Home Ownership Expression Of Interest - Indigenous Business Australia (Iba) (Page 7 of 8) in pdf

Home Ownership Expression Of Interest - Indigenous Business Australia (Iba) Page 7

L. CUSTOMER CONSENT FOR CENTRELINK CONFIRMATION SERVICES

Only fill in this section if you receive Centrelink benefits.

If you do not wish other joint applicants to see your consent for Centrelink Confirmation Services, please contact

IBA to request a separate Centrelink consent form.

Applicant 1

Centrelink reference number/s

Applicant 2

This consent will be used for the sole purpose of authorising the Department of Human Services

(the department) to provide information to Indigenous Business Australia to assess your eligibility in relation

to housing finance being sought from Indigenous Business Australia.

I / we

Applicant 1

Applicant 2

authorise the department to electronically provide a statement of information to Indigenous Business Australia to

assist in the assessment of my entitlement to services from Indigenous Business Australia.

I / we acknowledge that:

1. The information provided by the department may include, where relevant, current or historical details of

payments received, dependants, Centrelink deductions, income, assets and confirmation of my current

address.

2. Once signed, this authority is effective only for the period I am a customer of Indigenous Business Australia.

3. This authority, which is ongoing, can be revoked by me / us at any time by giving notice to Indigenous

Business Australia.

4. I / we can obtain a written copy of the statements at any time from either Indigenous Business Australia or the

department.

More information about Centrelink’s Confirmation Services is available from the department shopfronts and the

department website at

Applicant 1

Applicant 2

Print name

Signature

Date

Signature

Date

Home Ownership Expression Of Interest - Indigenous Business Australia (Iba) Page 7