HRNILS Centrelink Confirmation eServices Authority

If you would like HRNILS to download your Centrelink details for you, please carefully read and complete the following form.

CLIENT DETAILS:

First Name *

Last Name *

Date of Birth *

CRN *

Email:

Don't have an email address?

Please provide your phone number: *

Are you applying with someone else as a Joint Loan Application?
If they are with you, and would also like us to download their Centrelink details, please tick the box so they can provide their information.

CLIENT 2 DETAILS:

First Name *

Last Name *

Date of Birth *

CRN *

Email: *

Don't have an email address? *

Please provide your phone number: *

Centrelink Confirmation eServices (CCeS)

Do you authorise:

Hunter Region No Interest Loans Scheme Inc. (Hunter Region NILS) to use Centrelink Confirmation eServices to perform a Centrelink enquiry of your customer details in order to enable the business to determine if you qualify for a NILS service.
Services Australia to provide the results of that enquiry to Hunter Region NILS and Good Shepherd Australia New Zealand.

Do you understand:

Services Australia will disclose personal information to Hunter Region NILS including your name, payment type, payment status, one off payment, income, assets, deductions, shared care arrangements and Youth Allowance Independent Rate to confirm your eligibility for relevant NILS service.
this consent, once given, remains valid while you are a customer of Hunter Region NILS unless you withdraw it by contacting Hunter Region NILS or Services Australia.
You can get proof of your circumstances/details from the department and provide it to Hunter Region NILS so that your eligibility for relevant NILS service can be determined.
if you withdraw your consent or do not alternatively provide proof of your circumstances/details you may not be eligible for the NILS service provided by Hunter Region NILS.

If you have any questions, please contact us BEFORE giving us your official authority.

02 49877660

info@hrnils.org.au

CLIENT AUTHORITY CONFIRMATION

Do you authorise Hunter Region NILS to use Centrelink Confirmation eServices to download a copy of your Detailed Centrelink Statement? *

NO, I don't give my authorityYES, I do give my authority

For your authority to be considered official, we need your electronic signature and a photo of your Centrelink Card, and your Drivers License or Medicare Card.

This ensures that we are acting on your behalf, and it helps to keep your information safe, and confidential.

If you would like to proceed with your application, you will need to provide us with a copy of your 'Detailed Income and Asset Statement'. This will include a breakdown of any Centrepay deductions you may have in place.

As you will need to provide your ID as part of your application. Would you like to provide your ID now?

YES, I wouldNO, I will forward to you later.

I consent to signing this form electronically and I confirm that my signature is legally binding. *

To give official authority you must provide your signature in the box below. * Only one signature can be entered. *

Clear

I confirm that the electronic signature in this consent represents my signature.

Please include a photo of your Centrelink Card **Make sure your ID is current *

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Please include a copy of your Drivers License or Medicare Card. **Make sure your ID is current. *

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Date and Time *

CLIENT 2: AUTHORITY CONFIRMATION

** The following authority must be completed by the second client applying .

Do you authorise Hunter Region NILS to use Centrelink Confirmation eServices to download a copy of your Detailed Centrelink Statement?

NO, I don't give my authorityYES, I do give my authority

For your authority to be considered official, we will also need your electronic signature and a photo of your Centrelink Card, and your Drivers License or Medicare Card.

This also ensures that we are acting on your behalf, and it helps to keep your information safe, and confidential.

As you will also need to provide your ID as part of your application. Would you like to provide your ID now?

YES, I wouldNO, I will forward to you later.

If you would like to proceed with your joint application, you will need to provide us with a copy of your 'Detailed Income and Asset Statement'. This will include a breakdown of any Centrepay deductions you may have in place.

I consent to signing this form electronically and I confirm that my signature is legally binding. *

To give official authority you must provide your signature in the box below. *Only one signature can be entered.

Clear

I confirm that the electronic signature in this consent represents my signature. *

Please upload a photo of your Centrelink Card *

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Please upload a photo of your Drivers License or Medicare Card *

Browse

Date and Time *

Please make sure your CRN number and your Date of Birth are correct before you submit your form