Notice Of Withdrawal Of Application For A Child Support Assessment Form (Page 3 of 3) in pdf

Notice Of Withdrawal Of Application For A Child Support Assessment Form Page 3

Statement

IMPORTANT INFORMATION

Privacy and your personal information

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

www.

from the department.

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.

Your signature

Date

3 of 3

CS1669.1412

Notice Of Withdrawal Of Application For A Child Support Assessment Form Page 3