Hospital TV Hire Assistance

HOSPITAL TV HIRE ASSISTANCE
CFT recognises that long stays in hospital can be boring and that passing the time of day by watching tv can be useful. With the costs of tv hire increasing, CFT will assist you with offsetting these costs during your stay.

Eligibility:
- Membership of CFT must be current;
- Available to all adults and children with CF.
Entitlement:
- Up to $300 each calendar year per member.
- The funds will be provided via reimbursement.
Process:

1. Sign up for your tv hire by clicking here. You will need to pay for the service with a credit card, and they will email you an invoice.

2. Complete this online form;

3. Include a copy of the invoice with your form and we will process your reimbursement.

4. CFT will endeavour to process your application within 7-10 days (subject to staff availability).
Name of Hospital Inpatient *

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Post Code
Email*

Confirmation Emailexample@example.com
Mobile Number*
Details of person completing this form (if different from above)

Name

Street Address Line 2

Relationship

Mobile Number
DETAILS OF HOSPITAL ADMISSION*
Please upload a photo of any receipts if you have asked for a reimbursement.

Cancelof
BANK ACCOUNT DETAILS

Please provide the bank account details for any reimbursements.
BSB
Account Number
Bank account holder
Name
DECLARATION

I declare that all information I have provided to Cystic Fibrosis Tasmania is true and accurate. I understand if it is found that I have knowingly provided false or inaccurate information I may no longer be eligible to be a member, or receive any or all of the services and benefits provided by Cystic Fibrosis Tasmania.
E-Signature Name*
Date*

DayMonthYear
Date
Should be Empty:

HOSPITAL TV HIRE ASSISTANCE

CFT recognises that long stays in hospital can be boring and that passing the time of day by watching tv can be useful. With the costs of tv hire increasing, CFT will assist you with offsetting these costs during your stay.

BANK ACCOUNT DETAILS