Retirement Living – Expression of Interest Retirement Living Locations* Victoria Point - Victoria Point, QLD Capricorn - Yeppoon, QLD Caloundra - Little Mountain, QLD Melody Park - Nerang, QLD Who is applyingAre you applying on behalf of someone else? Yes No Your Contact InformationTitleMr.Mrs.Miss.Ms.Dr.Prof.Rev.First Name* Last Name* Contact Phone Number* Contact Email* Relationship to the Applicants/Occupants* Son, Daughter or OtherProspective Resident Information - Primary Applicant/OccupantApplicant/Occupant 1 - Title*Mr.Mrs.Miss.Ms.Dr.Prof.Rev.Applicant/Occupant 1 - First Name* Applicant/Occupant 1 - Last Name* Applicant/Occupant 1 - Date of Birth* DD slash MM slash YYYY Applicant/Occupant 1 - Type of Identification*Please SelectDrivers LicensePassportPhoto Identification CardAdult Proof of Aged CardKeypass IDPlease select from the list a method of identification you can provide.Applicant/Occupant 1 - Religion (Optional) Applicant/Occupant 1 - Are you a return service person?* Yes No Applicant/Occupant 1 - Income* Invalid Pension Old aged Pension War Pension / Vet Affairs Sustentation Superannuation Other Applicant/Occupant 1 - Income Other* Applicant/Occupant 1 - Do you currently receive in-home-care?* Yes No Applicant/Occupant 1 - Who is your current provider?* Applicant/Occupant 1 - Do you own a house or an investment property?* Yes No Applicant/Occupant 1 - Do you need to sell your existing house?* Yes No Applicant/Occupant 1 - When will you sell?* Advise us when you plan to sell your existing home.Is there a Second Applicant/Occupant ? Yes No Secondary Applicant/OccupantApplicant/Occupant 2 - Title*Mr.Mrs.Miss.Ms.Dr.Prof.Rev.Applicant/Occupant 2 - First Name* Applicant/Occupant 2 - Last Name* Applicant/Occupant 2 - Date of Birth* DD slash MM slash YYYY Applicant/Occupant 2 - Type of Identification*Please SelectDrivers LicensePassportPhoto Identification CardAdult Proof of Aged CardKeypass IDPlease select from the list a method of identification you can provide.Applicant/Occupant 2 - Religion (Optional) Applicant/Occupant 2 - Are you a return service person?* Yes No Applicant/Occupant 2 - Income* Invalid Pension Old aged Pension War Pension / Vet Affairs Sustentation Superannuation Other Applicant/Occupant 2 - Income Other* Applicant/Occupant 2 - Do you currently receive in-home-care?* Yes No Applicant/Occupant 2 - Who is your current provider?* Applicant/Occupant 2 - Do you own a house or an investment property?* Yes No Applicant/Occupant 2 - Do you need to sell your existing house?* Yes No Applicant/Occupant 2 - When will you sell?* Advise us when you plan to sell your existing home.Primary Applicant/Occupant 1 - Contact DetailsAddress* Suburb* State* Post Code* Contact Phone Number* Primary Applicant/Occupant 1 - Email* Character ReferenceCharacter Reference - Name* Please provide contact information for a Character Reference.Character Reference - Contact Phone Number* Type of Accommodation - CapricornRental Studio Apartment (Concessional Accommodation Unit) 1 Bedroom Villa (Concessional Accommodation Unit) 2 Bedroom Villa (Concessional Accommodation Unit) Purchased 1 Bedroom Villa (Licence Only) 2 Bedroom Villa (Licence Only) 3 Bedroom Villa (Licence Only) Type of Accommodation - CaloundraRental Studio Apartment (Concessional Accommodation Unit) 1 Bedroom Villa (Concessional Accommodation Unit) 2 Bedroom Villa (Concessional Accommodation Unit) Purchased 1 Bedroom Villa (Licence Only) 2 Bedroom Villa (Licence Only) 3 Bedroom Villa (Licence Only) Type of Accommodation - Victoria PointRental Studio Apartment (Concessional Accommodation Unit) 1 Bedroom Villa (Concessional Accommodation Unit) Purchased 1 Bedroom Villa (Licence Only) 2 Bedroom Villa (Licence Only) 3 Bedroom Villa (Licence Only) Type of Accommodation - Melody ParkRental 2 Bedroom Villa (Concessional Accommodation Unit) Purchased 2 Bedroom Villa (Licence Only) 3 Bedroom Villa (Licence Only) Any Special RequirementsPlease advise if you have any specific requirements.Anticipated date needed to enter the ARPLUS Retirement Community* DD slash MM slash YYYY Spam ProtectionI declare the enclosed details are true and accurate to the best of my knowledge.* Declare CAPTCHAPlease enter the following letters/symbols in the space below.PhoneThis field is for validation purposes and should be left unchanged.
