If yes, please provide that name.
e.g.Maiden Name, Name change
Annexure 1 - Disability Supplement
The purpose of the Disability supplement is to provide additional information to assist with answering the
disability question.
If you indicated the presence of a disability, impairment or long-term condition, please select the
area(s) in the following list:
Disability in this context does not include short-term disabling health conditions such as a fractured leg,
influenza, or corrected physical conditions such as impaired vision managed by wearing glasses or lenses.
'11 — Hearing/deaf'
Hearing impairment is used to refer to a person who has an acquired mild, moderate, severe or profound hearing
loss after learning to speak, communicates orally and maximises residual hearing with the assistance of
amplification. A person who is deaf has a severe or profound hearing loss from, at, or near birth and mainly
relies upon vision to communicate, whether through lip reading, gestures, cued speech, finger spelling and/or
sign language.
'12 — Physical'
A physical disability affects the mobility or dexterity of a person and may include a total or partial loss of a
part of the body. A physical disability may have existed since birth or may be the result of an accident,
illness, or injury suffered later in life; for example, amputation, arthritis, cerebral palsy, multiple
sclerosis, muscular dystrophy, paraplegia, quadriplegia or post-polio syndrome.
‘13 — Intellectual’
In general, the term ‘intellectual disability’ is used to refer to low general intellectual functioning and
difficulties in adaptive behaviour, both of which conditions were manifested before the person reached the age
of 18. It may result from infection before or after birth, trauma during birth, or illness.
‘14 — Learning’
A general term that refers to a heterogeneous group of disorders manifested by significant difficulties in the
acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities. These
disorders are intrinsic to the individual, presumed to be due to central nervous system dysfunction, and may
occur across the life span. Problems in self-regulatory behaviours, social perception, and social interaction
may exist with learning disabilities but do not by themselves constitute a learning disability.
‘15 — Mental illness’
Mental illness refers to a cluster of psychological and physiological symptoms that cause a person suffering or
distress and which represent a departure from a person’s usual pattern and level of functioning.
‘16 — Acquired brain impairment’
Acquired brain impairment is injury to the brain that results in deterioration in cognitive, physical, emotional
or independent functioning. Acquired brain impairment can occur as a result of trauma, hypoxia, infection,
tumour, accidents, violence, substance abuse, degenerative neurological diseases or stroke. These impairments
may be either temporary or permanent and cause partial or total disability or psychosocial maladjustment.
‘17 — Vision’
This covers a partial loss of sight causing difficulties in seeing, up to and including blindness. This may be
present from birth or acquired as a result of disease, illness or injury.
‘18 — Medical condition’
Medical condition is a temporary or permanent condition that may be hereditary, genetically acquired or of
unknown origin. The condition may not be obvious or readily identifiable, yet may be mildly or severely
debilitating and result in fluctuating levels of wellness and sickness, and/or periods of hospitalisation; for
example, HIV/AIDS, cancer, chronic fatigue syndrome, Crohn’s disease, cystic fibrosis, asthma or diabetes.
‘19 — Other’
A disability, impairment or long-term condition which is not suitably described by one or several disability
types in combination. Autism spectrum disorders are reported under this category.
