What happens if my income changes Authorisation form for Income Confirmation AUTHORISATION FORM FOR INCOME CONFIRMATION Name * CRN * Date of Birth * Address * I authorise: Women’s Property Initiatives to use Centrelink Confirmation eServices to perform a Centrelink/DVA enquiry of my Centrelink income, asset and payment details to enable the organisation to determine if I qualify for a service. the agency to provide the results of that enquiry to Women’s Property Initiatives. Yes I authorise I understand: the agency will use information I have provided to Women’s Property Initiatives (WPI) to confirm my eligibility for relevant rebate/service and will disclose to WPI personal information including my name, address, concession card status, payment type, payment status, income, assets, one-off payment, deduction and shared care arrangements. I can obtain proof of my circumstances/details from the agency and provide it to WPI so that my eligibility for relevant rebate/service can be determined. if I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may not be eligible for the rebate/service provided by Women’s Property Initiatives. 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 this consent which is ongoing, may be withdrawn by me, at any time, by giving notice in writing to Women’s Property Initiatives. Women’s Property Initiatives will maintain a record of my consent for 2 years from the date Women’s Property Initiatives ceases to provide the service. I will be able to obtain a written copy of the income statements the agency provides to my housing organisation at any time from either the agency or Women’s Property Initiatives. Signature * signature keyboard Clear Date If you are human, leave this field blank. Submit