Please provide description) Value of Loans to Third Parties including any Interest Free Loans and surrender values of Entry Contribution Value of any Debts/Charges/Encumbrances relating to the Real Estate and Person Assets Total Value of Net Assets: $ NO NO $... $... ($... )

3 ASSET DECLARATION FORM SCHEDULE A If your level of assets is less than $ 400,000 you can only elect to sign and date this Schedule. I agree to complete a: Permanent Residential Aged Care Request for an Assets Assessment Form Which is available by phoning the Department of Health and Ageing on or by downloading a copy from their website And then: Submit it to either Centrelink or the Department of Veterans Affairs (DVA) in accordance with the instructions in the form. When I have received the Asset Assessment letter from either Centrelink or DVA, I will forward a copy directly to Alwyndor Administration. I understand that accommodation cannot be offered until this letter has been received by Alwyndor Aged Care. Applicants Signature: Date:

4 ASSET DECLARATION FORM SCHEDULE B If your asset level exceeds $ 400,000 Please complete the following information: A) Have you or your partner owned a home in the last 2 years: Y / N B) Is your partner or a dependent child living in this home: Y / N C) Has a carer or close relative, eligible for a pension, resided in this home for the last 2 years and 5 years respectively Y / N You now have two (2) Options from which to choose. EITHER OPTION 1: I agree to complete a: Permanent Residential Aged Care Request for an Assets Assessment Form Which is available by phoning the Department of Health and Ageing on or by downloading a copy from their website And then: Submit it to either Centrelink or the Department of Veterans Affairs (DVA) in accordance with the instructions in the form. When I have received the Asset Assessment letter from either Centrelink or DVA, I will forward a copy directly to Alwyndor Administration. I understand that accommodation cannot be offered until this letter has been received by Alwyndor Aged Care. Applicants Signature: Date: OR

5 OPTION 2: I choose not to undertake Option 1 and my assets exceed $ 400,000. and I agree to pay the following: a. For LOW CARE accommodation an Accommodation Bond of $ 350,000 or b. For HIGH CARE accommodation a daily charge of - $ for applicants in receipt of a means tested part Australian Pension - $ for applicants that are self funded retirees Applicants Signature: Date:

Dear Applicant, FORMS REQUIRED: Part A Applicant Details. Part B Appointed Representatives. Part C Care Facilities Required

Dear Applicant, FORMS REQUIRED: Part A Applicant Details. Part B Appointed Representatives. Part C Care Facilities Required Dear Applicant, Thank you for your enquiry regarding Anglicare Aged Care Services. Please find enclosed the required application forms for you to complete. Before returning your application, please check