Sign Up on Behalf of
a Participant

Complete this form if you are a nominee, guardian, or authorised representative signing up on behalf of a participant.

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is Safe With Us

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1
Representative & Participant Details
2
Plan & Coordination
3
Consent & Authorisation
4
Review & Submit

1. Representative / Nominee Details

You are signing this form on behalf of the participant. Please provide your details as the authorised representative.

Your Full Name *

Relationship to Participant *

Your Phone Number *

Your Email Address *

A verification code will be sent to this email before submitting.

Representative Type *

Representative Authorisation

I am authorised to communicate regarding the participant's NDIS funding and services, including:

Receiving funding information and reports.
Receiving statements and correspondence.
Discussing invoices and payment enquiries.
Communicating with SD Case Management regarding NDIS funding administration.
Liaising with providers regarding invoice and payment matters.

2. Participant Details

Tell us about the participant you are signing up for.

Participant Full Name *

Preferred Name

Date of Birth *

NDIS Number *

NDIS Plan Start Date

NDIS Plan End Date

3. Participant Contact Information

Contact details for the participant.

Mobile Number *

Email Address *

Residential Address *

Suburb *

State *

Postcode *

Participant's Preferred Contact Method *

Phone

SMS

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Sign Up on Behalf ofa Participant

1. Representative / Nominee Details

2. Participant Details

3. Participant Contact Information

Need Help Signing Up?

Sign Up on Behalf of
a Participant