Appointment of Advocate Or Authorised Representative

Dear Member,

If you would like to appoint an Advocate or an Authorised Representative to handle your matters with us, please follow these steps:

  • Review the important information provided below.
  • Complete the form on the following page.
  • Take the completed form, along with proof of your identity, to a witness as instructed.
  • Sign the form in front of a lawyer, doctor, pharmacist, Centrelink officer, or police member, who will act as the witness.
  • Send the signed form to us at the address above.

If you need help with this process, feel free to contact us.

Important Information:

  1. What is an Advocate?
  • An ‘Advocate’ you appoint can speak with us on your behalf (including lodging a complaint), but they:
    • Cannot modify your account or services.
    • Can only act on your behalf or access your information if you are present and give your consent.
  1. What is an Authorised Representative?
  • An ‘Authorised Representative’ you appoint acts as your agent and can deal with us on your behalf, including making a complaint. They:
    • If given limited rights, can only access the information and rights you specify.
    • If not given limited rights, they have full authority to act and access your information as if they are you.
  1. If there is uncertainty about whether you are appointing an Advocate or an Authorised Representative, we will assume you intend to appoint an Advocate.
  1. Power of Attorney or Guardianship Orders:
  • We may accept someone holding a valid Power of Attorney or Guardianship Order as an Advocate or Authorised Representative.
  • Please provide a certified copy of the Power of Attorney or Guardianship Order with this form (signed by the Attorney or Guardian).
  • We may need to verify the documents before accepting the appointment.
  1. Submission Process:
  • For privacy, security, and fraud prevention, this form must be submitted by post with your original signature and witnessed by a lawyer, doctor, pharmacist, Centrelink officer, or police member.

FORM

Date:___________________________

DD/MM/YYY

Account  ID: ___________________________

Account Holder Name: ___________________________

I wish to Appoint: ___________________________

APPOINTED PERSON’S INFORMATION

Name: ___________________________

Phone:___________________________

Mobile:___________________________

Physical Address:___________________________

Limitation/s on authorisation:___________________________

Time limits on appointment: ___________________________

My Appointment and Authority:

I authorise you to communicate with the individual mentioned above as my Advocate or Authorised Representative (whichever applies). I acknowledge that I am responsible for any actions my Advocate or Authorised Representative takes on my behalf, as specified in this Appointment.

I release Go Troppo from any claims I might otherwise have against you, based on any actions you take in reliance on this Appointment. You may assume you are dealing with the correct person if they identify themselves as my Advocate or Authorised Representative when contacting any of the contact numbers or addresses provided above.

This appointment remains in effect until I formally revoke it in writing.