Department Of Human Services Business Application Electronic Verification Of Rent (Page 6 of 7) in pdf

Which of the following forms, documents and other attachments

Use of information provided in this application

are you providing with this form?

If you are not sure, check the question to see if you should attach

By signing this application, the Business acknowledges that

the documents.

the Department of Human Services may disclose information

collected in this application to Regulatory bodies or other

Where you are asked to provide documents, please attach

Commonwealth Departments and agencies including:

documents.

• to assess this application

• to administer, evaluate and monitor the operation of EVoR,

Relevant printed Business policies and procedures

in accordance with the EVoR Policy and EVoR Terms, or

(required at question 18 and/or 19)

• upon request from Regulatory bodies or other

Details of any investigations or complaints

Commonwealth Departments or agencies.

(if you answered Yes at question 20)

The personal information collected about any individual named

Details of any judgement, decision or undertaking to a

in this application is protected by the Privacy Act 1988 , and is

Regulatory body

collected by the Department of Human Services for the

(if you answered Yes at question 21)

purposes of assessing this application and, if this application

is successful, for administration of EVoR.

Your information may be used by the Department of Human

Services or given to other parties for the purposes of research,

investigation or where you have agreed or where it is required

or authorised by law.

You can get more information about the way in which the

Department of Human Services manages personal information,

including our privacy policy at

humanservices.gov.au/privacy

www.

or by requesting a copy from the Department of Human

Services.

The Department of Human Services may publish a list of

Businesses that are approved to participate in EVoR on its

website.

Agreement

I/we:

• confirm that all information provided in this application is

correct and is not misleading and I/we have not withheld any

relevant information

• undertake to inform the Department of Human Services if

any information provided changes

• agree that the Business (and its agents/contractors) will

comply with the EVoR Policy and EVoR Terms (including the

Department of Human Services expectations) if the

Department of Human Services approves the Business to use

EVoR.

I/we confirm that:

• the Business will protect customer information in accordance

with our obligations under the relevant secrecy provisions and

the Privacy Act 1988

• the Business will comply with any directions of the

Department of Human Services related to the collection,

recording, use or disclosure of customer information

• the Business will obtain customer consent before verifying

and updating customer rent amounts.

I/we understand that:

• giving false or misleading information to the Commonwealth

is a serious criminal offence

• this application must be signed by the person(s) authorised to

do so and in accordance with the laws for executing a

contract.

I/we warrant that:

• I/we have authority to make this application and bind the

Business to the contractual obligations set out in the EVoR

Policy and EVoR Terms.

SA436.1508

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Department Of Human Services Business Application Electronic Verification Of Rent Page 6

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