Financial and Clerical Assistance Request Form-0046

FINANCIAL AND CLERICAL ASSISTANCE REQUEST (Form-0046)

Personal Care Services – Level 3 Approved Accreditation – Additional Fees and Charges Apply
Resident's Details
Name*

First NameLast Name
Date*

DayMonthYear
Date
Which of the following services would you like Skymac to assist you with:*

Opening incoming mail and responding on your behalf – a Consent to Open Mail Form must be completedManaging appointments, including assisting with initial booking and rebooking (if required)Assisting to allocate daily funds for weekly spending – an Allocation of Funds for Spending form must be completedFilling in forms, applicationsMaking and receiving phone calls for personal mattersAssisting with outgoing postal needs including organising letters and parcelsCorrespondence and appointments with government organisation (e.g., Centrelink, Queensland Health)Managing TransLink account, ensuring it is valid, renewing pass if required, replacing if lost/stolen/damagedPaying additional services (e.g., podiatrist, hairdresser, nails, and beauty services)Filing, printing, or any other general personal administration
Would you like Skymac to store any personal property? (E.g. Pension Cards, Translink Cards) in a secure and safe place?

NoYes
By selecting yes, you request and approve Skymac to store the following belongs in a safe place. You understand that you can ask for these at any time.

Should you wish to revoke this agreement, you must let Skymac know in writing that I will take full responsibility for all my property.
Please indicate which property you would like Skymac to keep safe:

Pension CardsCentalink CardsBank Passports/Visa/Debit CardsCompanion CardsTranslink CardsTravel Passports
Signature of Resident

*Or signature of person acting on authority under Guardianship Administration Act 2000 or Powers of Attorney Act 1998 for the person named above, OR an Informal Decision Maker (must have an Informal Decision Maker Details Form-0071 signed) for the person named above.
Name*

First NameLast Name
Signature*

Clear
Date*

DayMonthYear
Date
In the presence of (Witness)
Name*

First NameLast Name
Signature*

Clear
Date*

DayMonthYear
Date
Should be Empty:

FINANCIAL AND CLERICAL ASSISTANCE REQUEST (Form-0046)

Resident's Details

Signature of Resident

In the presence of (Witness)