Aged Care Request for a nominee for Department of Veterans' Affairs customers form (AC019)

Use this form to choose another person or organisation to deal with us on your behalf for aged care costs if you’re a Department of Veterans’ Affairs customer.

You can do this if both the following apply:

  • you get a Department of Veterans’ Affairs payment
  • you live in an aged care home or get a Home Care Package.

The person you authorise is known as a nominee.

Download and complete the Aged Care Request for a nominee for Department of Veterans’ Affairs customers form.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 17 November 2022