Complete this form to update or add a concession to your energy account.South Australian customers: Please click here to apply for a concessionyour details (as per your concession card) apply for all accounts * account number * name * first name * last name contact details* email address * phone number * address address * Is this your principal address? Yes No concession card details* card issuer - Select -CentrelinkDepartment of Veteran Affairs (DVA)QLD Department of CommunitiesDepartment of Immigration and Border Protection card type - Select -Pensioner Concession CardHealth Care Card card type - Select -DVA Gold CardDVA Gold Card (Repatriate Health Card)DVA Gold Card (TPI only)DVA Gold Card (War Widow)DVA Gold Card (Disability Pension)DVA Pension Concession Card card type - Select -Department of Communities Senior Card (QLD only) card type - Select -ImmiCard for Asylum Seekers (QLD only)* card number * card start date * card end date I authorise The use of Centrelink Confirmation eServices to perform a Centrelink/DVA enquiry of my Centrelink or Department of Veterans’ Affairs Customer details and concession card status in order to enable amaysim Energy to determine if I qualify for a concession, rebate or service.* I authorise The Australian Government Department of Human Services, DHS, to provide the results of that enquiry to amaysim Energy.* I understand DHS will use information I have provided to amaysim Energy to confirm my eligibility for the relevant concession or rebate and will disclose to amaysim Energy personal information including my name, address, payment and concession card type and status.* I understand This consent, once signed, remains valid while I am a customer of amaysim Energy unless I withdraw it by contacting amaysim Energy in writing or the DHS.* I understand I can obtain proof of my circumstances/details from the department and provide it to amaysim Energy so that my eligibility for the relevant concession or rebate can be determined.* I understand If I refuse to give, or withdraw my consent or do not alternatively provide proof of my circumstances/details, I may not be eligible for the concession, rebate, or service.* I understand I must advise amaysim Energy if my circumstances change and I am no longer eligible to receive a concession.