Centrelink Rent Deduction Scheme Authorisation Form Your Detail Name CRN Date of Birth Address Amount Start Date Payment to be deducted from: Disability pension New start Allowance Parenting Payment Austudy Family Tax Benefits Age Pension Youth allowance OtherOther Our Detail Women’s Property Initiatives CRN: 555 075 996 B I understand that: this consent, once signed, is effective for the service/s indicated, and only for the period that I am a customer of Women’s Property Initiatives. this consent may be withdrawn by me, at any time, by contacting Women’s Property Initiatives. every time that Women’s Property Initiatives provides information to the department for Centrepay, I will be advised. Women’s Property Initiatives will maintain a record of my consent for 2 years after the deduction has stopped. Information shared will be for the purpose of rent deduction and in line with the privacy act 1988 For more information visit humanservices.gov.au/centrepay Signature Clear Date Email Submit
