90MP

03/09

Separation declaration
Family Law Act 1975
Important information about this declaration
Who should use this declaration?
You should use the appropriate declaration in
either Part A or Part B if you have:
• entered into a superannuation agreement with your former spouse,
and
• separated, but are not divorced, from your former spouse.
You should not complete the declaration if you have divorced from your former spouse. Instead,
you should provide us with a certified copy of your decree absolute.

Does my former spouse have to complete this as well?

No. The declaration only needs to be signed by either you or your former spouse to be effective.
You may both sign the declaration if you wish.

What happens if neither of us completes this declaration?

If neither you nor your former spouse serves a properly completed declaration on Commonwealth
Superannuation Corporation (CSC), your superannuation agreement will not be effective.

Should I complete the Part A declaration or the Part B declaration?

You should use the Part A declaration if the withdrawal value of the superannuation benefit (as
determined under the Family Law regulations) is greater than the superannuation lump sum
payment threshold for the financial year in which the declaration is made.
Information about the superannuation lump sum payment threshold can be obtained online from
ato.gov.au or by contacting the Australian Taxation Office (ATO) on 13 10 20.
If the withdrawal value is less than the superannuation lump sum payment threshold for
the financial year in which the declaration is made, you should use the Part B declaration.
You do not need to complete both declarations – only complete the part relevant to your situation.

What happens if I make a false declaration?

There are severe penalties for providing a false or misleading declaration. A person serving a
false declaration on CSC may be subject to 12 months imprisonment. Therefore, you should not
complete the appropriate declaration if it could amount to a false declaration.

Important: The meaning of separated is defined under sections 48 and 90XP of the Family Law
Act 1975. You should consider seeking professional advice if you are unsure whether you satisfy
this definition.
CSC cannot provide you with that information.

How to use this declaration

Please use CAPITAL LETTERS and a black or blue pen.
Mark boxes like this with a  or  then fill out the next question or section.

The information provided in this document is general advice only and has been prepared without taking account of your personal objectives, financial situation or needs. Before acting on any such
general advice, you should consider the appropriateness of the advice, having regard to your own objectives, financial situation and needs. You may wish to consult a licensed financial advisor.
You should obtain a copy of the CSS Product Disclosure Statement (PDS) and consider their content before making any decision regarding your super.
Commonwealth Superannuation Corporation (CSC) ABN: 48 882 817 243 AFSL: 238069 RSEL: L0001397
Trustee of the Commonwealth Superannuation Scheme (CSS) ABN: 19 415 776 361 RSE: R1004649
90MP 1 of 3
A Separation declaration
where the withdrawal value is greater than the superannuation lump sum payment threshold for
the financial year in which this declaration is made.
GIVEN NAME(S)
I,

SURNAME

D D M M Y Y Y Y
born on
/ /
(FULL NAME OF FIRST SPOUSE)
and,

D D M M Y Y Y Y
born on
/ /

are (tick which is applicable) married in a de facto relationship

but separated and have been living separately and apart for a continuous period of at least 12
months immediately before making this declaration and in my/our opinion, there is no reasonable
likelihood of resuming cohabitation.
SIGNATURE OF FIRST SPOUSE MAKING DECLARATION
Date of declaration
Sign D D

/
M M

/
Y Y Y Y

(FULL NAME OF FIRST SPOUSE MAKING DECLARATION)

SIGNATURE OF SECOND SPOUSE MAKING DECLARATION

Date of declaration
Sign D D

/
M M

/
Y Y Y Y

(FULL NAME OF SECOND SPOUSE MAKING DECLARATION)

90MP 2 of 3
B Separation declaration
where the withdrawal value is less than the superannuation lump sum payment threshold for the
financial year in which this declaration is made.
GIVEN NAME(S)
I,

SURNAME

D D M M Y Y Y Y
born on
/ /
(FULL NAME OF FIRST SPOUSE)
and,

D D M M Y Y Y Y
born on
/ /

are (tick which is applicable)

married in a de facto relationship

but at the time of this declaration are separated.

SIGNATURE OF FIRST SPOUSE MAKING DECLARATION
Date of declaration
Sign D D

/
M M

/
Y Y Y Y

(FULL NAME OF FIRST SPOUSE MAKING DECLARATION)

SIGNATURE OF SECOND SPOUSE MAKING DECLARATION

Date of declaration
Sign D D

/
M M

/
Y Y Y Y

(FULL NAME OF SECOND SPOUSE MAKING DECLARATION)

End Form

Need assistance?
Call us on the phone
numbers below

Email Phone Financial Advice Post

formsandapplications@csc.gov.au 1300 000 277 1300 277 777 CSS
GPO Box 2252
Web Overseas Callers Fax Canberra ACT 2601
csc.gov.au +61 2 6275 7000 (02) 6275 7010
90MP 3 of 3