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First Name

Middle Name

Last Name

Enquiry Type

Individual / Personal

Company

Broker

Company Name

ACN Number

Date of Birth

Day

Month

Year

Gender

Male

Female

Current Address

Address

City

State

Post Code

I have lived in this house for less than 3 years

Previous Address (if you have lived in your current address less than 3 years)

Address

City

State

Post Code

Mobile Number

Proof of ID type

Australian Passport Number

Driving License Number

Driving License Card Number

Check the box for help on where to find your driving license card number on your Australian driver's licence

New South Wales

Your NSW licence number is under ‘Licence No.’ on the front of the card. Your card number is also on the front of your card in the top right-hand corner.

Victoria

Your VIC driver’s licence number is under ‘LICENCE NO.’ on the front of your card. Your card number is on the right-hand side on the back of your card.

Queensland

Your QLD driver’s licence number is under ‘Licence No.’ on the front of your card. Your card number is either on the front or back of your card in the centre.

Western Australia

Your WA driver’s licence number is under ‘Licence Number’ on the front of your card. You'll find your card number on the back.

South Australia

Your SA driver’s licence number is under ‘Licence No.’ on the front of your card. Your card number is on the back of your card.

Tasmania

Your TAS driver’s licence number is under ‘LIC NO.’ on the front of your card. Your card number is in the top right-hand corner on the back of your card.

Northern Territory

Your NT driver’s licence number is under ‘Licence Number’ on the front of your card. Your card number is at the bottom on the back of your card.

Australian Capital Territory

Your ACT licence number is under ‘Licence No.’ on the front of your card. Your card number is next to your photo on the card.

Driving Licence Issuing State

Foreign Passport Number

Foreign Passport Country

Medicare Card Number

Name as it appears on Medicare Card

Medicare Card Type

Australian Citizen Medicare Card

Interim Medicare Card

Reciprocal Heath Care Card

Medicare Valid Until Date

Position on Medicare Card

I confirm that I am providing my details only. If I have provided document details above, I consent to my information being matched with the document issuer or official issuer via third party systems for the purpose of verifying my identity.

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