Application for free NSW Seniors Card

What is a NSW Seniors Card?
NSW Seniors Card is a free program which recognises
the valuable contribution seniors have made and
continue to make to the community. Its purpose is
to assist semi-retired and retired people to enjoy an
active and healthy lifestyle in NSW.
Benefits for members
Members receive discounts and special offers
provided by thousands of businesses from a range
of categories including entertainment, health,
travel, trades and services, along with access to
NSW Government funded transport concessions.
Seniors Card Discount Directory
You’ll receive an annual Discount Directory detailing
member discounts and special offers for the region
in which you live. All five regional Directories can be
also accessed at www.seniorscard.nsw.gov.au
eNewsletter
The monthly eNewsletter includes regular articles
about gardening, health and travel as well as special
offers, discounts, competitions and much more.
www.seniorscard.nsw.gov.au
The website contains online versions of the
Discount Directories and eNewsletters as well
as other useful information for seniors. Members
can also use the website to update their contact
details, subscribe to the eNewsletter and request
a replacement for lost, stolen or broken cards.
Please advise Seniors Card if you change
address or your card has been lost or stolen.
NSW Seniors Card
Phone 1300 364 758 (cost of a local call)
Email info@seniorscard.nsw.gov.au
Website www.seniorscard.nsw.gov.au
Telephone Interpreting Service 13 14 50
Cut here for your reference
To be eligible
1. Complete the attached application form or an
online application form.
2. Take the form to one of the following authorised
witnesses to verify your identity, age, Australian
residency, NSW address and witness your statutory
declaration
• Justice of the peace;
• Solicitor or barrister admitted to practice in NSW;
• Notary public;
• Commissioner for affidavits; or
• The Registrar-General or a deputy registrar general.
You will need the following ID with you:
Proof of identity and age
(take one of the following)
• NSW Driver’s Licence
• NSW Photo Card
• NSW Birth Card
• Passport
Proof of Australian residency
(take one of the following)
• Green Medicare Card
• Australian or New Zealand Birth Certificate
• Australian or New Zealand Passport
• Australian or New Zealand Citizenship Certificate
• Permanent Resident Visa in foreign passport
Proof of NSW address
(take one of the following)
• NSW Driver’s Licence
• NSW Photo Card
• Recent bank statement or utility account
with current residential address
3. Post your form to:
NSW Seniors Card
Locked Bag 7001,
LIVERPOOL NSW 1871
Privacy statement
The personal information we collect on this form
is used to provide you with your NSW Seniors
Card, annual Discount Directory, mail outs and
information about activities for members. Seniors
Card may also survey some members in order to
improve our services.
To enable Seniors Card to perform these functions,
we utilise external service providers including a
mail house and contact centre. We may disclose
information to these service providers so they
can carry out the services that we have contracted
to them. We may provide information to other
government agencies that provide services
to members. We may also disclose personal
information with your consent; or if required or
authorised by law, or our Privacy Code of Practice.
If you wish to update your personal details,
or if your circumstances change please call
1300 364 758.
For more information:
www.seniorscard.nsw.gov.au
1043 SC AF – 0412
Application
for free NSW
Seniors Card
Join more than a million seniors
saving money through thousands
of discounts and special offers

Guidelines for completing this form
� check you meet all three eligibility criteria
� use a black or blue ballpoint pen and fill out every section
� use CAPITAL LETTERS and tick the appropriate circles e.g.
� take identification documents to a authorised witness and
sign the statutory declaration in front of the them
� Post your form to: NSW Seniors Card, Locked Bag 7001,
LIVERPOOL NSW 1871
NSW Seniors Card membership application
1 Are you eligible?
You are eligible for a NSW Seniors Card if you:
• are 60 years of age or over; and
• are a permanent resident of NSW; and
• work no more than 20 paid hours per week.
2 Your details
Title Mr Ms Miss Mrs Other Gender Male Female
First name Middle initial
Surname
Postal address
Suburb
(state) (postcode)
Date of birth
(day) (month) (year)
Home phone
(area code)
Country of birth
Mobile
What language do you speak at home?
Are you of Aboriginal or Torres Strait Islander origin? Yes No
Do you receive a pension from Centrelink or the Department of Veterans’ Affairs? Full Pension Part Pension No
3 eNewsletter
Sign up to the monthly eNewsletter to receive information about gardening, health and travel as well as special offers,
discounts and competitions (you can unsubscribe at any time). Please print in CAPITAL LETTERS.
Email address
4 Special offers
Do you wish to receive special offers, arranged by Seniors Card, by post or email? Yes No
If yes, please tell us about your interests so that we can try to source offers relevant to you:
Computers Sport / exercise Theatre
Travel – overseas Reading
Gardening Movies
Travel – domestic Travel – group tours Wine
5 Annual Discount Directory
A printed Discount Directory listing exclusive offers will be sent to you along with your Seniors Card.
Tick ‘mail’ to be posted an updated Discount Directory annually. The Directory is also on our website Mail
where you can view all the available discounts at any time (please consider the environment).
6 Statutory declaration
NOTE: It is an offence to falsely sign a statutory declaration. To be completed by an authorised witness #
I, (name)
a (qualification)
certify the following matters concerning the making
of this statutory declaration by the person who made it:
* please cross out any text that does not apply
1. *I saw the face of the person OR *I did not see the face of
the person because the person was wearing a face covering,
but I am satisfied that the person had a special justification
for not removing the covering, and
2. *I have known the person for at least 12 months OR *I have
not known the person for at least 12 months, but I have
confirmed the person’s identity using an identification
document and the document/s I relied on was
I, , do solemnly and
sincerely declare that the information on this form is true in every
particular and I am over 60 years of age, I am not working more
than 20 paid hours each week and I am a permanent resident of
the State of New South Wales and I make this solemn declaration
conscientiously believing the same to be true, and by virtue of
the provisions of the Oaths Act 1900.
Declared at (place)
on [date]
Applicant to sign
# Authorised witnesses include a justice of the peace, a notary public,
a solicitor or barrister with a current New South Wales or interstate
practising certificate, a commissioner of the court for taking affidavits
or a person by law authorised to administer an oath.
Date
Signed
Commonly asked questions
Can I apply before I turn 60?
No. You must be 60 years or over.
What is defined as a
permanent resident of NSW?
Australian citizens and residents
with a permanent visa who are
living in NSW on a permanent
basis. Temporary visa holders
are ineligible.
Where can I find an authorised witness to
verify my form?
Authorised witnesses include a justice of the
peace, a notary public, a solicitor or barrister
with a current New South Wales or interstate
practising certificate, a commissioner of the court
for taking affidavits or a person by law authorised
to administer an oath. You can locate one of these
authorised witnesses at councils, courts, libraries,
MP offices, police stations and government offices.
You can also search for a justice of the peace at
www.lawlink.nsw.gov.au
How long will it take to process my application?
21 days from receipt of your application.
Can I use my NSW Seniors Card interstate?
Yes, NSW Seniors Card holders receive public
transport concessions and discounts from most
interstate participating businesses.
How do I identify if a business gives a Seniors
Card discount?
All participating businesses that offer 10%
or more discount are listed in the annual
Discount Directory and on our website at
www.seniorscard.nsw.gov.au.
Most businesses also display
Seniors Card Welcome Here
signage.