Notification Of Overseas Travel Form
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1
2IMPORTANT
Notification of Overseas Travel
DVA File number
Privacy notice
Security check (for counter and telephone use only)
Your personal information is protected by law, including the Privacy Act
1988. Your personal information may be collected by the Department of
DOB
Address
File No.
Veterans’ Affairs (DVA) for the delivery of government programs for war
veterans, members of the Australian Defence Force, members of the
Account for payment
Partner’s name
Australian Federal Police and their dependants.
Other
Read more: How DVA manages personal information
Name of person providing information
Telephone advice
Privacy information disclosed to
person providing information
Phone No.
Relationship to pensioner
Counter visit
Client’s details
8. To which country(ies) will you be travelling?
1. Surname
2. Given name(s)
9. Do you want your mail from Veterans’ Affairs to go
to another address while you are overseas?
3. Address
No
Yes - please provide details below
Postcode
4. Phone No.
(
)
10. Will you continue to pay rent for your home in
Travel details
Australia while absent from Australia?
5. Who is travelling overseas?
No
Yes
Please list family members who are leaving Australia
Declaration
I declare that the information I have given in this form is complete
and correct.
Your signature
/
/
Your partner’s signature
/
/
6. Date of departure from Australia
/
/
Office Use
A copy of this notification has been sent to:
7. Are you leaving Australia permanently?
No - what is your expected date of return to Australia?
Your name (BLOCK LETTERS)
Markout
/
/
Yes - please provide your new residential address
Signature
outside Australia
/
/
Copy forwarded to Health
Change of address required?
Yes
VIEW comments only
Set reviews?
Yes
Not required
D578 - 07/15 - p1 of 2
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Parent category: Legal