AkinCare Reimbursement Claim Form

1
Client and Account Information* This field is required.This section identifies who is submitting the claim and routes the form to the correct approval pathway.
Please Select
Please Select
Client
Staff Member
Care Manager
Other
Please Select Your Relationship To AkinCare
Please Enter Your Full Name
Please Enter Your Telephone Number
Please Enter Your Email Address (If You Have One)
2
Approving Manager / Care Coordinator* This field is required.Let us know who authorised this expense or who looks after your care plan. Just pick their name from the list below, and our automated system will make sure this form gets sent directly to them for a speedy review.
Please Select
Tracey Betts (Care Manager)
Jarred (Accounts Manager)
Belinda (DSDO)
Sarah (SSDO)
Other/Unsure
3
Expense Information* This field is required.This section gathers the context of the purchase so the approver can verify it aligns with AkinCare policies or your Aged Care / NDIS budget.
Please Enter the date of purchase found on the receipt
Where did you purchase the items or services? (e.g., Woolworths, Therapy Clinic).
Description Of Goods Purchased Or Services Rendered
If you are a staff member who purchased this on behalf of a client, please provide the client's full name. Leave blank if you are a client or this is a general staff expense.
4
Financial And Payment Information* This field is required.This section ensures our finance team can process the reimbursement accurately once approved.
Please enter the total amount you are claiming for reimbursement.
Please Select
Please Select
Yes
No
Unsure
Does this amount include GST?
Please Share Any Additional Details Or Comments About The Reimbursement You Would Like Us To Know
Please Select
Please Select
Yes, I dont need to provide them again
No, I will provide them in the next section
Unsure - Ill provide them anyway
Could you please confirm if the AkinCare Finance team currently has your bank account information for reimbursement?
5
Bank Account Information* This field is required.Please provide your bank details below so AkinCare can process the refund/reimbursement to your bank account..
Please Select
Please Select
CBA - Commonwealth Bank
ANZ
NAB - National Bank
WBC - Westpac
SUN- Suncorp
BOQ- Bank Of QLD
ING
Macquarie Bank
Bendigo Bank
Other/Not Listed
Which Bank Is Your Account Held At?
Account Holder Name
BSB Number 000-000
Account Number
6
Your Receipt UploadTo process your reimbursement, please provide a photo or PDF of your receipt or tax invoice.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
7
Declaration And Next Steps* This field is required.By checking this box, you agree to the AkinCare reimbursement terms. If you do not agree or consent to this statement, please exit this form and contact us directly at 1300 140 473 or accounts@akincare.com.au
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