Aged Care Appointment of a Nominee form (AC019)
Use this form to authorise another person to deal with us on your behalf if you are in residential aged care or are receiving a home care package.
Download and complete the Aged Care Appointment of a Nominee form.
The person you authorise is known as a nominee.
This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.
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: 28 January 2020
This information was printed 18 September 2020 from https://www.servicesaustralia.gov.au/individuals/forms/ac019. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.