Department Of Human Services Business Application Electronic Verification Of Rent Page 2

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5
The Business is:
Note: We will NOT consider this Business Application if all relevant
Tick one
questions have not been completed.
Partnership
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Trustee of a Trust
Go to 7
Information about the Business
Company
Go to 8
1
Is the Business now, or has the Business ever been approved for
Individual (sole trader)
Go to 8
Centrelink Confirmation eServices (CCeS), Centrepay, Income
Go to 8
Unincorporated Association
Management (IM), BasicsCard or Electronic Verification of Rent
(requires an Individual’s undertaking)
(EVoR)?
Local, state/territory or
Go to 8
No
Go to next question
Australian (Commonwealth)
government organisation
Yes
What is your current or previous reference number?
Go to 8
Incorporated Association
5 5 5
Other
Give details below
If more than one reference number, attach a
separate sheet with details.
2
Has the Business ever applied for CCeS, Centrepay, IM,
BasicsCard or EVoR and not been approved?
Go to 8
No
Go to next question
Yes
Give details below
6
What are the full names and dates of birth of all the partners?
1
Name of partner
Date of birth
/
/
2
3
Name of partner
Legal name of the Business
Note: Insert the full Legal name of the relevant individual
(sole trader), company, partnership, trustee of a trust,
Date of birth
/
/
association, or statutory authority.
A trading name by itself is NOT sufficient.
If more than 2 partners, attach a separate sheet with details.
Go to 8
7
Is the Trustee of a Trust:
an individual Trustee
Give details below
4
Trading and/or Registered Business Name (if different from
Legal name)
Full name
Date of birth
/
/
a company Trustee
Give details below
Company name
Director(s) name
CLK0SA436 1508
SA436.1508
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