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SA Seniors Card Application Form Oct 2020

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Make the most of your Seniors Card Public transport The Seniors Card was introduced by the South Australian The Seniors Card also serves as your metrocard for use on the Government and private enterprise in 1993 to acknowledge and Adelaide Metro public transport system. Simply validate your show appreciation to seniors for the contribution they have made Seniors Card when boarding a bus, train or tram. to their communities in South Australia. The Seniors Card provides a cash-less method of payment during The Seniors Card program provides members with a peak periods where you simply add credit ($) onto your Seniors South Australian Seniors Card range of benefits including public transport concessions and access Card and the metrocard system will deduct the correct fare. to specially discounted goods and services around South Australia. For more information about how to use your Seniors Card The Seniors Card Discount Directory, Your Lifestyle Guide is on the Adelaide Metro public transport system, please visit Application Form updated annually and lists hundreds of business partners that www.sa.gov.au/seniorscard. offer discounts and benefits to Seniors Card members and will be The metrocard ticketing system is administered by the Department posted to you along with your new card. for Infrastructure and Transport. WeekendPlus is a lifestyle-focussed digital magazine for over Please ensure you have ticked the box overleaf if you wish to 60’s that delivers discounts, special offers, news, events and manage your Seniors Card as a metrocard online. If you have not competitions straight to your inbox each fortnight. Make sure ticked the box, you will not be able to access the Adelaide Metro to include an email address in your application or subscribe by website. emailing [email protected]. We are constantly seeking ways to provide you with a better and metroCARD wider range of benefits throughout the year. We may send you information about the latest special offers available to members that are additional to those listed in the annual Seniors Card Discount Directory, Your Lifestyle Guide. The Seniors Card is a lifetime card and will not be reissued unless it is lost, stolen, broken or if you change your name. If you require a new card, use Seniors Card member online services (available at the Seniors Card website) or contact the Seniors Card Unit. The Seniors Card is for personal use and is not transferable to other people including family members, friends or colleagues. Please use this application form if you are applying for a Seniors Card for the first time. What if my circumstances change? Disclaimer and privacy notice If you require a replacement card, please use Seniors Card Your Seniors Card remains valid provided the eligibility criteria The Seniors Card program collects and uses your personal information for the member online services (available at the Seniors Card website) continue to be met. Should your circumstances change, please purpose of administering the program. This includes mailing your Seniors Card, or contact the Seniors Card Unit. notify the Seniors Card Unit as soon as possible. providing you with free and discounted public transport services, government Please complete the application form clearly using information and special offers from participating businesses. BLOCK LETTERS and tick each appropriate box e.g. n4 To enable us to perform these functions, we utilise some external service Contact the Seniors Card Unit providers including a mail house and we may disclose information to these Phone: 1800 819 961 service providers under strict security rules so they can carry out the services Eligibility we have contracted to them. We may provide your information to other To be eligible for a South Australian Seniors Card, (free call, Monday to Friday 9am – 4pm) Government agencies that provide services to members. We may also disclose you must meet all three of the following eligibility criteria: Email: [email protected] personal information with your consent, or if required or authorised by law. The Web: www.sa.gov.au/seniorscard Seniors Card program requires its contractors to treat your personal information > You are 60 years of age or over confidentially and in accordance with the South Australian Information Privacy > You are a permanent resident of South Australia Facebook: www.facebook.com/seniorscardSA Principles (IPPS) Instruction. Seniors Card member online services: Please note that the Seniors Card program does not endorse or guarantee the > You are not working more than 20 hours per week in www.sa.gov.au/seniorscard/onlineservices quality or suitability of any goods or services offered by participating businesses. paid employment (or do not work at all). Hours can be Please make your own evaluation of each product. The Seniors Card program averaged over a 12 month period. does not provide your personal information to participating businesses. By submitting this application form, you confirm To order more of these forms, If you wish to access or alter the personal information we hold about you, that you meet all of the eligibility criteria. please email the Seniors Card Unit. please contact the Seniors Card Unit by phoning 1800 819 961 or emailing [email protected]. October 2020 Cover photo courtesy of Shelley Milbank. Your details Important Declaration and witness Please complete all details: Please tick the following boxes to show you agree and Seniors Card applicant consent to the following statements: I, ___________________________________________________ (name) Date of birth: ________ / ________ / ________ (day/month/year) I would like to receive special offers and > confirm that I meet the eligibility criteria for the Gender: n Male n Female promotions from the Seniors Card Unit. SA Seniors Card, and > confirm that the information I have provided is true You may receive special offers and other information from and correct, and Title: n Mr n Mrs n Ms n Miss the Seniors Card Unit via email (if you have an email address) > agree to advise the Seniors Card Unit immediately if my and post (up to 12 per year). circumstances change. First name:_______________________________________________ You can opt-out at any time by contacting the Seniors Card Unit. Signature of applicant: ______________________________________ Last name: _______________________________________________ I would like to receive WeekendPlus Date: ________ / ________ / ________ (day/month/year) (must provide an email address). Telephone: _______________________________________________ Witness WeekendPlus is a fortnightly digital lifestyle magazine for seniors, delivering news, special offers and competitions to Mobile: ___________________________________________________ I, ___________________________________________________ (name) your inbox. Email address: _____________________________________________ You can opt-out at any time by contacting the Seniors of _______________________________________________________ Card Unit. ___________________________________________________ (address) Country of birth: ____________________________________________ I consent for my personal information to be confirm that: stored by the Department for Infrastructure Language spoken at home: __________________________________ > I am 18 years of age or over, and and Transport and for the purpose of > I am not related to the applicant, and providing me with services associated with > I have sighted the applicant’s date of birth. For statistical purposes, please tick the box which best describes public transport concessions your income status: Proof of age document sighted (please tick relevant box): The Seniors Card is a dual-use card and is used to obtain Birth certificate Drivers licence Passport n Pension/Government allowance concessions on Adelaide Metro’s public transport network. n n n n Fully/partly self-funded (e.g. superannuation/part-time work) If you do not tick this box, you will not be able to n Other (please specify): ___________________________________ access the Adelaide Metro website to manage your Seniors Card as a metrocard for public transport. Signature of witness: _______________________________________ Postal address: ____________________________________________ Date: ________ / ________ / ________ (day/month/year) Complete this form and _________________________________________________________ return to the address or fax Thank you for your application. below, or complete the online application form at You will receive your Seniors Card within 10 business days. www.sa.gov.au/seniorscard. Suburb: __________________________________________________ Office use only Seniors Card Unit PO Box 196 Seniors Card number: _______________________________________ State: ____________________________ Postcode: ______________ Rundle Mall SA 5000 Fax: 8204 2430 Entered by: __________________________ Date: _____ /_____ /_____.
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