Essential Medical Equipment Payment - Equipment User Declaration form (SA450)

Use this form to consent to your carer receiving the Essential Medical Equipment Payment instead of you.

Download and complete the Essential Medical Equipment Payment - Equipment User Declaration form.

This declaration form is part of the claim for Essential Medical Equipment Payment. To claim the Essential Medical Equipment Payment you’ll also need the Essential Medical Equipment Payment - Medical confirmation 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: 3 March 2022