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Authorisation form Multiple consent and authority (web)

Download Evolve Housing 'Authorisation form Multiple consent and authority' Form (PDF)

Please read each service, and clearly indicate if you wish for this customer consent to be applied. Please complete the form below.

Electronic Verification of Rent (EVoR)

I authorise:

  • Evolve Housing ABN 16 127 713 731 to collect and use my current and future accommodation information and provide it to the Australian Government Department of Human Services (the department) for reassessment of my eligibility for Commonwealth Rent Assistance.

I understand that:

  • the information collected and used by Evolve Housing and provided to the department may include my Centrelink Customer Reference Number, Family Name, Given name, date of birth, address, household rent, individual rent, and relationship status.
  • every time Evolve Housing provides information to the department, the department will advise me in writing.
  • I must contact the department myself if:
    • I change my address
    • My relationship status changes
    • I start or stop sharing my accommodation with someone else
    • I purchase or sell any real estate

Centrelink Confirmation eServices - Income Confirmation

I authorise:

  • Evolve Housing to use Centrelink Confirmation eServices to perform a Centrelink enquiry of my Centrelink income, asset and payment details to enable Evolve Housing to determine if I qualify for a concession, rebate or service.
  • the department to provide the results of that enquiry to Evolve Housing.

I understand that:

  • the department will disclose personal information to Evolve Housing including my name, address, payment type, payment status, income, assets, one-off payment, deductions, shared care arrangements, partner status or Youth Allowance Independent Rate to confirm my eligibility for any relevant concession, rebate or service.
  • I can obtain proof of my circumstances/details from the department and provide it to Evolve Housing so that my eligibility for any relevant concession, rebate or service can be determined.
  • if I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may not be eligible for the concession, rebate or service provided by Evolve Housing.

Centrepay

I authorise Evolve Housing to advise the department:

  • to change my existing Centrepay deduction from time to time to ensure my housing payments are met, and
  • of my correct account or billing number if required.

I authorise the department to provide Evolve Housing:

  • information for the purpose of reconciling my payment deduction details.

I acknowledge:

  • I can cancel my Centrepay deduction at any time. This will remove my consent from Evolve Housing and Evolve Housing cannot set up any deductions until I provide new authorisation.
  • If I cancel my Centrepay deduction, I will be required to make alternative arrangements to pay my rent if I am continuing my rental agreement with Evolve Housing or if I have rent owing.

I understand that:

  • this consent, once signed, is effective for the service/s indicated, and only for the period that I am a customer of Evolve Housing.
  • consent for EVoR and Income Confirmation, which is ongoing, may be withdrawn by me, at any time, by giving notice to Evolve Housing or by contacting the department.
  • I can contact the department to cancel my Centrepay deduction at any time, however, I will be required to make alternative arrangements to pay my rent including any rent owing.
  • If I cancel my Centrepay deduction, I will be required to give new consent before Evolve Housing can restart a deduction.
  • every time that Evolve Housing provides information to the department for EVoR and/or Centrepay, the department will advise me in writing.
  • Evolve Housing will maintain a record of my consent for a minimum of 2 years from the date I cease to be a customer of Evolve Housing.
  • if I withdraw part or all of this consent in relation to EVoR, I will be responsible for notifying the department of all future changes to my accommodation circumstances.
  • I will be able to obtain a copy of the income statements the department provides to Evolve Housing from either the department or Evolve Housing.
  • I must tell the department if:
    • I change my address
    • My relationship status changes
    • I start or stop sharing my accommodation with anyone else
    • I purchase or sell any real estate

 
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