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Tenants

Tenants

WCH General consent to exchange information & Authority to Act on Client’s Behalf

This form is to be completed by social housing clients as follows:

For information or assistance with this form, contact 4777 8000 during business hours. Please mark relevant boxed with a X. If you need more room to answer any questions, please include details on a separate page and attach it to this form.

Client Consent to exchange personal information
Authority to Act on client’s behalf
General Information about Privacy
Wentworth Community Housing collects personal information about you in order to make sure you receive the assistance you may be entitled to. You have a right to have that personal information kept private. All social housing providers are bound by privacy and confidentiality laws that limit who can look at information about you and when it can be given out.
Privacy Notice
Wentworth Community Housing complies with NSW privacy legislation when collecting and managing personal information. The information we collect from you or from an authorised third party will be held by Wentworth Community. It will be used to deliver services and to meet our legal responsibilities. We may also use your information within Wentworth Community Housing as a whole to plan, coordinate and improve the way we provide services. Wentworth Community Housing is also legally authorised to disclose information to outside bodies in certain circumstances.
Your consent is needed:
Your consent is not needed if required or authorised by law in limited instances including child protection, urgent health and lawful investigation situations.

General Consent to Exchange Information & Authority to Act on Client’s Behalf

Only one person and/or agency can be authorised to act on your behalf on this form. If you require an interpreter or assistance please contact Wentworth Community Housing on 4777 8000.

Personal Details

Part A: Giving consent for the collection, use and exchange of information

(Complete this section ONLY if you are giving consent to Wentworth Community Housing to collect, use and exchange information with another person or agency)

Details of the person/agency to be contacted

Correspondence address details

Part B: Authorising a person/agency to act on your behalf

(Complete this section ONLY if you are authorising someone to act on your behalf)

Name of person/agency and their relationship to you

Period for Authority (please tick appropriate box below)

To complete this form you will need to click on "Send" button and it will generate a PDF, next step is to print that file, sign it and send it to Wentworth.

Wentworth acknowledges the Darug, Gundungurra and Wiradjuri peoples as the traditional owners of the land on which we work and pay respect to Elders, past and present, and to all Aboriginal people living or working in our communities.

© Wentworth Community Housing. All rights reserved.

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