Application To Receive Or Change The Australian Government Rebate On Private Health Insurance As A Reduced Premium Page 3

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Privacy notice
14
Your personal information is protected by law, including the
Privacy Act 1988, and is collected by the Australian Government
Department of Human Services for the assessment and
administration of payments and services. This information is
required to process your application or claim.
Your information may be used by the department or given to
other parties for the purposes of research, investigation or
where you have agreed or it is required or authorised by law.
You can get more information about the way in which the
Department of Human Services will manage your personal
information, including our privacy policy at
humanservices.gov.au/privacy or by requesting a copy from
www.
the department.
Claimant’s declaration
15
I declare that:
•
the information I have provided in this form is complete and
correct.
I understand that:
•
giving false or misleading information is a serious offence.
Claimant’s signature
-
Date
/
/
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MS006.1407 (formerly 2838)

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