Transport Access Scheme application form

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Transport Access Scheme application form Please read the guidelines attached to this formDepartment of State GrowthPart one: To be completed by the applicant or their advocateWhich concession/s are you applying for? Please mark applicable boxes with X:For taxi subsidies you must provide a copy of both sides of your current Pensioner Concession Card, Health Care Card or Commonwealth Seniors Health Card issued by Centrelink or your Pensioner Concession Card issued by the Department of Veterans Affairs(DVA) but not a DVA Gold Card. This requirement is waived if you are wheelchair ConcessionsTaxi SubsidiesWheelchair Accessible Taxi SubsidiesTitle: Family name: Given name(s): Residential address: Suburb/Town: Postcode: Postal address (if not same as above): Suburb/Town: Postcode: Mobile: Daytime phone number: dd/mm/yyyyDate of birth: Email address: Applicant (person with disability) informationMember number:office use onlyTitle: Family name: Given name(s): Residential address: Suburb/Town: Postcode: Postal address (if not same as above): Suburb/Town: Postcode: Daytime phone number: Relationship to applicant: Email address: Advocate details (if applicable)PT20 0 of birth: dd/mm/yyyyVehicle registration and licence detailsYou may be eligible for vehicle registration/driver licensing concessions.

Transport Access Scheme application form Please read the guidelines attached to this form Department of State Growth Part one: To be completed by the applicant or …

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