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MR22 Application for Client Concession - South Australia

MR22. Application FOR Client Concession 07/19. Incapacitated Ex-Serviceperson, Incapacitated Person, Pensioner 1. About the applicant PLEASE USE BLOCK LETTERS. Surname Given Names Client / Licence Number Date of Birth / /. Residential (Home) Address Number and Street Mobile or daytime phone number Suburb / Town Postcode Email address Postal Address (if different to above address). Suburb / Town Postcode 2. Does this Application for Concession apply to a: (Not applicable to vehicles with an unladen mass or Driver's Licence and / or Registered Vehicle, Cycle or Trailer GVM greater than 4500kg). Plate number of your vehicle/cycle Plate number of your trailer/caravan 3. About the Concession Read other side for full details Which Concession applies to you?

To claim concession you must provide your Pension Card number at the time of lodging this application. Concession can apply to only ONE vehicle or cycle and ONE trailer or caravan registered in your name. To qualify for concession you must receive a pension and hold a COMMONWEALTH Pensioner Entitlement Card entitling you

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