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100 Point Identity Verification Form the Purpose of This Form Is to Verify the Identity of People Who Chose “Requesting Organisation” Rather Than Online Verification

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100 Point Identity Verification Form the Purpose of This Form Is to Verify the Identity of People Who Chose “Requesting Organisation” Rather Than Online Verification Synod of South Australia 100 Point Identity Verification Form The purpose of this form is to verify the identity of people who chose “Requesting Organisation” rather than online verification. This form should be used after the Department of Human Services (DHS) online application has been completed. The Synod Safe Church Committee has determined that, from the list of possible verifers provided by the DHS, those in the following roles in the Uniting Church in South Australia can confirm applicants identity by sighting the required documents: • Ministers • Members of Church Council • Ministry and office staff of Uniting Churches in South Australia These verifiers should use this form to record which identity documents they have sighted. No identification documents are required to be forwarded or filed. SECTION 1: PERSONAL INFORMATION Use BLOCK LETTERS and black ink to complete this form. Full name as listed on DHS online application Surname (Current Legal) Given Names (Current Legal) Date of Birth (dd/mm/yyyy) Application Number (begins with AP) Phone Email SECTION 2: VERIFICATION OF IDENTITY (100 POINT CHECK) You will be asked to provide personal identity documents that add up to a minimum of 100 points. • The combination of documents supplied should, as a minimum, evidence your full name, date of birth and photograph. • All documents must be originals or certified true copies. A certified copy means a document that has been certified as a true copy of an original by a person listed in Schedule 2 of the Statutory Declarations Regulations 2018 (Cth) which is available from https://www.legislation.gov.au/Details/ F2018L01296. • If an individual does not have a photographic identity document from Category A or B, they must submit a passport-style photograph that has been certified by an individual listed in Schedule 2 of the Statutory Declarations Regulations 2018 (as above). • Documents must be selected and ticked on the list overleaf. Change of Name on identity documents If the name you use to apply to the DHS is different from that shown on any of your personal identity documents, you must provide evidence of the name change, e.g. Marriage or Change of Name Certificate issued by a State or Territory Registry of Births, Deaths and Marriages and Divorce papers issued by the Family Court. These documents must be originals or certified true copies and DO NOT count towards the 100-points. Questions regarding this form should be initially directed to your Safe Church Congregation Liaison. 100 Point Identity Verification Form v1 20 August 2019 1 of 3 Document Type Document - 100 points must include: Points Points • ONE from Category A or at least ONE from Category B Value Scored • ONE of the above must include a photograph P Please tick which document was used to verify the identity Only ONE form Category A of identification Birth Certificate (complete - not extract) accepted from this Certificate of Australian Citizenship category Australian Passport (Current, or expired within the previous two years, but not cancelled) 70 Foreign/International Passport (Current, or expired within the previous two years, but not cancelled) Other international document of identity having same characteristics as a passport e.g. diplomatic/refugee (Photo or signature) The first document Category B in Category B will Australian Motor Vehicle Driver’s Licence/ Learner Permit score 40 points. Public Employee Photo ID Card (Government Issued) Department of Veterans’ Affairs (DVA) Card Additional Centrelink Pensioner Concession Card OR Health Care Card documents will be (One only) 40 or awarded 25 points Current student photo ID (high school/TAFE/university) 25 each. Reference from a medical practioner (must have known the applicant for a period of at least 12 months) Working With Children card/Teachers Registration card Aviation Security OR Maritime Security Identification card (One only) If you wish to use Category C more than one Extract of a Birth Certificate document from Proof of Age Card (Government Issued) Category C, Medicare Card OR Private Health Care Card (one only) they must be Senior’s Card from different Assessment Notice from the Australian Taxation Office organisations. Superannuation Statement Electoral roll registration notice Professional or trade association card Foreign/International Driver’s Licence Council rates notice Property lease/rental agreement 25 Property insurance papers Motor vehicle registration or insurance documents 1st Utility bill: electricity / gas / telephone / water (please circle) 2nd Utility bill: electricity / gas / telephone / water (please circle) 3rd Utility bill: electricity / gas / telephone / water (please circle) 1st bank / financial institution statement or passbook 2nd bank / financial institution statement or passbook 3rd bank / financial institution statement or passbook 1st credit card / debit card (please circle) 2nd credit card / debit card (please circle) 3rd credit card / debit card (please circle) Points subtotal Continue onto next page 100 Point Identity Verification Form v1 20 August 2019 2 of 3 SPECIAL PROVISIONS ONLY TO BE USED IF 100 POINT CHECK ABOVE CANNOT BE MET For recent arrivals 6 weeks or less – proof of arrival date required: in Australia Note arrival date here:____________________ 100 Current passport The full 100 point check is required when the applicant has been in Australia for longer than 6 weeks. Aboriginal person or If 100 points can’t be completed from Category A, B, or C: up to Torres Strait Islander two letters provided by recognised community leaders in the 100 resident in a remote community to which the applicant belongs can be counted as area/community 50 points each. Child under 18 Birth Certificate Australian Passport (current, or expired within the previous two years, but not cancelled) Australian Citizenship Certificate International Passport (current, or expired within the previous two years, but not cancelled) NA NA Other document of identity having same characteristics as a passport eg. diplomatic/refugee (Photo or Signature) OR Statement from an educational institution, signed by the principal or deputy principal, confirming that the child attends the institution (statement must be on the institution’s letterhead) Points must equal a total of 100 or more. Total Points Scored Requesting Organisation Verifier (you must tick all three) I declare that I have sighted and confirmed the applicant’s original or certified true copy personal identity documents and that verification has been achieved using the 100 point check. I confirm that the applicant’s identity is proven. I confirm that I have sighted a photographic evidence of identity. Name of verifier: (please print) Role: (either: minister, church council member, ministry/office staff) Congregation/Body of verifier: Contact phone/email: Signature of verifier: Date: Privacy Statement All information collected on this form is managed in accordance with the Uniting Church SA Privacy Policy 2014. It has been collected for the primary purpose of verifying the identity of an individual applying for screening as conducted by the Synod of South Australia. If you need clarification about what constitutes an authorised activity or you have any other privacy related queries, please contact Rev Sue Page on (08) 8236 4217 or [email protected] Return this form only to: Scan and email: [email protected] Post: Attn: Screening Services Unit UCA SA Synod GPO Box 2145 Synod of South Australia Adelaide SA 5001 100 Point Identity Verification Form v1 20 August 2019 3 of 3.
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