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Cardholder Application Form

All 16 pages MUST BE printed and send to Companion Card Program. Applications with missing pages will not be processed.

The Companion Cardholder Application form is available in the following format for you to download and print.

Please do not change any settings when printing this form.

Adobe Acrobat icon Cardholder Application Form (PDF, 134 kb, 16 pages)

This document is provided as an Adobe Portable Document Format. To access this document you will need the program Adobe Reader. This may already be installed on your computer; otherwise you may download it from the Adobe website (http://www.adobe.com/products/acrobat.html).

Have the Cardholder Application Form mailed to you

If you are unable to download the form, please contact the Companion Card program on 1800 650 611 to organise the application form to be sent to you in the mail. Or you may send your request to companioncard@dhhs.vic.gov.au.