Seniors Fund Application Form

  • Please upload your Proof of Residential Address. You can upload a PDF, JPEG or Microsoft Word document.
    Drop files here or
    Accepted file types: pdf, jpg, doc, docx, Max. file size: 10 MB.
    • Please upload your Proof of Vehicle Ownership. You can upload a PDF, JPEG or Microsoft Word document.
      Drop files here or
      Accepted file types: pdf, jpg, doc, docx, Max. file size: 10 MB.
      • Please upload a copy of your quote. You can upload a PDF, JPEG or Microsoft Word document.
        Drop files here or
        Accepted file types: pdf, jpg, doc, docx, Max. file size: 10 MB.
        • 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.
        • For any application enquiries please contact the office on 08 9997 3444 or email members@wajarri.com.au