Instructions

Business details

Return this form online or to one of our service centres by / /

Your Centrelink Reference Number

Purpose of this form You (and/or your partner) must complete this form if:
you (and/or your partner) are self-employed or involved in a sole trader business or
partnership (in Australia or outside Australia), or
you (and/or your partner) were involved in a business before claiming Newstart
Allowance or Youth Allowance.
If you (and/or your partner) have ceased involvement in a business and are not claiming
Newstart Allowance or Youth Allowance, any residual assets from the business should be
declared as personally owned by you (or your partner).

What else you will If you and your partner have both completed a form Mod F, only one copy of documents
need to provide per couple is required.
If you need your accountant to provide documents and/or information, we will not
reimburse fees charged by the accountant.

Definition of a partner Under social security and family assistance law, a person is considered to be
your partner if you and the person are:
married, or
in a registered relationship (different-sex or same-sex), or
in a de facto relationship (different-sex or same-sex),
and you and the person are not living separately and apart on a permanent or indefinite
basis.
Note: Two people not physically living together can still be considered a member of a
couple.
We generally consider a person to be in a de facto relationship from the time they
commence living with another person as a member of a couple.
We recognise all couples, opposite-sex and same-sex.
For more information, go to humanservices.gov.au/moc

Filling in this form Please use black or blue pen.

Print in BLOCK LETTERS.
Mark boxes like this with a or .
Where you see a box like this Go to 5 skip to the question number shown.
You do not need to answer the questions in between.

Mod(F).1707
1 of 8
Returning your form Check that all required questions are answered and that the form is signed and dated.
Important Note: If you are making a claim, you must return this form and all other
supporting documents at the same time you lodge your claim form. If you do not return
all documents, your claim may not be accepted. The only exception will be if you are
waiting for medical evidence or other documents from a third party.
You can return this form and any supporting documents:
online submit your documents online. For more information about how to access an
Online Account or how to lodge documents online, go to
humanservices.gov.au/submitdocumentsonline
by post
in person if you are unable to submit this form and any supporting documents online
or by post, you can provide them in person to one of our service centres.

For more information If you need help to fill in this form or you need more information about the questions,
go to humanservices.gov.au/business or visit one of our service centres or call us on:
ABSTUDY 1800 132 317
Disability and Carers 132 717
Employment Services 132 850
Parenting Payment 136 150
International Services 131 673
Older Australians 132 300
Youth and Students 132 490
If you need a translation of any documents for our business, we can arrange this for you
free of charge.
To speak to us in languages other than English, call 131 202.
Note: Call charges may apply.
If you have a hearing or speech impairment, you can contact the TTY service Freecall
1800 810 586. A TTY phone is required to use this service.

Mod(F).1707
2 of 8
1 Your name 8 Do you have an interest in any business run through a
private trust?
Mr Mrs Miss Ms Other
No Go to next question
Family name
Yes Do NOT use this form to provide details for any
business run through a private trust.
First given name Instead you will need to complete a Private Trust
form (Mod PT) for each private trust you have
an interest in. If you do not have this form,
Second given name go to humanservices.gov.au/forms
www.

Note: If you have another business that is not

part of a private trust Go to next question

2 Your date of birth

9 Do you have an interest in any business run through a
/ / private company?
No Go to next question

3 Do you have a partner? Yes Do NOT use this form to provide details for any
business run through a private company.
No Go to 8
Instead you will need to complete a
Yes Go to next question Private Company form (Mod PC) for each
private company you have an interest in.
4 Your partners name If you do not have this form, go to
www. humanservices.gov.au/forms
Mr Mrs Miss Ms Other
Note: If you have another business that is not
Family name part of a private company Go to next question

First given name 10 Do you have an interest in any type of business not run through
a private trust or private company?
No Do NOT continue with this form.
Second given name Contact us on the appropriate number listed
on page 2 of this form.
Yes Go to next question

5 Your partners date of birth

11 Are you involved in more than one business as a sole trader
/ / and/or partnership?
No Go to next question
6 Who is self-employed or involved in a sole trader business or Yes You can only enter details for one business on this
partnership? Mod F form.
You Go to 8 You will need to complete a SEPARATE Mod F for
Your partner Your partner will need to complete other businesses that you are involved in and have
and sign this form. not told us about before.
Go to 8 If you do not have this form, go to
humanservices.gov.au/forms
You and your partner Go to next question
www.

How many Mod F forms will you be filling out?

7 Are you and your partner only involved in the same partnership?
No If you and your partner are both self-employed and/or
You are completing this Mod F for which type of
sole traders or involved in separate partnerships,
your partner will need to complete a separate Mod F business:
for their business. If you do not have this form, go to Sole trader Go to next question
www. humanservices.gov.au/forms Partnership Go to 24
Go to next question
Yes Go to next question

CLK0Mod(F) 1707

Mod(F).1707
3 of 8
12 Are you self-employed or a sole trader? 19 Can you provide the latest profit and loss statement?
No Go to 24 No I will provide it by
Yes Go to next question / /

Note: If a profit and loss statement has never been

13 What is the name and address of the business? completed for the business and you are unable to
Name of business obtain one from your accountant, you can complete
an interim Profit and loss statement form (SU580).
If you do not have this form, go to
Address of business www. humanservices.gov.au/forms
Yes
Attach the latest profit and loss statement
to this form.

Postcode
20 Can you provide the latest balance sheet?
No I will provide it by
14 On what date did you commence operating this business? / /
/ /
Note: If you are unable to provide a balance sheet,
provide a list of the type and amount of each
liability and asset of the business.
15 What type of business or self-employment are you involved in
(e.g. dairy farm, milk bar, newsagency)? Yes
Attach the latest balance sheet to this form.

16 Does the business hold any real estate? 21 Is the value of the current business assets and liabilities
different to that shown on the latest balance sheet?
No Go to next question
No Go to next question
Yes
You will need to complete and attach a Yes
Real estate details form (Mod R). A separate Attach a separate sheet with the following
form must be completed for each property. details:
If you do not have this form, go to the current market value of the business
www. humanservices.gov.au/forms assets and any liabilities
reasons why the business asset value is
different, and
17 Please read this before answering questions 18 to 22. any documents that support your business
You need to provide documents for your claim to be assessed. estimate.
If you cannot attach the requested documents to this form,
you must advise the date you will be providing them.
22 Can you provide the latest depreciation schedule?
We may not be able to pay you until you provide the
requested documents. No I will provide it by
/ /

18 Can you provide your latest personal income tax return? Yes
Attach the latest depreciation schedule to
No I will provide it by this form.
/ /
Yes 23 Is your current income from your business different to that
Attach your latest personal income tax shown on the latest profit and loss statement or tax returns?
return to this form.
No Go to 43
Yes
It would be in your interest to provide the
following:
your estimate of the type (e.g. wages,
distributions, dividends etc.) and gross
amount of the income for this financial year
reasons why the income is different to the
latest income tax returns, and
documents which support your estimate
(e.g. interim profit and loss statement).
Go to 43

Mod(F).1707
4 of 8
24 Are you involved in a business partnership? 31 Please read this before answering questions 32 to 41.
No Go to 43 You need to provide documents for your claim to be assessed.
Yes Go to next question If you cannot attach the requested documents to this form,
you must advise the date you will be providing them.
25 Do you have a partnership agreement? We may not be able to pay you until you provide the
requested documents.
No Go to next question
Yes
Attach a copy of the partnership agreement 32 Can you provide your latest personal income tax return?
to this form.
No I will provide it by
/ /
26 What is the name and address of this partnership?
Name of partnership Yes
Attach your latest personal income tax
return to this form.

Address of partnership
33 Is any business partner listed in question 28, your partner?
No Go to 35
Yes Go to next question
Postcode
34 Can you provide your partners latest personal income tax return?
27 When did the partnership commence? No I will provide it by
/ /
/ /
Yes
Attach your partners latest personal
28 Who are the partners of this partnership? income tax return to this form.
Give details below of each partners share of profit/loss.
Share of 35 Can you provide the latest partnership income tax return?
Partner name profit/loss
No I will provide it by
%
/ /
% Yes
Attach the latest partnership income tax
return to this form.
%

% 36 Can you provide the latest profit and loss statement?

% No I will provide it by
/ /

29 What type of business is the partnership involved in Note: If a profit and loss statement has never been
(e.g. property development)? completed for the partnership and you are unable to
obtain one from your accountant, you can complete
an interim Profit and loss statement form (SU580).
If you do not have this form, go to
www. humanservices.gov.au/forms
30 Does the partnership hold any real estate?
Yes
No Go to next question Attach the latest profit and loss statement
to this form.
Yes
You will need to complete and attach a
Real estate details form (Mod R). A separate
form must be completed for each property. 37 Can you provide the latest balance sheet?
If you do not have this form, go to
No I will provide it by
www. humanservices.gov.au/forms
/ /

Note: If you are unable to provide a balance sheet,

provide a list of the type and amount of each debt
and asset of the partnership.
Yes
Attach the latest balance sheet to this form.

Mod(F).1707
5 of 8
38 Is the value of the current partnership assets and liabilities 43 Is your business still operating?
different to that shown on the latest balance sheet? No Go to next question
No Go to next question Yes Go to 47
Yes Attach a separate sheet with the following
details:
44 Why is your business no longer operating (e.g. sold, lease
the current value of the partnership assets expired, in liquidation)?
and any liabilities
reasons why the partnership asset value is
different, and
any documents that support your
partnership estimate.

39 Can you provide the latest depreciation schedule?

No I will provide it by 45 When did your business stop operating?
/ / / /
Yes
Attach the latest depreciation schedule to
this form. 46 Do you intend to resume trading in your business?
No
Go to 52
40 Can you provide the current and capital account details for Yes
each business partner?
No I will provide it by 47 Is your business generating any income?
/ / No
Yes Yes
Attach your business partners current and
capital account details to this form.
48 Have you stopped working in your business?
No Go to next question
41 Can you provide separate schedules showing balances, income
Yes Go to 50
and expenses for each investment, loan and bank account
itemised on tax returns?
No I will provide it by 49 Provide details of the type of duties you perform and the
number of hours you spend each week on these duties.
/ /
Type of duties performed (e.g. maintenance of No. of hours
Yes equipment, obtaining contracts, book keeping) per week
Attach separate schedules showing
balances, income and expenses for
each investment, loan and bank account
itemised on tax returns to this form.

42 Is your current income from the partnership different to that

shown on the latest profit and loss statement or tax returns?
No Go to next question
Yes
It would be in your interest to provide the
following:
Go to 51
your estimate of the type (e.g. wages,
distributions, dividends etc.) and gross
amount of the income for this financial year 50 Do you intend to resume work in the business?
reasons why the income is different to the No
latest income tax returns, and
documents which support your estimate Yes
(e.g. interim profit and loss statement).

Mod(F).1707
6 of 8
51 Is anyone else helping you with running the business? 54 Your accountants details
No Go to next question Name of accountant
Yes Tick applicable box(es) and provide details
No. of hours Address
Type of help per week
Substitute

Business partner
Postcode
Contractor Phone number
( )
Partner or de facto
Other (give details below)
55 Which of the following forms, documents and other attachments
are you providing with this form?
If you are not sure, check the question to see if you should
attach the documents.
52 Are you claiming or receiving Newstart Allowance or Youth
Allowance? Where you are asked to supply documents, please attach
original documents.
No Go to 54
Yes Go to next question Real estate details form (Mod R)
(If you answered Yes at question 16 or question 30)
53 Are you looking for full-time work? Latest personal income tax return
(If you answered Yes at question 18 or question 32)
No Explain why you are not looking for full-time work
Latest profit and loss statement
(If you answered Yes at question 19 or question 36)
Latest balance sheet
(If you answered Yes at question 20 or question 37)
Business/Partnership details
(If you answered Yes at question 21 or question 38)
Latest depreciation schedule
(If you answered Yes at question 22 or question 39)
Your estimates, reasons income is different to the latest tax
returns, and documents which support your estimate
(If you answered Yes at question 23 or question 42)
Go to 54 Partnership agreement
Yes Give details below (If you answered Yes at question 25)
Partners latest personal income tax return
(If you answered Yes at question 34)
Latest partnership income tax return
(If you answered Yes at question 35)
Business partners current and capital account details
(If you answered Yes at question 40)
Separate schedules showing balances, income,
expenses for each investment, loan and bank account
itemised on tax returns
(If you answered Yes at question 41)

Mod(F).1707
7 of 8
56 IMPORTANT INFORMATION
Privacy and your personal information
Your personal information is protected by law (including
the Privacy Act 1988) and is collected by the Australian
Government Department of Human Services for the
assessment and administration of payments and services. This
information is required to process your application or claim.
Your information may be used by the department, or given
to other parties where you have agreed to that, or where it
is required or authorised by law (including for the purpose of
research or conducting investigations).
You can get more information about the way in which the
department will manage your personal information, including
our privacy policy, at humanservices.gov.au/privacy
www.

57 Statement
I declare that:
the information I have provided in this form is complete and
correct.
I give permission to contact my accountant for any relevant
information necessary to assess my claim.
I understand that:
giving false or misleading information is a serious offence.
if submitting this document as part of a claim, the claim may
not be accepted unless supporting documents are lodged
at the same time as the claim. The only exception will be if I
am waiting for medical evidence or other documents from
a third party.
the Australian Government Department of Human Services
can make relevant enquiries to make sure I receive the
correct entitlement.

Your signature

On completion of this form,

please print and sign by hand

Date
/ /

Print Clear

Mod(F).1707
8 of 8