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Form16.

Participant Representative / Nominee Authority Verification

Complete this form only when someone other than the participant will sign, direct, consent, receive information or make decisions. The participant keeps their own capacity, preferences and supported decision-making rights — record them here rather than working around them.

0 of 12 required questions answered

Fields marked * are required.

PARTICIPANT AND REPRESENTATIVE0/3

Conditional form. Complete only when someone other than the participant will act for them. Where the participant signs and decides for themselves, record the person as a support person and say so in the checklist below.

Optional.

AUTHORITY TYPE AND PERIOD0/1

Authority type (required)

For example "12 August 2026 – 12 August 2027", or "no expiry stated".

VERIFICATION CHECKLIST

Answer every row. Rows that do not apply to this authority are marked "Not applicable" — leaving one blank is not the same as ruling it out.

Participant signs and decides for themselves; representative is only a support personOptional
NDIS plan nominee or child representative evidence sightedOptional
Legal guardian / administrator / enduring authority evidence sightedOptional
Parental responsibility evidence sighted for a child participantOptional
Other lawful authority verified and described belowOptional
Identity of participant and representative verifiedOptional
Scope and limits of authority explained and recordedOptional
Participant's will, preferences, communication and supported decision-making arrangements recordedOptional

EVIDENCE, SCOPE AND LIMITS

Name the document you actually saw, who issued it, its reference and date, and where the copy is filed.

A scan or photo of the document sighted. Stored privately with this record.

JPG, PNG, HEIC, WEBP or PDF, up to 5 MB each. You can drop files here.

What this person may do — and be told — on the participant’s behalf.

VERIFICATION RECORD0/2

Whichever comes first: the authority’s own expiry or the next planned check.

Service restriction pending proofOptional

SIGNATURES0/6

Both columns of the paper form are signed in the same sitting. Signing records that the scope and limits above were explained and are agreed — it does not create the authority, the evidence does.

Sign with your mouse, or your finger on a phone.

Sign here using your mouse or finger

Sign with your mouse, or your finger on a phone.

Sign here using your mouse or finger

Your report goes straight to the coordinator for review.