Elders Christmas Bonus Application Form 2020

NAME:*
FIRST NAME: MIDDLE NAME: SURNAME:
I AM 65 YEARS OF AGE AS AT 31 DECEMBER 2020*
- Yes
- No
Sorry, unfortunately you are ineligible for the Christmas Bonus. You must be 65 or over to on the 31st of December 2020 to receive the Christmas Bonus.
DATE OF BIRTH:*
ADDRESS:*
STREET: SUBURB: POSTCODE:
EMAIL:*
MOBILE:*
REGISTERED MEMBER OF MEENANGU WAJARRI ABORIGINAL CORPORATION:*
- Yes
- No
BANK ACCOUNT DETAILS*
Please be sure that your current bank account details have been updated in the ATMS.
Are your details up to date in ATMS?
- Yes
- No
Application Declaration
I have read and understand the Policy and I declare all information supplied to be true and correct. I agree that my typed name below can be used as a digital representation of my signature to that fact.
TO ACCEPT, TYPE YOUR NAME BELOW*
For any application enquiries please contact the office on 08 9997 3444 or email members@wajarri.com.au

Application Declaration