Beneficiary Intake Pack
The intake form and process that opens a Life Without Debt case. It captures the identity, health status, and financial position needed to assess eligibility; obtains the consents required by the Privacy Policy; and structures the first conversation so that a terminally-ill beneficiary is not asked to repeat their story twice. Written to be filled out over one or more sessions — the beneficiary is never obliged to finish it in a single sitting.
Intake is conducted by a Beneficiary Liaison Officer (BLO) either in person, by phone, or by video — whichever the beneficiary prefers. Written forms are filled in by the BLO with the beneficiary, not by the beneficiary alone, unless the beneficiary specifically requests that. The intake may be paused at any point and resumed later. Nothing in this pack is a "test" and there is no wrong answer. Where the beneficiary is unable to speak with the BLO directly (in hospital, palliative-care, cognitively unable, or bereaved family case) the process is adapted — see §7 of the Privacy Policy and Step 6 below.
BLO guidance — how to use this pack
- Read the beneficiary the Welcome & expectations block (Step 0) before opening any form. It sets what happens in the next 30 minutes and what happens after.
- Complete Steps 1–5 with the beneficiary. Skip any question the beneficiary is not ready to answer; return to it later.
- Obtain and record every consent in the Consents block (Step 3). No consent, no next step. Consent may be withdrawn at any time.
- At the end of the session, complete the BLO closing summary (Step 6) and the Case-opening decision — one of Open case / Warm referral / Continue conversation / Not proceeding.
- File the completed pack in the case management system with restricted access per Privacy Policy §6.2. Return any paper originals to the beneficiary; retain scans.
- Book the follow-up contact within 7 days.
"Hello, I'm your Beneficiary Liaison Officer — my job is to be your single point of contact at Life Without Debt. Everything you tell me is confidential. I will only share what you specifically ask me to share, with the people you ask me to share it with — usually the banks or debt collectors chasing you, and sometimes your super fund or insurer if we're working on an early-release application.
Today's conversation is to understand your situation. It's not a test. There's no wrong answer. If you don't want to answer something, that's fine — we can come back to it, or leave it out entirely. If you get tired or upset, we stop.
By the end of today I'd like us to have agreed one of four things: (1) we open your case and start work; (2) I refer you to someone better placed than us — a financial counsellor, a legal centre, palliative care support; (3) we keep talking — you go home, think about it, and we book another chat; or (4) you decide this isn't for you and we stop, with no obligation. You are in charge of which of those four happens. Do you have any questions before we start?"
| Full legal name | |
| Preferred name / how you would like to be addressed | |
| Date of birth | |
| Current residential address | |
| Best phone number | Ask: best time to call? OK to leave voicemail? |
| Email (optional) | |
| Preferred contact method & timing | Phone / SMS / email / in-person / carer-mediated. Times to avoid (e.g. morning treatment appointments). |
| Do you have a support person or carer you would like copied on communications? | Name · relationship · contact. If yes, third-party consent required — see Step 3. |
| Next of kin / emergency contact | |
| Executor of your Will (if appointed) | Not required to answer. Recorded for continuity in the event of the beneficiary's death. |
| Interpreter or communication needs | Language · plain-English adjustments · large-print · Auslan · deaf/blind services. |
| Do you identify as Aboriginal and/or Torres Strait Islander? | Optional. Used for culturally-appropriate service adjustments and de-identified reporting only. |
| ID verification method used | Driver licence / Medicare + secondary ID / passport / other. Photocopy filed with limited access. |
The following section collects health information, which is "sensitive information" under s.6 of the Privacy Act 1988 (Cth). LWD collects only the minimum necessary to (a) confirm eligibility, (b) support hardship advocacy with creditors and debt collectors, and (c) if the beneficiary chooses, support an early-release-of-superannuation application under SIS Regulation 6.01A or a life-insurance terminal-illness benefit trigger. LWD does not collect a full medical history. See Privacy Policy §2, §7.
| Diagnosis (in your words is fine) | |
| Date of diagnosis | |
| Treating team — name of hospital / clinic / palliative care service | |
| Primary treating specialist | |
| GP | |
| Have you been given a prognosis? | Optional. LWD does not require the beneficiary to disclose a specific timeframe unless they choose to pursue SIS Reg 6.01A or 12-month insurance triggers, which require specific certification. |
| Do you have medical certificates already? | If yes, which — SIS Reg 6.01A (two practitioners, one specialist, prognosis ≤24 months) · 12-month insurance certificates · other. If not, does the beneficiary want LWD to assist to obtain them? |
| Social worker / palliative care nurse we can be in touch with (with your consent) | |
| Are you well enough to work? (any capacity) | Relevant for TPD / income protection insurance. Not a test of eligibility for LWD. |
| Anything about your health you want us to know so we can adjust our support? | Communication limits · fatigue · pain flares · cognitive changes · hospital admissions cadence. |
Any consent may be withdrawn at any time by telling the BLO or writing to the Secretary at carla@cosaicfo.com (Board-Appointed CFO Advisor — interim contact, LWD domain pending). Withdrawal is effective from the day LWD is notified. LWD will act on it immediately in respect of future use and disclosure, and cannot recall a disclosure already made.
4.1 Household income and essential outgoings — indicative only. The BLO records what the beneficiary can share; nothing is refused for want of documentation on day one.
| Household income (weekly / fortnightly / monthly — circle) | |
| Source(s) of income | Employment · Centrelink · super pension · insurance income protection · TPD · partner income · other. |
| Rent / mortgage | |
| Utilities (electricity · gas · water · phone · internet) | |
| Groceries & household | |
| Medical / pharmacy / travel-to-treatment | Frequently understated. Ask specifically about parking, taxis to chemo, script gap fees. |
| Insurance premiums (health, life, car, home) | |
| Other essential outgoings |
4.2 Creditors — the debts we are being asked to help with — one row per creditor. Add rows as needed.
| Creditor / lender / collector | Type | Approx balance | Repayment status | Account reference | Contact pressure level |
|---|---|---|---|---|---|
Type key: credit card · personal loan · car loan · mortgage · BNPL · utility arrears · telco · medical · tax · fine · other. Repayment status: current · <30 days · 30–60 · 60–90 · 90+ · default listed · court proceedings. Contact pressure: none · monthly · weekly · daily · relentless.
4.3 Superannuation and insurance snapshot
| Super fund(s) & approximate balance(s) | |
| Life insurance held (inside or outside super) | Sum insured · terminal-illness benefit trigger (12 months or 24 months)? |
| TPD / income protection cover | |
| Beneficiary nominations in place? | Binding / non-binding / lapsed / none. Referral to solicitor may be appropriate. |
4.4 What is worrying you most today?
Based on the information gathered, the BLO discusses with the beneficiary which of the four LWD activity pillars may help. Tick all that apply.
| Hardship negotiation with creditors | Case-work under NCC ss.72–75 · Banking Code Ch 39 · RG 96 / RG 271. BLO to prepare hardship notices for creditors identified in §4.2. Expected duration: [weeks]. |
| Direct financial relief | Bounded direct payments per Direct Relief Policy and Board Charter DAS §5.4 caps. Indicative need: $ [amount]. Category: [medical travel / utilities / groceries / funeral / other]. Approver required: CEO / dual-sign / Board. |
| Direct debt payoff | One-off or bounded debt payoff to end harassment or clear a single high-pressure account. Indicative amount: $ [amount]. Board Charter DAS §5.4 caps apply ($5k dual-sign / $5–15k Board / >$15k Board + external advice). |
| Advocacy: cease-contact / harassment stop | Formal letters to debt collectors relying on ASIC Act s.12DJ and RG 96 / RG 271 vulnerable-customer expectations; escalation to AFCA where appropriate. |
| Super early release under SIS Reg 6.01A | Assistance to compile two medical certificates (specialist + treating practitioner) and lodge with trustee. Timeline: typically 4–8 weeks. Consent C required. |
| Life-insurance terminal-illness trigger | Where a 12-month or 24-month terminal-illness benefit exists in a policy, LWD assists to lodge the claim. Consent C required. |
| Warm referral | To financial counsellor · community legal centre · palliative care social worker · Centrelink advocate · super fund advocacy · other. Referral logged with beneficiary consent. |
| Executor / secondary-beneficiary path (post-mortem cases only) | See Privacy Policy §7.4. Executor/administrator to provide written authority + evidence of appointment. |
Case decision (circle one):
- Open case — assign case ID; BLO to prepare hardship notices; direct-relief request to appropriate approver per DAS §5.4; follow-up booked within 7 days.
- Warm referral — LWD not the right primary support; refer to [named service] with warm handover. Follow-up call in 14 days to check outcome.
- Continue conversation — beneficiary needs more time; re-book within [7 / 14 days]; nothing done in the interim except at beneficiary request.
- Not proceeding — beneficiary declines; case closed on file with reason; retention rules under Privacy Policy §11 apply.
BLO closing summary
| Case ID assigned | |
| Case complexity (1–3) | 1 = single-creditor negotiation · 2 = multi-creditor + relief · 3 = super/insurance/estate + relief + advocacy. |
| Immediate actions committed by BLO | |
| Direct-relief approval path required (per DAS §5.4) | CEO ≤ $1.5k / dual-sign $1.5–5k / Board > $5k. Direct payoff: dual-sign ≤ $5k / Board $5–15k / Board + external advice > $15k. |
| Follow-up contact date & method | |
| Risks flagged for Beneficiary Services Committee (if any) | e.g. imminent enforcement · court proceedings · self-harm indicators · related-party interest — see Conflicts Policy. |
| BLO name & signature | |
| Date closing summary completed |
If, during intake, the BLO identifies any indicator of self-harm risk, family violence, elder abuse, imminent homelessness, or coercion, the BLO must (a) offer the appropriate crisis referral (Lifeline 13 11 14, 1800RESPECT, Elder Abuse Helpline 1800 353 374) and (b) inform the CEO the same day. This does not require the beneficiary's consent — see Privacy Policy §4.2 (APP 6.2 exception: serious threat to life or health).
Process flow — intake to case open
| Stage | What happens | Who | Timing | Document |
|---|---|---|---|---|
| 0 | Beneficiary contacts LWD (phone / web / referral) | Beneficiary or referrer | Day 0 | Contact log |
| 1 | BLO assigned; first-contact call scheduled | CEO / BLO Lead | Within 24–48 hours | Assignment note |
| 2 | Intake session — Steps 0–5 completed with beneficiary | BLO + beneficiary | 1 session (may split) | Beneficiary Intake Pack (this document) |
| 3 | Consents recorded; ID verified | BLO | Same session | Consent block Steps A–E |
| 4 | Case-opening decision — one of the four options in Step 6 | BLO with beneficiary | Same session | Step 6 decision block |
| 5a | If Open case: case ID assigned; hardship notices drafted; direct-relief request routed to appropriate approver per DAS §5.4 | BLO + CEO + Treasurer | Within 7 days | Case file · direct-relief request |
| 5b | If Warm referral: referral made with beneficiary consent; check-in booked | BLO | Within 7 days | Referral note |
| 5c | If Continue conversation: follow-up booked; nothing further done in interim | BLO | 7–14 days | Diary entry |
| 5d | If Not proceeding: file closed; retention per Privacy Policy §11 | BLO + Secretary | Same day | Case closure note |
| 6 | Ongoing casework: creditor negotiation, direct relief disbursement, super/insurance support, advocacy — cycle continues under DAS §5.4 controls | BLO + CEO + Beneficiary Services Committee (as escalation) | Weeks to months | Case file entries |
| 7 | Case closure: outcome recorded; consent to de-identified use confirmed; retention period starts | BLO + Secretary | On closure | Case closure summary |
Adoption
Resolution — adoption of Beneficiary Intake Pack:
"That the Board adopts the Beneficiary Intake Pack (Draft v1.0) as the standard operational intake process for Life Without Debt Ltd, notes that the Pack operationalises the consents required by the Privacy & Beneficiary Data Handling Policy and the assessment required by the Direct Relief Policy, and directs that the Pack be reviewed at least annually by the Beneficiary Services & Case Review Committee alongside the case-outcome data it generates."
- Privacy & Beneficiary Data Handling Policy — the policy this intake operationalises
- Direct Relief Policy — assessment criteria for Step 5
- Board Charter — DAS §5.4 — direct-relief and direct-payoff approval thresholds
- Conflicts Policy — BLO / Director conflict handling if a case involves a related party
- Case Studies Bank — three worked examples of intake → outcome
- Compliance Calendar Y1–Y3 — Beneficiary Services Committee cadence