Spousal Pensioner Concession Rates Application

About this Form

This form may be completed by a spouse who does not ordinarily meet the Pensioner Concession Rebate eligibility and is not the legal registered owner of the property but is jointly liable for the payment of the rates and charges and is the recipient of an eligible benefit or allowance under the Commonwealth Social Security Act 1991. In compliance with Council's Administrative Guidelines and Hardship Assistance Policy, Council may extend the rebate to the applicant for reasons of ongoing financial hardship. In addition to this application, Council may require reasonable proof of financial hardship, details of assets and income and living expenses, and other such information required to make a valid assessment.

NOTES TO APPLICANT

Applicant must be the holder of either;
- the PCC (Pensioner Concession Card);
- a gold card embossed with ‘TPI’ (Totally Permanently Incapacitated);
- a gold card embossed with ‘EDA’ (Extreme Disablement Adjustment) or a
- War widow or widower or wholly dependent partner entitled to the Pensioner ConcessionCard
If a copy of the eligible PCC or eligible Concession Card is not submitted with the application, the application cannot be approved, and the rebate will not be granted.
If documentation is required, it must be submitted with the application or the application cannot be approved, and the rebate will not be granted.

CONDITIONS OF AGREEMENT

The rebate amount granted will be proportionate to the percentage of ownership shown on the Certificate of Title and to the date from which the applicant became eligible.
The applicant must be the spouse of the registered owner listed on the Certificate of Title and both must be living at the property as their principal place of residence.
The registered owner listed on the Certificate of Title must be named on the applicant’s PCC.
If the registered owner listed on the Certificate of Title is not named on the applicant’s PCC, evidence of the owner’s income must be submitted with;
- a copy of recent bank account statement/s
- a notice of Assessment or BAS statement (if self-employed)
The applicant agrees to notify Council if;
- there is a change in the ownership of the property through sale or estate
- the applicant no longer resides at the property
- the applicant becomes ineligible for a pensioner concession
If approved, the rebate is valid for the financial year that it was applied for only.
A new Spousal Pensioner Concession Rates Application must be submitted by the end of July for each financial year hardship is still applicable.

The applicant must provide a photocopy of both sides of the PCC or eligible Concession Card.

PROPERTY ADDRESS

Rate Account Number *

Property Address. *

Suburb: *

Postcode: *

Is this your sole / principal place of living? *

YesNo

When did you move into the property? *

APPLICANTS DETAILS

First Name *

Surname *

Email Address *

Phone (mobile preferred) *

DETAILS OF CIRCUMSTANCES *

PENSIONER CONCESSION CARD ENTITLEMENT

Are you the recipient of a Pensioner Concession benefit? *

YesNo

Concession Card Type *

Concession Card Number *

Date of grant of Concession Card *

Attach a copy of the Pensioner Concession Card (both sides) *

Browse

please upload files in following formats only jpeg, jpg, pdf, gif.

Have you claimed a pensioner rebate for any other property in the last 12 months? *

YesNo

Address: *

APPLICANT’S CONSENT

The information provided on this form is private and confidential and Council must not disclose the information to any person or body, if it is not directly related to the purpose for which the information was collected. If you have a complaint about the use of your personal information, contact Council’s Public Officer. The information contained or referred to in this application form may be corrected and updated by you, by contacting Council.

Please read the conditions and sign below to confirm your consent to Council checking your concession eligibility with Services Australia or the Department of Veterans Affairs. Your details may be checked regularly, to confirm ongoing eligibility. At any time, you have right to withdraw your consent by contacting Council.

I (the applicant) authorise:

Council to use Services Australia Confirmation eServices to perform a Centrelink/DVAenquiry of your Centrelink or DVA customer details and concession card status toenable Council to determine if I qualify for a rebate.
Services Australia will provide the results of that enquiry to Council.

I (the applicant) understand that:

Confirmation eServices will disclose personal information to Council including my name,address, payment type, payment status and concession card type and status to confirm myeligibility for a rebate.
This consent, once signed, remains valid while I am a customer of Council unless I withdrawit by contacting Council or the department. I can get proof of my circumstances/details fromServices Australia/Department of Veteran Affairs and provide it to Council so my eligibility fora rebate can be determined.
If I withdraw my consent or do not alternatively provide proof of my circumstances/details, Imay not be eligible for the rebate.

APPLICANT ACKNOWLEDGEMENT

I have read and agree to the terms and conditions as outlined in this agreement *

Signature *

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Date *

Privacy Statement:

In submitting this form, you consent to Council:

1. collecting your personal information as contained in the form; and

2. using the information for the purposes outlined in the form and for any other Council function.

Providing your information is voluntary. Should you choose not to provide the information, Council is unable to process your application/request.

You may access any of your personal information that Council holds upon request.