Test Page – SolutionsEmpowerment.org

NC #5

NC#5 - Non Consent To Digital ID (Round 1)

"*" indicates required fields

Step 1 of 8

12%

Comments

This field is for validation purposes and should be left unchanged.

Before you start

Please ensure you have pre purchased 2 A4 Registered Post Mailing Envelope before starting.

You will need the Registered Post Mailing Number to complete the document creation process. Registered Post enevelopes can be purchased from any Post Office.

Country*

Welcome to Round 1 of Non Consent To Digital ID Notification Process

Name*

First Last

Your Initials*

E.g John Dow Smith is JDS

Email*

Address*

Street Address Suburb ZIP / Postal Code

State*

Region*

Please select your gender (wo/man)*

Friend's Full Name

First Last

This field is hidden when viewing the form

son

This field is hidden when viewing the form

man

This field is hidden when viewing the form

daughter

This field is hidden when viewing the form

woman

This field is hidden when viewing the form

Unique ID

Spouse or Partner

Do you live with a Spouse (Husband, Wife, Partner) that you would like to add to your documents?

I want to add my Spouse?*

Yes

This field is hidden when viewing the form

I me

This field is hidden when viewing the form

comma

This field is hidden when viewing the form

none waived ever

Spouse's Name*

First Last

Please add their details below.

Children

Would like to add any children (under 18 years) to your documents?

Would you like to add your children?*

Yes

This field is hidden when viewing the form

comma 2

Child's Name*

First Last

Would you like to add another child? (2)*

Yes

This field is hidden when viewing the form

comma 3

Child's Name (2)*

First Last

Would you like to add another child? (3)*

Yes

This field is hidden when viewing the form

comma 4

Child's Name (3)*

First Last

Would you like to add another child? (4)*

Yes

This field is hidden when viewing the form

comma 5

Child's Name (4)*

First Last

Childcare Subsidy & Family Tax Benefit A

Have you had either your Family Tax Beneift A or Childcare Subsidy payments, cancelled, suspended or reduced as a result of non vaccination or not up to date immunisation record?

Do you need a reinstatement letter added for Family Tax Benefits A or Childcare Subsidy*

Yes

Please note you will receive an Extra Document for retaining your benefits / entitlements that will be added to your documents.

Registered Post Mailing Number

Please enter your Registered Post Mailing numbers that is located on the sticker on your Registered Post Envelopes.

Registered Post Mailing Number 1*

Add Respondent #1 Mailing Number

Registered Post Mailing Number 2*

Add Respondent #2 Mailing Number

Mailing Date

What date are you going to Mail your documents. Please leave adequate time to prepare and autograph your documents.

Day*

Month*

Year*

Private Agreement Terms & Conditions for using this Non Consent Process*

I agree to the Terms of Service

Note: You won't be able to check the checkbox and agree to the terms unless you've scrolled to the bottom.

NC#5 - Non Consent To Digital ID (Round 1)

"*" indicates required fields

Step 1 of 8

12%

Name

This field is for validation purposes and should be left unchanged.

Country*

Welcome to Round 1 of Non Consent To Digital ID Notification Process

Name*

First Last

Your Initials*

E.g John Dow Smith is JDS

Email*

Address*

Street Address Suburb ZIP / Postal Code

State*

Region*

Please select your gender (wo/man)*

Friend's Full Name

First Last

This field is hidden when viewing the form

son

This field is hidden when viewing the form

man

This field is hidden when viewing the form

daughter

This field is hidden when viewing the form

woman

This field is hidden when viewing the form

Unique ID

Spouse or Partner

Do you live with a Spouse (Husband, Wife, Partner) that you would like to add to your documents?

I want to add my Spouse?*

Yes

This field is hidden when viewing the form

I me

This field is hidden when viewing the form

comma

This field is hidden when viewing the form

none waived ever

Spouse's Name*

First Last

Please add their details below.

Children

Would like to add any children (under 18 years) to your documents?

Would you like to add your children?*

Yes

This field is hidden when viewing the form

comma 2

Child's Name*

First Last

Would you like to add another child? (2)*

Yes

This field is hidden when viewing the form

comma 3

Child's Name (2)*

First Last

Would you like to add another child? (3)*

Yes

This field is hidden when viewing the form

comma 4

Child's Name (3)*

First Last

Would you like to add another child? (4)*

Yes

This field is hidden when viewing the form

comma 5

Child's Name (4)*

First Last

Childcare Subsidy & Family Tax Benefit A

Have you had either your Family Tax Beneift A or Childcare Subsidy payments, cancelled, suspended or reduced as a result of non vaccination or not up to date immunisation record?

Do you need a reinstatement letter added for Family Tax Benefits A or Childcare Subsidy*

Yes

Please note you will receive an Extra Document for retaining your benefits / entitlements that will be added to your documents.

Registered Post Mailing Number

Please enter your Registered Post Mailing numbers that is located on the sticker on your Registered Post Envelopes.

Registered Post Mailing Number 1*

Add Respondent #1 Mailing Number

Registered Post Mailing Number 2*

Add Respondent #2 Mailing Number

Mailing Date

What date are you going to Mail your documents. Please leave adequate time to prepare and autograph your documents.

Day*

Month*

Year*

Private Agreement Terms & Conditions for using this Non Consent Process*

I agree to the Terms of Service

Note: You won't be able to check the checkbox and agree to the terms unless you've scrolled to the bottom.

NC#5 - Non Consent To Digital ID (Round 1)

"*" indicates required fields

Step 1 of 8

12%

Facebook

This field is for validation purposes and should be left unchanged.

Country*

Welcome to Round 1 of Non Consent To Digital ID Notification Process

Name*

First Last

Your Initials*

E.g John Dow Smith is JDS

Email*

Address*

Street Address Suburb ZIP / Postal Code

State*

Region*

Please select your gender (wo/man)*

Friend's Full Name

First Last

This field is hidden when viewing the form

son

This field is hidden when viewing the form

man

This field is hidden when viewing the form

daughter

This field is hidden when viewing the form

woman

This field is hidden when viewing the form

Unique ID

Spouse or Partner

Do you live with a Spouse (Husband, Wife, Partner) that you would like to add to your documents?

I want to add my Spouse?*

Yes

This field is hidden when viewing the form

I me

This field is hidden when viewing the form

comma

This field is hidden when viewing the form

none waived ever

Spouse's Name*

First Last

Please add their details below.

Children

Would like to add any children (under 18 years) to your documents?

Would you like to add your children?*

Yes

This field is hidden when viewing the form

comma 2

Child's Name*

First Last

Would you like to add another child? (2)*

Yes

This field is hidden when viewing the form

comma 3

Child's Name (2)*

First Last

Would you like to add another child? (3)*

Yes

This field is hidden when viewing the form

comma 4

Child's Name (3)*

First Last

Would you like to add another child? (4)*

Yes

This field is hidden when viewing the form

comma 5

Child's Name (4)*

First Last

Childcare Subsidy & Family Tax Benefit A

Have you had either your Family Tax Beneift A or Childcare Subsidy payments, cancelled, suspended or reduced as a result of non vaccination or not up to date immunisation record?

Do you need a reinstatement letter added for Family Tax Benefits A or Childcare Subsidy*

Yes

Please note you will receive an Extra Document for retaining your benefits / entitlements that will be added to your documents.

Registered Post Mailing Number

Please enter your Registered Post Mailing numbers that is located on the sticker on your Registered Post Envelopes.

Registered Post Mailing Number 1*

Add Respondent #1 Mailing Number

Registered Post Mailing Number 2*

Add Respondent #2 Mailing Number

Mailing Date

What date are you going to Mail your documents. Please leave adequate time to prepare and autograph your documents.

Day*

Month*

Year*

Private Agreement Terms & Conditions for using this Non Consent Process*

I agree to the Terms of Service

Note: You won't be able to check the checkbox and agree to the terms unless you've scrolled to the bottom.