Household Representative (HHR)

Household Representative (HHR) Registration

Applications for the General Health Grants must be applied for by a nominated Household Representative (HHR).
The HHR will make the General Health Grant applications on behalf of all whanau who live in your home;
and the grant will be paid into the bank account of the nominated HHR.
General Health Grant applications will only be processed once a Household Representative Registration
Form has been received with supporting documentation, signed consents and declaration.

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: 100 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

Household Representative (HHR) Registration

Household Representative Registration - International

Personal Details - must be over the age of 18

Contact Information

Address

Bank Account

Household Members Details

Declaration