Fillable Interstate Seniors (excluding ACT Seniors) Application for a

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Interstate Seniors (excluding ACT Seniors) Application for a

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The Interstate Seniors (excluding ACT Seniors) Application for a form is 2 pages long and contains:

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  • 9 check-boxes
  • 21 other fields

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UNCLASSIFIED
SENSITIVE: PERSONAL
Section B – Application type (select one option only)
Section A – Conditions of issue and use
Section C – Applicant details
IMPORTANT
• You should submit this application at least three to four weeks before you need to travel to allow time for
processing and postal delivery.
• You need to include a photocopy or scan of your Seniors Card (front and back) with your application.
• The Gold Opal card will not expire while you remain eligible for your interstate Seniors Card.
• We recommend that once you receive your Gold Opal card you should register it at
www.transportnsw.info/opal to keep track of your journeys and card balance, set up auto top up, and
protect your balance if your card is lost or stolen.
• If you’re an ACT Seniors Card holder or an interstate Pensioner Concession Card holder, you do not need
to fill out this form. You can apply for your Gold Opal card at www.opal.com.au/ordercard.
This form is for use by interstate (excluding ACT) Seniors Card holders only.
ACT Seniors Card holders should NOT use this form
To be eligible for a Gold Opal card, you must hold a valid government-issued Seniors Card issued by
an Australian State or Territory. You will need to include a copy of your Seniors Card (front and back)
with this application. The Gold Opal card provides half-fare concession travel in the Opal network
(Sydney, the Blue Mountains, Central Coast, Hunter, Illawarra and Southern Highlands) capped at
$2.50 per day. An additional station access fee applies when travelling to or from Sydney Airport
Domestic or International stations. Gold Opal cards for interstate seniors will remain active while you
remain eligible for your interstate Seniors Card. Using the Gold Opal card is subject to the Opal
Terms of Use, available at www.transportnsw.info/opal-terms-of-use.
Transport for NSW - Form no. 5341 (January 2020)
Page 1 of 2
Interstate Seniors (excluding ACT Seniors)
Application for a Gold Senior/Pensioner Opal card
Surname:First name:
Street number / name:
Suburb: State: Postcode:
Address
Delivery
address
(if different)
Contact phone number:
How would you like to be contacted in the future about this Concession Entitlement? (select one option only)
Email – Provide your email address:Post
Seniors card number:
State or Territory that issued your card:
Postcode:State:Suburb:
Street number / name:
Date of birth:
day month year
If the card was issued in the ACT, please do not use
this form but instead apply online at opal.com.au
New application
Replacement application
UNCLASSIFIED
SENSITIVE: PERSONAL
Section E – Applicant declaration – please read and complete the applicant declaration
Check list
I wish to apply for a Gold Senior/Pensioner Opal card. I have read the Privacy Notice (at Section D), and
I consent to the collection, use and disclosure of my personal and health information by TfNSW as
described in the Privacy Notice available at transport.nsw.gov.au/about/privacy.
I confirm that I have read and agree to the Opal Terms of Use described in Section A and available at
transportnsw.info/tickets-opal/opal/opal-terms-of-use
. I also confirm that I have read and agree to the
Conditions of issue and use (at Section A).
I declare that the information provided by me in this application is true and correct. I understand that is an
offence to attempt to obtain the benefit of a concession entitlement by false statement or other dishonest
means.
Section D – Privacy notice
Save this completed application form.
Then select the link below to submit your application and upload any supporting documents.
Online
transportnsw.info/concessions-application
Name:
Transport for NSW (TfNSW) is committed to
protecting the privacy of your personal information,
in accordance with the Privacy and Personal
Information Protection Act 1998 (NSW) and the
Health Records and Information Privacy Act 2002
(NSW) (NSW privacy laws).
Personal information provided on this application
form is collected for the purpose of administering
and managing your entitlement to concession
travel and for directly related purposes such as
audit, management and operational activities for
concession travel.
You may choose not to provide your personal
information to TfNSW. However this may mean
that it is not possible or practicable for us to deal
with your application for concession travel.
So that we can deal with your application and
manage your entitlement to concession travel,
we may share your personal information with
agencies issuing Seniors Cards in Australian
states and territories.
Otherwise we will not disclose your personal or
health information unless you consent, or we
are permitted or required to by law.
Where TfNSW engages contractors to assist
us in providing our services to you, we generally
engage them under contract terms that ensure
that they use personal information solely for the
purpose of fulfilling their contract with us. We also
generally require them to manage the personal
and health information that they hold on our behalf
in a way that complies with NSW privacy laws.
For information about how your personal
information is collected, used and disclosed by
us, please see our Privacy Policy at
transport.nsw.gov.au/about/privacy
.
For information about how your personal
information is collected, used and disclosed in
the Opal ticketing system, read our Opal Privacy
Policy at transportnsw.info/opal-privacy-policy
.
TfNSW will keep your information at 18 Lee Street,
Chippendale NSW 2008. You can ask to access
or amend your personal information held by us at
any time during business hours, by contacting
privacy@transport.nsw.gov.au
or PO Box K659,
Haymarket NSW 1240.
Date:
I am submitting this application at least three to four weeks before my travel date (to allow enough time to
receive my Opal card)
I am attaching a photocopy or scan of my Seniors Card (front and back)
Page 2 of 2
Transport for NSW - Form no. 5341 (January 2020)
day month year
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Interstate Seniors (excluding ACT Seniors) Application for a

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Completed 13 October 2021

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