= Required Fields

Online Form - Example Wizard Form

Pensioner Review Form Declaration

DECLARATION:

  • I/We have read and understood the provision of the Act as provided with my/our previous application.
  • I/We have neither obtained nor applied for a rebate under the Act in respect of any other property for the charged period.
  • I/We do not occupy any other property.
  • I/We authorise the Local Government to use Centrelink Confirmation eServices to perform a Centrelink/DVA enquiry of my Centrelink or Department of Veterans’ Affairs Customer details and concession card status in order to enable the Local Government to determine if I qualify for a concession, rebate or service.
  • I/We authorise appropriate government departments to relase to Water Corporation, Local Government and/or the Officer of State Revenue, confirmation that I/we hold a current Pensioner/Seniors Card or State Concession Card.
  • I/We declare that I/we am/are currently in receipt of a Pension. (applicable only to pensioners)
  • I/We declare that the details provided in this application are true and correct in relation to the above property.

A PENALTY OF $1,000 APPLIES FOR FALSE OR MISLEADING INFORMATION (Section 38)

Property Address for which the pensioner/senior rebate is claimed