Pension Concession Application Form

Eligible pensioners are able to apply for a rebate against their rate account. To be assessed for a pensioner concession, please complete the below form or an application can also be made by submitting a Pension Concession Application Form to Council.

Application for Council Pensioner Concession Rates Rebate

If joint owners are eligible for a pensioner concession and they are not spouses, a separate form will need to be completed by each owner to receive the maximum rebate, otherwise only a partial rebate will be granted.

Rate Assessment Number *

Name

Concession Card Type (eg. Pensioner Concession Card, DVA Gold Card)

Concession Card Number

Date of Grant of Concession on Card

Mobile Telephone Number *

E-mail Address

Property Address

When did you move into this property?

The information contained in this application form and any information requested for the purpose of assessing eligibility for a pensioner concession is required under the Local Government Act 1993 and the Local Government (General) Regulation 2005.

By submitting this form, you declare that the information provided is true and correct and that you are the person making this application. If you make a false statement in an application, you may be guilty of an offence and fined up to $2,220.

I have read and accepted the declaration and authority.

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 tick box 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 your Council.

I consent:

• Council to use Services Australia Confirmation eServices to perform a Centrellink/DVA enquiry of your Centrelink or DVA customer details and concession card status to enable Council to determine if I qualify for a rebate.

• Services Australia will provide the results of that enquiry to Council.

I 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 my eligibility for a rebate.

• This consent, once signed, remains valid while I am a customer of Council unless I withdraw it by contacting Council or the department.

• I can get proof of my circumstances/details from Services Australia/Department of Veterans Affairs and provide it to Council so my eligibility for a rebate 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 rebate.

I have read and accepted the above consent.

Full Name of Individual Making the Above Declaration:

ADDITIONAL INFORMATION

Council will determine your eligibility to receive a rebate of up to $250 on your rates account. You may also
be eligible to receive up to $87.50 on your annual water charges and up to $87.50 off your annual sewerage
charges, if council provides these services. Alternatively, if council does not provide these services, contact
your water/sewer service provider for more information.

Eligibility:
• Holders of the PCC (Pensioner Concession Card);
• Holders of a gold card embossed with ‘TPI’ (Totally Permanently Incapacitated);
• Holders of a gold card embossed with ‘EDA’ (Extreme Disablement Adjustment);
• War widow or widower or wholly dependent partner entitled to the Pensioner Concession Card*.

* If you are a war widow or widower or wholly dependent partner but do not have a Pensioner Concession
Card, you should contact the Department of Veterans’ Affairs (DVA) to test your eligibility for the DVA income
support supplement. Eligibility is subject to an income and assets test. Holders of cards other than those
listed above are not eligible for the concession. For assistance from the DVA call 133 254.

Downloads

Pension Concession Application Form

Pension Concession Application Form

Application for Council Pensioner Concession Rates Rebate

ADDITIONAL INFORMATION

Downloads

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