Section 1: Completed by the Applicant or Representative

Part A: Applicant’s Information

In Part A, you need to provide some information about yourself and where you live. To be eligible for the NDIS you must be under 65, live in Australia and be an Australian citizen or hold a permanent or special category visa.

Applicant Details
1. Title: (e.g. Ms, Mr, Mx)
2. Given name/s:
3. Preferred name:
4. Surname:
5. Have you ever used, or been known by another name? No / Yes – provide details below.
6. Do you have a preferred gender and/or pronoun?
7. What is your date of birth? (DD/MM/YYYY)
8. Are you of Aboriginal and/or Torres Strait Islander origin?
9. What is your country of birth?
10. Are you living in Australia permanently?
11. Are you an Australian citizen?
12. What type of visa do you have?
13. What is your current home address?
14. Is your postal address the same as your home address?
15. Do you have an immediate family member who is applying for the NDIS or is already a participant?