Completing this form:
Allows Link Wentworth to collect and use your personal information from a third party (such as a
relative, doctor, support person).
Allow Link Wentworth to exchange information with a third party.
Authorises the third person to give or receive information about you and for information to be
exchanged between Link Wenworth and the third party.
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
9412 5111 (Chatswood Hub)
4777 8000 (Penrith Hub)
If you require an interpreter please advise Link Wentworth, or if you have a hearing or speech impairment please use the TTY service Freecall or
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 Full Name *
Date of Birth * Address
All the details in this section relate to the person or agency that you are authorising to give or receive information about you. Giving Consent for the Collection, Use and Exchange of Information Address for correspondence
Tenant declaration I authorise the third party named on this form to exchange information 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 Link Wentworth unless there is a current legal order in place. Proof of Identity *
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 clicking submit, check that you have answered all the questions you need to answer. Don’t forget to sign and date the form. Before you go 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 9412 5111 or 4777 8000 or email firstname.lastname@example.org. 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 email@example.com. Saving this form