Instructions

Authorising a person or organisation

to enquire or act on your behalf

Purpose of this form To arrange for another person or organisation to enquire or act on your behalf when dealing with
the Australian Government Department of Human Services about Centrelink payments and services.
The arrangements you can make are for a:
• Person Permitted to Enquire — this arrangement authorises a person or organisation to make
limited enquiries only on your behalf
• Correspondence Nominee — this arrangement authorises a person or organisation to receive
copies of your Centrelink mail and to enquire, act and make changes on your behalf
• Payment Nominee — this arrangement authorises a person or organisation to receive your
payments on your behalf
• BOTH Payment and Correspondence Nominee — this arrangement authorises a person or
organisation to enquire, act and make changes AND receive your payments on your behalf.
If you or your nominee are subject to Income Management you should contact us on
1800 132 594 to discuss before lodging this form.

How many arrangements can you authorise on this form?

Only one person or organisation can be authorised on this form.
You can only have one Correspondence Nominee and one Payment Nominee, however,
they do not have to be the same person or organisation. You cannot nominate a person to act or
receive payments on your behalf if that person has a Centrelink nominee arrangement in place.
If you wish to arrange to have a different Correspondence Nominee to your Payment Nominee,
you will need to complete a separate form for each.
A separate form will also be required if you want to change your nominee arrangement.
IMPORTANT: Authorising a person or organisation to enquire, act on your behalf or receive your
payment does not take away your right to deal with us about your Centrelink business. This
authorisation can be cancelled or changed at any time, unless it is a court appointed arrangement.

Filling in this form • Please use black or blue pen.

• Print in BLOCK LETTERS.
• Mark boxes like this with a  or .
• Where you see a box like this Go to 5 skip to the question number shown. You do not need
to answer the questions in between.

Returning your form Check that you have answered all the questions you need to answer, and that you have signed and
dated this form.
This form and all additional documents, including proof of your nominee’s identity, are to be returned
to one of our Service Centres.

Person Permitted to A Person Permitted to Enquire can be a partner, a friend, a family member, a professional, an
Enquire organisation or a combination depending on the type of enquiry. Some examples of professionals
and organisations are accountants, financial advisers, social workers, doctors, etc. This list is not
limited. You can change this arrangement at any time.
Continued over the page

Please keep these Notes (pages 1 to 4) for your information.

SS313.1402 Notes—1 of 4
 What type of access can the Person Permitted to Enquire have
It is your responsibility to make sure that the person you have given authority to make enquiries on
your behalf is aware of what you are allowing them to enquire about, and any limitation you may place
on this authority. We can provide information that is necessary to satisfy the enquiry and no more.
The extent of information we can provide to a Person Permitted to Enquire may include the current
rate of your Centrelink payment, cancellation or rejection reasons to your payment, factors affecting
your payment for example assets and income, overpayment and arrears information.
If we have any doubt about the person’s authority to make an enquiry on your behalf, the enquiry
will not be answered until clarification is obtained from you.

Nominee obligations Correspondence Nominee

and responsibilities A correspondence nominee can act on your behalf and is authorised to deal with us on all Centrelink
matters (except payment destination). These include:
• making changes to your information
• enquiring on your behalf
• completing Centrelink forms/applications on your behalf
• receiving copies of your Centrelink mail
• attending Centrelink appointments with you or on your behalf (if appropriate).
A correspondence nominee is required to:
• advise us of any changes in your circumstances within 14 days (28 days if outside Australia)
• respond to notices if required to do so, including reporting notifiable events and must be aware
that failure to respond to a notice means that you have failed to meet your obligations
• act in your best interests
• advise us of any changes that may affect their ongoing ability as a nominee.
Payment Nominee
A payment nominee will receive your Centrelink payments and make sure:
• payments are used exclusively for your benefit
• records of payments received and the money he/she spends on your behalf are kept. We can
review the arrangement from time to time and request the nominee to provide this information.
Penalties may apply if the information is not provided
• they act in your best interests
• we are advised of any changes that may affect their ongoing ability as a nominee.
A payment nominee may be given relevant information by us if there are issues with your payment.
If you receive more money from us than you are entitled to, you will be required to repay this money.
Your nominee is not required to repay your Centrelink debt on your behalf.

Online Services Nominees can register for Online Services to access Centrelink services online.
Our Online Services provides a secure and convenient way to do Centrelink business through the
internet, using Customer Online Services or Business Online Services. Through these services
your nominee can:
• view and update your personal and payment related information
• request and print a document, such as an Income Statement or Payment Summary
• apply for an Advance Payment on your behalf
• update your contact details
• report your employment income
• view your payment history
• receive and view your letters
• receive an email or SMS notification that a new online letter has been sent.

Privacy and your Your personal information is protected by law, including the Privacy Act 1988, and is collected by
personal information the Australian Government Department of Human Services for the assessment and administration
of payments and services. This information is required to process your application or claim.
Your information may be used by the department or given to other parties for the purposes of
research, investigation or where you have agreed or it is required or authorised by law.
You can get more information about the way in which the Department of Human Services will
manage your personal information, including our privacy policy at humanservices.gov.au/privacy
www.

or by requesting a copy from the department.

SS313.1402 Notes—2 of 4
For more information Go online humanservices.gov.au or call us or visit one of our Service Centres.
www.

for customers Seniors 132 300 International Services 131 673

inside Australia Employment Services 132 850 Information in other languages 131 202
Youth and Students 132 490 Indigenous Services 136 380
Families 136 150
Disability and Carers 132 717
To speak to us in a language other than English call 131 202.
Note: Call charges apply – calls from mobile phones may be charged at a higher rate.

If you have a hearing TTY service Freecall™ 1800 810 586. A TTY phone is required to use this service.
or speech impairment
Interpreters and If you need an interpreter or translation of any documents for our business, we can arrange this
translations for you free of charge.
IMPORTANT INFORMATION: If there are any allegations of misuse of the nominee arrangement,
call us on the above numbers.

For more information If you want another person to act on your behalf when dealing with Centrelink and/or to receive your
for customers Centrelink payments while you are outside Australia, you will need to complete this form and return
it to:
outside Australia
Department of Human Services
International Services
PO Box 7809
CANBERRA BC ACT 2610
AUSTRALIA
Fax number (+61 3) 6222 2799
If you need help with this form, please call International Services between 8.00 am to 5.00 pm
Australian Eastern Standard Time, Monday to Friday.
If you live in one of the following countries, you can call us direct (free of charge). This service may
not be available from all locations in your country.
From Austria 0800 295 165 From New Zealand 0800 441 248
From Canada 1888 2557 493 From The Philippines 1800 1611 0046
From China (North)* 10 800 6100 427 From Poland 00800 6111 220
From China (South)* 10 800 2611 309 From Portugal 800 861 122
From Denmark 8088 3556 From Singapore 800 6167 015
From Germany 0800 1802 482 From Spain 900 951 547
From Greece 0080 0611 26209 From Thailand 001 800 611 4136
From India 000 800 61 01098 From Turkey 00 800 6190 5703
From Indonesia 001 803 61 035 From The United Kingdom 0800 1695 865
From Italy 800 781 977 From The United States
From Korea Republic 003 081 32326 of America 1866 3433 086
From The Netherlands 0800 0224 364 From United Arab Emirates 800061 04319

If you do not live in one of these countries or you are not able to contact us on the relevant number
above, please call (+61 3) 6222 3455. You may reverse the charge by asking your local telephone
operator if this service is offered by your local telephone provider. Alternatively, you may leave a
message with our answering service outside business hours and we will return your call.
If you cannot call International Services, you can contact us by post or fax.

* China (North) is the provinces of Beijing, Tianjin, Hebei, Shanxi, Inner Mongolia, Heilongjiang, Liaoning, Jilin,
Shandong and Henan. All other provinces are considered to be China (South) for this purpose.

SS313.1402 Notes—3 of 4
Information in other languages

SS313.1402 Notes—4 of 4
 Instructions

Authorising a person or organisation

to enquire or act on your behalf

1 Your name 10 Your nominated organisation’s details

Mr Mrs Miss Ms Other Trading name of organisation
Family name This is the name of the organisation, not the contact person.
The contact person can be identified below.

First given name

Business name of organisation

Second given name

Australian Business Number (ABN)

2 Your date of birth ABN is mandatory to access online services

/ /

Organisation Centrelink Reference Number

3 Your permanent address

Name of contact person

Postcode

4 Your Centrelink payment type 11 What is their relationship to you (e.g. father, sister, guardian,
administrator, Public Trustee)?

5 Your Centrelink Reference Number

12 What are their contact details?
Street address

6 Is this authorisation for a person or organisation?

Tick ONE box only
Authorise a PERSON Go to next question
Postcode
Authorise an ORGANISATION Go to 10
Postal address (if different to above)
7 Your authorised person’s name
Mr Mrs Miss Ms Other
Family name
Postcode
Phone number Fax number
First given name
( ) ( )
Email
Second given name

@
8 Your authorised person’s date of birth
/ /

9 Your authorised person's Centrelink Reference Number

CLK0SS313 1402
Go to 11
SS313.1402 1 of 2
13 What is the arrangement you are authorising? 18 Third party authorisation
Read the Notes if you are not sure about which arrangement The person signing this form on behalf of the customer cannot
you wish to make. If you want to authorise a different person be a nominee authorised on this form, unless it is a court
for each arrangement, complete a separate form for each appointed arrangement.
person.
Make sure you have read the Privacy and your personal
Person Permitted to Enquire Go to 16 information on page 2 of the Notes.
Authorises a person to make an enquiry only on your behalf
Correspondence Nominee Go to 15 You will need to provide evidence of the customer’s
Authorises a person to enquire, act and inability to sign if it is not a court appointed arrangement.
make changes on your behalf
Payment Nominee Go to 14 Name of person signing on behalf of the customer
Authorises a person to receive your payments on your behalf
BOTH Payment and Correspondence Nominee Go to 14
Authorises a person to enquire, act and make changes AND
receive your payments on your behalf Relationship to customer

14 Give details of the nominee’s account into which your Centrelink

payments are to be paid Address
Direct credit is available in most countries outside of Australia
if required. (Refer to page 3 of the Notes for more detail.)
Name of bank, building
society or credit union Postcode
Branch where your Contact phone number
account is held
( )
Branch number (BSB)
Account number (this may Signature of the person signing
not be the card number) on behalf of the customer Date
On completion of this form, / /
Account held in the name(s) of
please print and sign this
field by hand.

For organisations only – Group Institution Code Nominee

(if applicable)
19 The nominee MUST provide a password to be used when
contacting us. The password needs to have 4 to 12 letters or
15 What is the reason for making this arrangement? numbers. Please remember the password.
Voluntary Go to next question
Power of Attorney Please attach
Court, Tribunal, Guardianship supporting
documents. 20 Nominee’s acceptance
or Administration Order
IMPORTANT INFORMATION: Check to make sure that your
personal and/or your organisation details are correct.
16 How long do you want this arrangement to last? Make sure you have read the Privacy and your personal
Indefinitely OR information on page 2 of the Notes.

From / / to / / I declare that:

• I have read the Notes on page 2 and understand and accept
the responsibilities and obligations for the arrangement for
17 Your authorisation – If unable to sign, go to next question which I am authorised.
Make sure you have read the Privacy and your personal I declare and accept that:
information on page 2 of the Notes.
• any personal information I am given access to under this
I authorise the person named on this form to deal with Centrelink arrangement is protected under Commonwealth legislation.
on my behalf according to the arrangements shown on this form. I agree to access, use or disclose the information only as
Your signature Date authorised by the person to whom the information relates.
On completion of this form,
• my appointment as a nominee under Commonwealth
/ / legislation may be revoked or suspended by the Australian
please print and sign this
field by hand. Government Department of Human Services should I not
comply with my responsibilities and obligations.
Signature of the nominee Date
On completion of this form, / /
please print and sign this
field by hand.
SS313.1402 2 of 2
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