Seniors Card Application

Complete the form below to apply for your Seniors Card. A one-time service fee of $29.95 AUD applies.

Your Information

Documentation & Payment

Your Information

Please provide us with some information about your application for a Seniors Card.

Select the state/territory where you wish to apply *

Title *

Date of Birth *

First Name *

Middle Name (optional)

Last Name *

Home Address *

Suburb *

State

Postcode *

My postal address is the same as my home address

Postal Address

Postal Suburb

Postal State

Postal Postcode

Phone Number *

Email *