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General Consent for a Third Party to Act on Your Behalf – Web Form

General Consent for a Third Party to Act on Your Behalf – Web Form

Important Information

This form is to be completed by current Link Wentworth tenants or occupants. If you are an applicant, you need to fill in a Housing Pathways consent form.

"*" indicates required fields

    Completing this form gives consent for Link Wentworth to exchange personal information with a third party and allows a third party:
  • To act on your behalf and deal with Link Wentworth on all matters that assist you in obtaining or maintaining accommodation and support.
  • Enquire on your behalf
  • Acting and making changes on your behalf that assist you in obtaining or maintaining accommodation and support
  • Receive copies of correspondence (if requested)
  • Attend Link Wentworth appointments with you or on your behalf
The third party can be a partner, a friend, a family member, or a professional or agency. This list is not limited and you may change this arrangement at any time. Authorising a third party to act on your behalf does not take away your right to contact Link Wentworth if you need to do so.

This information will be collected and recorded in your tenant records. Only information needed to make the best decisions to assist you in obtaining or maintaining housing and/or support will be shared.

If you have any questions, or need help completing this form please call 13 14 21 or email enquiries@linkwentworth.org.au.

If you require an interpreter please advise Link Wentworth, or if you have a hearing or speech impairment please use the TTY service Freecall 1800 810 586. A TTY phone is required to use this service.

Do you need a translator? TIS National provides access to phone and on-site interpreting services in over 150 languages. Call 13 14 50. You can also use the “Accessibility” drop down menu above for translations.

* Indicates a required field

Tenant details

Name*
Date of birth*
Address*

Authorising a Person/Agency to Act on your behalf

All the details in this section relate to the person or agency that you are authorising to act on your behalf.
E.g. daughter, son, father, mother, doctor, service provider.
For how long do you want this authority to last? (Select one only)*
Authority start date
Authority end date
Address for correspondence

Tenant declaration

I authorise the third party named on this form to act on my behalf about me in matters concerning Link Wentworth. I know that I can change my mind and stop my consent at any time by writing or telling a Link Wentworth unless there is a current legal order in place.
Drop files here or
Accepted file types: pdf, jpg, png, gif, Max. file size: 10 MB.
    Proof of Identity is mandatory for Link Wentworth to process this web form. Please upload one form of photo ID (e.g. driver’s license, ID card, passport), or two forms of non-photo ID (e.g. Medicare card, Centrelink card, bank card).
    Date*

    Before you go

    Before clicking submit, check that you have answered all the questions you need to answer. Don’t forget to sign and date the form.

    Saving this form

    If you would like a copy of this form, find the print option from the device you are working from and choose the “save as PDF”. You can also email a link to this form to your email address to complete later – click “Save and Continue” below. If you need help, please call 13 14 21 or email enquiries@linkwentworth.org.au. Please remember that if you save this form on a public computer your information may not be confidential and could be accessed by other parties. If you would like a copy of this form after you have submitted this file please call our team on 9412 5111 or 4777 8000 or email enquiries@linkwentworth.org.au.

    Link Wentworth collects personal information about you in order to make sure you receive the assistance you may be entitled to.

    Link Wentworth wishes to acknowledge the Traditional Custodians of the Land on which we work and pay our respect to the Elders past, present and emerging, and extend that respect to all Aboriginal and Torres Strait Islander people.

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