Pensioner Concession Application - Centrelink

Important Information

A separate pension application form is required for each pensioner owner.

All applications are to be completed in full and shall be treated as confidential.

All applications are subject to approval under the provisions of Council's Pensioner Concession Policy and/or Queensland Government Pensioner Rate Subsidy Scheme.

All applications are subject to confirmation.

All applications require a photocopy or scanned and emailed copy of both sides of the pensioner’s current signed Queensland "Pensioner Concession Card”.

Seniors Cards and Health Care Cards are not applicable.

Outstanding rates and charges will be recovered in accordance with Council’s Debt Recovery Policy.

SECTION 1 - Property Details

Billing Reference Number (if known) 🛈

Property Address *

Suburb *

Postcode *

SECTION 2 - Pension Details

Pensioner Concession Card Number *

All applications require a copy of both sides of the pensioner’s current signed Queensland “Pensioner Concession Card”. Please upload here. *

SECTION 3 - Personal Details

Surname *

Given Names *

Preferred contact number *

Date of Birth * +

Email address - a copy of your submission will be sent to this email

Postal Address *

Do you reside in this Property? *

Yes

No

A Statutory Declaration is required to be submitted with this application in the following situations:

The owner/applicant is residing in a nursing home or with friends or family due to ill health or infirmity and the property is not rented; OR

The co-owner of this property is my spouse, and this person does not reside at the property.

Once completed, please upload the signed Statutory Declaration below.

Statutory Declaration upload *

Is this property solely owned by you? *

Yes

No

If no, what is your relationship to the other owners?

Would you like to authorise a 3rd Party (spouse/child etc) to discuss all aspects of your rates? *

Yes

No

If yes, please provide their full name and contact number.

SECTION 4 - Declaration & Consent

DECLARATION
I the owner/applicant on this application do sincerely declare that the information shown on this application is true and correct.

CONSENT – CUSTOMER CONFIRMATION/INCOME CONFIRMATION
This consent will be used for the sole purpose of authorising Centrelink/Department of Veterans' Affairs to provide information to Townsville City Council to confirm your eligibility in relation to concessions or services provided by Townsville City Council:

I authorise the Townsville City Council to use Centrelink Confirmation eServices to perform a Centrelink/Department of Veterans' Affairs enquiry of my Centrelink/Department of Veterans' Affairs Customer details and concession card status in order to enable Townsville City Council to determine if I qualify for a Pension Concession on Rates and Charges.

I authorise the Australian Government Services Australia Centrelink/Department of Veterans' Affairs to provide the results of that enquiry to Townsville City Council.

I understand that the Townsville City Council will use information I have provided to Centrelink/Department of Veterans' Affairs to confirm my eligibility for Pension Concessions and will disclose to the Townsville City Council my personal information including my name, address, concession card status, payment type, payment status, income and one-off payment.

I understand that this consent, once signed, remains valid while I am the owner of this property unless I withdraw it by contacting the Townsville City Council or Centrelink/Department of Veterans' Affairs.

I can obtain proof of my circumstances/details from Centrelink/Department of Veterans' Affairs and provide it to the Townsville City Council so that my eligibility for Pension Concessions can be determined.

If I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may not be eligible for the Pension Concession provided by the Townsville City Council.

Signature *

clear

Privacy Collection Notice:
Townsville City Council collects and manages personal information in the course of performing its activities, functions and duties. We respect the privacy of the personal information held by us. The way in which Council manages personal information is governed by the Information Privacy Act 2009 (Qld). We are collecting your personal information in accordance with Local Government Act 2009 so that we can assess your application and update your details in relation to your account. Generally, we will not disclose your personal information outside of Council unless we are required to do so by law, or unless you have given us your consent to such disclosure. For further information about how we manage your personal information please see our Information Privacy Policy.