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Intake form
Help us serve you better
Name
*
Email address
*
What type of payment are you inquiring about?
Please select at least one option.
Age Pension
JobSeeker
Cost of Living Bonus
Pensioner Support Payment
What is your current employment status?
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Employed
Unemployed
Student
Retired
Are you currently receiving any centrelink payments?
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Yes
No
What is your preferred method of contact?
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Phone
Email
In-Person
Please specify your age group.
Select
Under 18
18-24
25-34
35-44
45-54
55-64
65 and over
Which service or services are you interested in?
Please select at least one option.
Age pension management
JobSeeker payment support
Payment management consultation
Additional questions or comments
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