Fillable Keypass Application Form Please ensure you take your (Australian National University)

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Keypass Application Form Please ensure you take your (Australian National University)

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The Keypass Application Form Please ensure you take your (Australian National University) form is 4 pages long and contains:

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  • 57 check-boxes
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Page 1 of 4
▼▼
Please turn page over
Keypass
Application Form
Please ensure you take your nominated original identity
documents (including one with a photo) and your
application form to a participating Australia Post Oice.
To be eligible for a concession price, please present an
approved government concession card.
Check the Australia Post website at auspost.com.au/locate
to find your nearest participating outlets or learn more
about Keypass at auspost.com.au/Keypass.
Complete the form using black ink and by placing an ‘X’ in
selection boxes where required.
AustraliaPostoersKeypassin
Digital iD
TM
via your smartphone.
Find out more at DigitaliD.com
Section 1: Personal details
Given name(s); middle initial(s)
Family name / surname
Residential address (exclude GPO boxes)
Unit number
Street number
Street name
Suburb
State Postcode
Gender
X
Male
X
Female
X
Other
Date of birth (DDMMYYYY) Contact number
Email address
Are you a concession card holder? (entitles the applicant to a Keypass concession price)
X
No Continue with this request
X
Yes
Card number
Accepted Government issued cards include:
• PensionerConcessionCard
• CommonwealthSeniorsHealthCard
• State Government Issued Seniors Card
• DepartmentofVeteranAairs(DVA)HealthCard(Gold/White/Orange)
• LowIncomeHealthcareCard
• HealthcareCard
• FosterChildHealthcareCard
• ExCarerAllowance(Child)HealthcareCard
Page 2 of 4
▼▼
Section 2: Application request type
X
A. New card request - 18 years+ (Minimum age: 17 years and 11 months to apply)
• Pleaserefertotheidenticationtableinsection4,choosethreeformsofidentityconsistingof:
1. One document X category A and
2. One document X category B and
3. One document X category B or category C
• Youmusthaveonephotoidentication
• Ifyourcurrentresidentaddressisnotshownonyouridenticationdocuments,chooseoneXcategoryDinadditiontothe
three documents above.
• Ifoneormoreidentitydocumentsdonotmatchthenameontheapplication,chooseoneXcategoryEinadditiontothe
three documents above.
X
B. New card request under 18 years old
• FollowtheidenticationdocumentrequirementsforNewCard18+(seesection2A)
X
C. Change of name and / or residential address request
Was your existing Keypass card issued prior to 2 October 2017?
X
No Continue with this request
X
Yes For a Keypassissuedpriorto2October2017,youhavetwooptions:
• Choose to upgradetothenewKeypasstoaccessmoreservicesbysubmittinga‘newKeypassrequest’(see
section 2A or 2B) to meet new identification requirements or
• Staywiththepre2October2017Keypass.Yourcardexpirydatewillbe1October2022
• For Change of name-Refertotheidenticationtablelist,chooseoneXcategoryE
• For Change of residential address-Refertotheidenticationtablelist,chooseoneXcategoryD
• Please hand in your existing Keypass card with your Keypass application.
X
D. Expired card
• IfyourKeypasscardwasissued prior to 2 October 2017,pleasenotethattheidenticationrequirementsforKeypass
havenowchangedtoahigheridentitylevel.Pleasesubmita‘newKeypassrequest’(seesection2Aor2B)
• ForKeypasscardsissued2 October 2017onwards,pleaseensureyoutakeyourexistingKeypassCardandthis
completedapplicationformtothePostOice.
Section 3: Delivery
Delivery format
X
Regular Post
X
ExpressPost-additionalfeeapplies#
X
Same Day Service (Melbourne only)* - additional fee applies
#CardswillbesentbyExpressPostorSameDayServiceoncetheapplicationhasbeenapproved.Nextbusinessdaydelivery
isonlyavailablewithintheExpressPostnextbusinessdaydeliverynetwork.Formoreinformationvisitauspost.com.au/
expresspostnetwork.Thenationalnextbusinessdaydeliverynetworkoperatesbetweencapitalcities(excludingDarwin;andfor
Perth between CBDs only) and some major centres.
* Same Day Service is onlyavailableatFlindersLaneorFootscrayPostOices,Victoria(appliestobusinessdaysonly)
Page 3 of 4
Section 4: Identification table
Keypass Card:
Choose your identification based on the instructions from your selected application type in Section 2: Application request type.
Note:
• All documents must becurrent/originalsunlessspeciedotherwise.IfadocumentisnotinEnglish,pleaseprovidea
translation,thismustbecompletedbyaNAATIaccreditedtranslator
*
• Inmostcases,youcannotchoosethesamedocumentforseparatecategories.Exceptionsare:
• Ability to choose Immicard in category A and Immicard in category B
• AbilitytochooseAustralianVisaincategoryAandInternationalPassport(Foreign)incategoryB
• ForanAustralianVisa,pleaseensureyoubringyourForeignPassporttotheAustraliaPostOice
• One identity documentmusthaveyourproofofaddress,otherwiseselectanidentitydocumentfromcategoryD.
Category A - Mandatory: Cross ‘X’ one option
X
Australian Birth Certificate (not an
extract)
X
AustralianVisa
I
X
Australian Passport (up to two
yearsexpired)
X
Australian Citizenship Certificate
X
Immicard
X
nternational Passport (if not in
English,withatranslationbya
NAATI accredited translator)
Category B - Mandatory: Cross ‘X’ one option
X
Student Identification Card with
a photo (issued by an Australian
University,AustralianTAFEor
Secondary School)
X
International Passport (Foreign)
X
Australian Passport
X
Australian Defence Force Photo
Identity Card
X
AustralianDriverLicence
X
AustralianLearnerPermit
X
Aviation Security Identification
Card
X
Consular Photo Identity Card
(issued by Department of Foreign
Aairs)
X
East Arnhem Regional Council
Identity Card
X
FirearmsLicence
X
HighRiskWorkLicence(issued by
Australian State /Territory
WorkSafeorSafeWork)
X
LarrakiaNationalIdentity Card
X
Maritime Security Identification
Card
X
PoliceForceOicerPhotoIdentity
Card
X
Prison Certificate release (with ID
Photo)
X
Proof of Age Card (Australian
Government issued)
X
Tangentyere Council Identity Card
X
WorkingwithChildrenCheckCard
Category C - Cross ‘X’ one option from Category C or an additional option from category B above
X
GovernmentBenet–Centrelink
Card
X
Debit / Credit or Savings Card
X
Medicare Card
X
Australian Birth Certificate (not an
extract)
X
Australian Electoral Role Card
X
Australian National Tenancy /
Rental Agreement
X
Certified Australian University
Academic Transcript
X
Commonwealth or State
Government Photo Identity Card
X
Construction Induction Card
X
Foreign Birth Certificate
#
X
ForeignDriverLicence
#
X
Government Benefit - Department
ofVeteranAairsCard
X
Identity Certificate Issued by
DepartmentofForeignAairs&
Trade
X
Identity Document Issued by
DepartmentofForeignAairs&
Trade
X
Security Guard (Crowd Control)
PhotoLicence
X
Student Identification Card with
a photo (issued by an Australian
University,AustralianTAFEor
Secondary School)
X
TaxAssessmentStatement
Notice
X
United Nations Travel Document
Issued by Department of Foreign
Aairs&Trade
Category D - Cross ‘X’ one option if your current address is not shown on any of your identity documents
X
AustralianDriverLicence
X
AustralianLearnerPermit
X
BankStatementorProofofBalance
(less than 6 months old)
X
Council Rates Notice (no older than
12 months)
X
Electoral Enrolment Card
X
LetterfromanAustralian
Government University Institution
X
MotorVehicleRegistration(not
older than 12 months)
X
Rental Agreement (less than 12
months old)
X
Telecommunications Bill (no older
than 12 months)
X
Utility Notice (no older than 3
months)
Category E – Cross ‘X’ one option if your application name diers from the name on your identity documents
X
Change of Name Certificate
X
Marriage Certificate (Australian)
Keypass POI AML V7.10 29/03/2018
Page 4 of 4
I, the Verifier listed below, hereby certify that;
1. This application relates to the person listed in section 2.
2. The identity verification was carried out on the date shown below.
3. The identification documents recorded in the Point of Sale system were produced to me and appear to be originals.
4. The person being identified appears to have similar facial characteristics as the person in the provided photo.
5. I witnessed the applicant sign this application form.
6. The identity verification has been conducted in accordance with standard procedures.
Verifier’s name
Verifier’s signature
Comments
Work centre code
Date (DDMMYY)
Australia Post use only
Min 32mm
Max 36mm
PASSPORT
QUALITY
PHOTO
Secure photo face up
Section 5: Terms and conditions / Lodgement
Section 6: Declaration by applicant
A. Identity verification opt-in
Australia Post offers a variety of identity verification services.
These services are designed to make it easier for you to
transact with Australia Post and other businesses that use
these services. In the future, we may - with your consent - be
able to re-use* this information to save you time on identity
checks for other products and services such as Australia Post
Digital iD™. Your details would not be re-used for any other
purpose.
X
Yes, I consent to Australia Post storing and re-using
my details to help verify my identity in the future, in
accordance with the Privacy Notice.
* Re-use is limited to subscribed providers and subject to the credentials used
for the ID verification being valid.
B. Privacy notice
Australia Post collects your personal information in order to
process your application, including the verification of your
identity. Without this information Australia Post will be unable
to produce your Keypass identity card. Your information will
be used by Australia Post to be matched against oicial
records held by government authorities and the result will
be provided to us via a third party system. In submitting
this form you confirm that you are authorised to provide the
information contained in it to us and consent for us to use
and access information received from your oicial records for
the purposes of processing your application. If one of your
identity documents is an Australian Secondary or Tertiary
Student Identification with Photo, then you consent to
Australia Post verifying your identity and current enrolment
directly with your Institution or Secondary School.
Whilst in our possession, your personal information is handled
in accordance with the Australia P
ost Group Privacy Policy
which outlines how to access and/or correct your personal
information or make a privacy related complaint. For more
information please visit austpost.com.au/privacy.
C. Marketing opt-in
Australia Post can send you information relating to products
and services offered by Australia Post or other businesses. As
part of providing this service, Australia Post will not send your
personal information to other businesses.
X
I would like to receive information on products and
services offered by Australia Post or other businesses.
D. How to lodge your completed application form
1. Locate your closest participating Post Oice at
auspost.com.au/pol or call 13 POST (13 76 78) and lodge
your application form, original identification documents
and payment.
2. The experience:
• AustraliaPostwillverifyyourdetails,copyyouroriginal
documents (check back to source where applicable),
take your photo, and issue a receipt (please retain this
until you receive your card). A secondary check will also
be performed post lodgement
• Ifsuccessful,you’ll receive you Keypass within 10
working days (regular post) or check auspost.com.au for
Express Post delivery times
• If your application is unsuccessful we will advise you in
writing.
Do not sign this form in advance.
Your signatur
e must be witnessed by the Australia Post verifier.
Declaration
I declare that the information in this application
form is true and correct.
Please sign in black ink
inside the box in the
presence of an Australia
Post verifier
Date (DDMMYY)
Photo to be attached
by Australia Post
oicer only
Warning: - It is a criminal oence to provide misleading or false information. Individuals who provide false or misleading
inf
ormation may be subject to prosecution under commonwealth law. Please note once the application is lodged and
payment made the application fee will not be refunded.
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Keypass Application Form Please ensure you take your (Australian National University)

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Completed 18 October 2021

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