Collect your reward Victorian Seniors Card Application Form What is the Seniors Card? The Seniors Card was introduced by the Victorian Government in 1991 to acknowledge and thank Seniors for the contribution they have made to their communities and the State of Victoria. Victorian Seniors Card holders can take advantage of the following benefits: • A wide range of retail and service discounts at over 6,000 outlets • Free entry to the Melbourne Museum, Immigration Museum and Scienceworks • Exemption from Fishing Licence to fish in Victorian waters • Access to the Seniors Daily fare on metropolitan train, tram and bus services • Concession fares on V/Line train and coach services at all times • Two free off-peak travel vouchers each year for travel within Victoria at off-peak times • Access to the Seniors Sunday Pass which provides free travel in metropolitan Melbourne and major regional cities on Sundays (application required, contact Metlink on Telephone: 131 638) • Free public transport during the annual Victorian Seniors Festival on metropolitan and regional town public transport and nominated V/Line services • Concession travel in all States and Territories of Australia How to apply for your Seniors Card Fill in this application form and have it signed by someone authorised to witness a Statutory Declaration. Take along documents such as those listed under ‘Authorised person to complete’ on the Statutory Declaration page. Members of the community who witness Statutory Declarations include: Accountants, Doctors, Justice of the Peace, Local Councillors, Pharmacists, Solicitors, State or Federal Members of Parliament, Sworn members of the Police Force and Vets. Application Form To be eligible for a Victorian Seniors Card, you must meet the following criteria and ensure each box is ticked 1. 2. 3. I am 60 years of age or over, or will be 60 within 3 weeks of the date of this application I am either working less than 35 hours per week in paid employment or do not work at all I am a permanent resident of Victoria Mr Mrs Miss Ms Other First Name Middle Initial Surname Postal Address Suburb/Town Postcode Telephone / Mobile No. Date of Birth Day Month Year Email Address Language Spoken at Home The Seniors Card Program produces directories of discount providers and other retail offers as well as information about Victorian Government programs. If you do not wish to receive the directories and other information, please tick this box Please tick where applicable If you have previously applied for a Seniors Card please indicate your reason for reapplying below: Replace my lost/stolen/damaged card Other Statutory Declaration I (name) of (address) acknowledge that this declaration is true and correct and I make it knowing that a person making a false declaration is liable to the penalties of perjury. Declared at (Suburb / Town) Signature of applicant Date Day Authorised person to complete Month Year Please sight each form of identification and verify by ticking all boxes. An application cannot be processed unless all boxes are ticked. Applicant’s name (e.g. driver’s licence or utilities bill) Age (e.g. driver’s licence, birth certificate or passport) Australian residency (e.g. Australian birth certificate, citizenship certificate, passport or permanent resident visa) Victorian address (e.g. Victorian driver’s licence or utilities bill) Before me Authorised person to sign Name Address Telephone Number Title Our contact details Telephone: 1300 797 210 Email: firstname.lastname@example.org Web site: www.seniorscard.vic.gov.au Please post your completed form to: Seniors Card Program GPO Box 4316, Melbourne, Vic, 3001 Privacy statement The personal information on this form is being collected so the Department of Planning and Community Development (DPCD) can administer the Seniors Card Program. DPCD is committed to maintaining the privacy of personal information and will adhere to the Information Privacy Act 2000.