Your details
Full name
Property address
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Postal address (if different from above)
Phone
Email
Your application
Service discount to be applied to
Water service charge
Sewer service charge
Pension type
Australian Pensioner Concession Card
DVA Gold Card - EDA or TPI
DVA Gold Card with confirmation of 70% disability pension or 50 or more impairment points
Concession or DVA card Number
Proof of your pension (Australian Pensioner Concession Card, DVA Gold Card and/or letter from DVA)
Proof of address (licence or copy of utilities bill with your name and property address displayed)
Card expiry date
Signature
Date