Authority to release personal information - Personal injury, insurance, superannuation or other matter form (SI039)
Use this form to consent to us releasing information about you to a third party.
Download and complete the Authority to release personal information - Personal injury, insurance, superannuation or other matter form.
We will only release personal information about you to a law firm, an insurance company, a superannuation fund, another government agency or other third party organisation, where the information sought can be disclosed under our administrative access scheme.
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: 18 August 2020
This information was printed 22 September 2020 from https://www.servicesaustralia.gov.au/individuals/forms/si039. 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.