Household Essentials Purchasing Card Application Form

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Household Essentials Purchasing Card Application Form

HOUSEHOLD ESSENTIALS PURCHASING CARD

HOUSEHOLD ESSENTIALS

The Household Essentials program provides up to $5,000 per financial year to spend on a range of essential household and personal living expenses.

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Applicant details

IBN Member Full Name(Required)

Membership Number

Date of Birth(Required)

DD slash MM slash YYYY

Language Group(Required)

Yinhawangka

Banyjima

Nyiyaparli

Postal Home Address(Required)

Phone(Required)

Email Address(Required)

I would like the remainder of my Household Essentials funds paid in instalments

I would like to organize a payment installment plan. Purchasing card officer will email payment installment plan agreement. Not applicable to members who have accessed their full financial years funds.

Please select from the options below. Please note: stolen cards MUST be reported to the police as theft.(Required)

New Member

Lost Card

Damaged Card

Expired Card

Stolen Card

Comments:

DECLARATION(Required)

I declare that the information I have provided on this form is true and correct.

My information with IBN is up to date.

I understand that I am responsible for my card and all purchases made using it, and misuse of funds can result in future penalties.

I agree that IBN may share my information with other organisations for application assessment purposes.

I understand that there is a $7.15 cancellation fee and a $9.25 replacement fee for my card.

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Total

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IBN Corporation Pty Ltd

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IBN Group acknowledges the the Yinhawangka, Banyjima and Nyiyaparli people as the traditional people in and around the Hamersley Ranges and custodians of the land.

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Household Essentials Purchasing Card Application Form

HOUSEHOLD ESSENTIALS PURCHASING CARD

HOUSEHOLD ESSENTIALS

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IBN Corporation Pty Ltd

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Aboriginal and Torres Strait Islander people are advised that this website may contain images, voices, or names of people who have passed away.