WA Seniors Card
Application and replacement card form
Eligibility requirements for the WA Seniors Card:
1. You meet the age conditions, as listed below:
Date of birth
Age to qualify for a WA Seniors Card
Before 1 July 1955
60 years
1 July 1955 to 30 June 1956
61 years
1 July 1956 to 30 June 1957
62 years
1 July 1957 to 30 June 1958
63 years
1 July 1958 to 30 June 1959
64 years
After 30 June 1959 65 years
2. You are a permanent resident of Western Australia
To be eligible for a WA Seniors Card, you must be a permanent resident of Western Australia.
3. You are working 25 hours or less per week
You can work 25 hours or less per week, averaged over a 12 month period and still be eligible for a
WA Seniors Card.
Member Benefits
TRANSPERTH
SMARTRIDER
LOCAL
GOVERNMENT
RATES
WATER
RATES
LICENSING
SPECTACLES
RECREATIONAL
FISHING LICENCE
MANY OTHER
WA GOVERNMENT
BENEFITS
BUSINESSES
DISCOUNTS
Conditions apply:
To apply online or to find out more about the exclusive member benefits please visit:
www.seniorscard.wa.gov.au
phone: (08) 6551 8800
email: [email protected]
1800 671 233 (country free call)
Page 1
Part 1 - Personal Details
For replacement card applications only
Attach 100
points of ID
New application
WA Seniors Card number (if known)
OR
Replacement card Update details This section MUST be completed.
Title
Mr
Your details
Mrs
Miss
Ms
Other (please specify)
First name
Middle name(s)
Surname
Date of Birth
Address
Gender
Address
Suburb
State
Postcode
Postal
Address
Postal address
State
Postcode
Contacts
Mobile
Home telephone
(if different
from above)
Email
If you have one of the following cards issued by the Department of Human Services (Centrelink) or
the Department of Veteran Affairs (DVA) please provide below:
Pensioner Concession Card CRN:
Commonwealth Seniors Health Card CRN:
DVA Card - includes Gold, White and Orange:
Are you a holder of an immigration visa? If so, what subclass immigration visa do you hold?
No
Yes
Do you currently work?
No
Yes
If you are currently employed, how many paid hours per week would you typically work?
Hours worked:
Current occupation:
We would like to send you information
relevant to seniors. If you do not wish to
receive this please tick the box below.
Disclaimer: Please read our Terms and Conditions
available at www.seniorscard.wa.gov.au relating
to our privacy policy.
No
Page 2
Part 2 - Checklist and Declaration
Checklist
1. I meet the eligibility requirements (See page 1)
2. My personal details are correct (Complete page 2)
3. I have attached copies of identification for 100 point ID check,
including proof of WA residency and date of birth (new cards only)
4. I have signed the declaration
Please note that the WA Seniors Card Centre may contact you for more information to assess your application.
Your card will be sent to your current address unless otherwise notified of a change in this application form.
Terms and Conditions
Please read the Terms and Conditions for full eligibility requirements and WA Seniors Card member’s
responsibilities before completing this application. The Terms and Conditions are available at
www.seniorscard.wa.gov.au or can be obtained by contacting the WA Seniors Card Centre on
(08) 6551 8800 or 1800 671 233 (country free call).
This section MUST be completed.
Declaration signature
Your signature
•
•
•
I agree to the Terms and Conditions and meet the eligibility requirements.
I declare that the information I have provided in this application form is true and correct to the
best of my knowledge.
I understand that providing false or misleading information is a serious offence and the
Department of Local Government and Communities can make relevant enquiries to ensure I
receive my correct entitlements.
Signature Of Applicant
Date
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Or visit the website at www.seniorscard.wa.gov.au
Please return this form and 100 points of
ID in an envelope to:
WA Seniors Card Centre
Locked Bag 3
Perth Business Centre WA 6849
Page 3
If you require assistance, please
call the WA Seniors Card Centre:
(08) 6551 8800
1800 671 233 (country free call)
[email protected]
Part 3 - Identification
You must provide copies of acceptable and valid documents to meet 100 points of identification with your
application. These documents must show evidence of your full name, date of birth, photo identity and current
permanent address being in Western Australia.
For example, you could provide us a copy of your Passport (Category A, 70 points) and Age Pension Card
(Category B, 40 points). The combination of these two documents satisfies evidence of your full name, date of
birth, photo identity and current permanent address being in Western Australia.
A list of accepted documents are below.
Category A
Identification
Please
ensure you provide a
copy
of
photo identification that
is either from Category A or B
listed below.
Australian Passport (current or expired within
Points
the last two years but not cancelled)
70
Australian Birth Certificate or Birth Card (extracts are not acceptable)
70
Australian Citizenship Certificate
70
International Passport
(current, not expired or cancelled)
70
Category B
If you wish to use more than
one document from this group,
first acceptable document
the
scores
40 points but subsequent
documents
only score 25 points
each.
WA Drivers Licence (must be current)
40
Centrelink Card
(must have WA address and be current)
40
Department of Veteran Affairs (DVA) Card
(must have WA address and be current)40
Category C
Photo Card Issued by the Department of Transport
40
All documents in this
group attract 25 points.
Only one card from each
institution
may be counted.
Medicare Card
25
Council Rates Notice
25
Motor Vehicle Registration
25
Utility Bills (e.g. Power, Water, Gas)
25
Attach
legible
photocopies
with
application
If your name is different to your identification, one of the following documents must be provided:
• Marriage Certificate • Divorce Papers • Change of Name Certificate from the Registrar General.
These documents do not contribute to 100 points of identification and only verify your name change.
For a complete list of acceptable documents for 100 point identification, visit www.seniorscard.wa.gov.au
Translating and Interpreting
Call the Translating and Interpreting Service on 131 450
Printed in Dec 2016.
Material number: 8839730
DLGC SO159 - Dec16
Page 4