Authority to Act as an Advocate

Use this form to authorise a nominated person to act on a participant’s behalf in their dealings with HappinessFirst Pty Ltd. This authority is given under, and managed in line with, the Consent Policy and Procedure and the Privacy Policy and Procedure.

Retain this completed form for seven (7) years.

Effective from: (Date) *

Participant Details

Participant Name *

Participant Last Name *

NDIS Number: *

Email Address

Advocate / Support / Nominated Person

Advocate / Support / Nominated Person Name *

Advocate / Support / Nominated Person Details *

Street address *

City *

State *

Postcode *

Email

Phone: *

Comments

Authority to Act:

I authorise HappinessFirst Pty Ltd to act on the instructions of my nominated person.
I understand that HappinessFirst Pty Ltd is not responsible for any actions of my nominated person using this authority.
I understand that this authority comes into effect from the date above, or from when the form is received, whichever is later.
I understand that I am giving my nominated person authority to access my information by telephone, email and letter.
I understand that I can write to or call HappinessFirst Pty Ltd at any time to cancel this authority, and HappinessFirst Pty Ltd will only cancel this authority if I ask in this way. Cancellation will not be effective until it is received by HappinessFirst Pty Ltd.

Participant's Approval *

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