Fillable Interstate Seniors - Application For A Gold Senior/pensioner Opal Card (Page 2 of 2) in pdf

Section C – Privacy notice

Transport for NSW (TfNSW) is committed to

Where TfNSW engages contractors to assists

protecting the privacy of your personal information,

us in providing our services to you, we generally

in accordance with the Privacy and Personal

engage them under contract terms that ensure

Information Protection Act 1998 (NSW) and the

that they use personal information solely for the

Health Records and Information Privacy Act 2002

purpose of fulfilling their contract with us. We also

generally require them to manage the personal

(NSW) (NSW privacy laws).

and health information that they hold on our behalf

Personal information provided on this application

in a way that complies with NSW privacy laws.

form is collected for the purpose of administering

and managing your entitlement to concession

For information about how your personal

travel and for directly related purposes such as

information is collected, used and disclosed by

audit, management and operational activities for

us, please see our Privacy Policy at

concession travel.

You may choose not to provide your personal

For information about how your personal

information to TfNSW. However this may mean

information is collected, used and disclosed in

that it is not possible or practicable for us to deal

the Opal ticketing system, read our Opal Privacy

with your application for concession travel.

Policy at

So that we can deal with your application and

TfNSW will keep your information at 18 Lee Street,

manage your entitlement to concession travel,

Chippendale NSW 2008. You can ask to access

we may share your personal information with

or amend your personal information held by us at

agencies issuing Seniors Cards in Australian

any time during business hours, by contacting

states and territories.

privacy@transport.nsw.gov.au

or Locked Bag 5085,

Parramatta NSW 2124.

Otherwise we will not disclose your personal or

health information unless you consent, or we

are permitted or required to by law.

Section D – Applicant declaration – please read and sign at the bottom of this section

I wish to apply for a Gold Senior/Pensioner Opal card. I have read the Privacy Notice (at Section C), and

I consent to the collection, use and disclosure of my personal and health information by TfNSW as described

in the Privacy Notice available at

I confirm that I have read and agree to, the Opal Terms of Use described in Section A. I also confirm that

I have read and agree to the Conditions of issue and use (at Section A), and available at

I declare that the information provided by me in this application is true and correct. I understand that is an

offence to attempt to obtain the benefit of a concession entitlement by false statement or other dishonest

means.

Name (print):

Signature:

Date:

Check list

I am attaching a photocopy or scan of my Seniors Card (front and back)

I have signed and dated Section D (above)

Send the completed form by one of the following methods

Post

Transport for NSW

concessions@transport.nsw.gov.au

Locked Bag 5085, Parramatta NSW 2124

Office contact details – Telephone 131 500 (cost of a local call)

Transport for NSW - Interstate Seniors – Application for a Gold Senior/Pensioner Opal card - Form no. 5341 (March 2016)

Page 2 of 2

Interstate Seniors - Application For A Gold Senior/pensioner Opal Card Page 2

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