Change of Household Rep (HHR)

Information

Please complete this form if you would like to change your household details for the purposes of General
Health Grant applications or alternatively if you are the household representative you can phone or email
to make changes.

Please complete online form below:

Household Representative Registration - International

Personal Details - must be over the age of 18
First Name*
Middle Name
Surname*
Date of Birth*
DD slash MM slash YYYY
Contact Information
Phone*
Mobile*
Email*
Address
Address*
Physical Address City Suburb Postcode Country
Postal Address (if different from above)
Physical Address City Suburb Postcode Country
Bank Account
Bank Account Name*
BSB*
Bank Account Number*
Bank Branch*

Branch
Bank Address*
Upload Documents*
Drop files here or

Max. file size: 250 MB.
(e.g. Bank Statement, deposit slip or bank chit)
Household Members Details
Name of household member (1)
Relationship to HHR
Date of Birth
MM slash DD slash YYYY
Name of household member (2)
Relationship to HHR
Date of Birth
MM slash DD slash YYYY
Name of household member (3)
Relationship to HHR
Date of Birth
MM slash DD slash YYYY
Name of household member (4)
Relationship to HHR
Date of Birth
MM slash DD slash YYYY
Name of household member (5)
Relationship to HHR
Date of Birth
MM slash DD slash YYYY
Declaration
As the nominated Household Representative, I hereby cerify that all information given is a true and correct to the best of my knowledge and understand the General Health reimbursements will be paid into myBank Account*
- Agree

Information

Household Representative Registration - International

Personal Details - must be over the age of 18

Contact Information

Address

Bank Account

Household Members Details

Declaration

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