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Application for Disaster Fund Assistance

IMPORTANT INFORMATION

In times of natural disaster (i.e. Fire, Floods, Earthquake), RSL DefenceCare is able to pay bills on behalf of, or transfer funds by EFT to an applicant. This assistance is initially limited to $3000; however increased assistance may be available depending on the circumstances. RSL DefenceCare encourages applicants to request any amount necessary, and will consider all applications for approval on their individual merits.

DETAILS OF PERSON SEEKING ASSISTANCE

This is a secure form. If you prefer you can download a PDF and email or mail it to RSL DefenceCare.

Given Names *

Surname *

Date of Birth *

Current Address *

Suburb *

State *

Post Code *

Country *

Phone Number *

Mobile

Email *

DETAILS OF VETERAN

RSL DefenceCare can only provide assistance to Veterans, Serving Members and their families please provide details of the person with eligible Australian Defence service.

Full Name *

Date of Birth

Relationship to Veteran

Address

City

State

Postcode

Phone

Mobile

Service/PMKeys Number

Unit

RSL sub-Branch Name

ASSISTANCE SOUGHT

What is the amount of assistance being requested

Is this assistance for Bill payment or cash payment

Provide a brief description of why the assistance is being requested

Please indicate if there has been a total loss

INSURANCE INFORMATION

Is the applicant insured for this type of disaster

Name of Insurance Company

Policy Number if Known

Type of insurance cover held

OTHER ASSISTANCE

Has the applicant received financial assistance from other sources

Who provided the assistance

What amount of assistance was received

Provide a brief description of why this assistance was provided

PAYMENT INFORMATION

If the assistance requested is for a BILL payment have you attached the bill?

If the assistance requested is for a CASH payment please complete below

Financial Institution

Account Name

BSB

Account Number

Attach File (250Mb Limit *)

NOTE: If you have more attachments to add to your application please email them to info@defencecare.org.au with your details.

DECLARATION BY APPLICANT

I declare that the statements made in this application are to the best of my knowledge and belief, true in every detail. *

Enter Word Verification in box below *

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