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Au fa012 -fill and sign printable template online
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- form au fa012 fill online, printable, fillable, blank
To: Health Minister JAI Prakash Name of patient: Date of birth: (2) Age: (3) Date of enrollment with Centrelink: Date on which you became unemployed and moved back into the family home: (4) Date on which you commenced full-time study: Date on which your partner, or anyone your spouse or de facto partner resides with at the time of the medical examination (if any): (5) DATE ON which you commenced working in your current employment: (6) Note: Information supplied under the provisions of Section 6 of these Notice to Seniors is exempt from the disclosure requirement in section 51(v). If the information you give under the provisions of Section 6 (1) or (2) is incorrect, please include in the medical examination the additional information (in section 6, subparagraph (b)(i)) that identifies the required information. If you provide the incorrect information to Centrelink, then, in addition to giving Centrelink the required medical evidence, you will need to.
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Get and sign centrelink proof of care arrangements - form
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