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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