Getting out and about

Companion Card interstate transfer form

Please complete this form if you are moving interstate and you would like us to release your Queensland Companion Card details to a Companion Card program in another state or territory.

  1. Cardholder details
    2. Name
    4. Queensland address
  2. Which state is the cardholder moving to? *
  3. Are you: *
  4. Cardholder contact details (If you chose 'The cardholder' above)
  5. Decision maker contact details (If you chose 'A decision maker' above)
    2. Name
  6. Cardholder/decision maker statement *
  7. Privacy

    1. The information on this form is managed in accordance with the Information Privacy Act 2009. A request for information held by Queensland Government can be made under the Information Privacy Act 2009 (personal information) and the Right to Information Act 2009 (non-personal). For further information about the Information Privacy Act 2009 or the Right to Information Act 2009 visit the legislation website.

Last updated:
10 September 2014