LAFHA Enquiry Form GNC

Title

Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

Prefer contact by

Residential Information

Where is your usual place of residence?

Current Address in Australia

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

If your are currently on a visa please provide details of type of visa

Employment Details

Name of Employer / Agency

Job Title

Pay Rate inclusive of Superannuation

Pay Cycle

Family Details

Do you have a partner or defacto living with you ?

YesNo

Do you have any dependants with you ?

YesNo

If yes, how many and what are their ages ?

Number of Dependants

Age of Dependant 1

Age of Dependant 2

Age of Dependant 3

Age of Dependant 4

Type of dwelling

HouseUnit

Number of bedrooms

Comments*