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Advice Line
03
8379
7300
NDIS Disability and Community Care Services
NDIS Disability and Community Care Services
Advice Line
03 8379 7300
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Business Details
Legal Entity/Insured Name
*
Trading Name
ABN
Lookup
Estimated Turnover
*
$
Estimated Number of Employees
*
Date Business Commenced (dd/mm/yyyy)
Business Activity
Total must be 100%:
Aged and/or Disability Care Worker
%
Support Co-Ordinator for Disability and Aged Care Services
%
Nursing Services
%
Disability Plan Management
%
Other
%
Please provide details of "Other" Activities
Yes
No
Do you provide any clinical nursing services?
*
Does your business undertake any work outside Australia?
*
Are there any business activities not disclosed above or outside your primary business operations?
*
Business Address
*
Street Number/ Name:
Suburb:
State:
Select state you reside in.
NSW
ACT
VIC
QLD
SA
WA
TAS
NT
Postcode:
Are you a small business eligible for exemption from paying NSW stamp duty
on certain types of Insurance?
Yes
No
Are you able to supply evidence of your Stamp Duty exemption to us upon request?
Yes
No
Contact Information
Is your Postal Address different from the above address?
Yes
No
Contact Address
Street Number/ Name :
Suburb:
State:
Select state you reside in.
NSW
ACT
VIC
QLD
SA
WA
TAS
NT
Postcode:
Name of Contact
Email
*
Contact Number
*
