First Choice Sign up form and SA/Consent

NDIS Plan Management
Participant Registration & Sign-up

The friendly and experienced team at First Choice Plan Management would love to help you on your NDIS journey.

Please fill out the registration details below and one of our team will contact you on the next steps.

NDIS Participant Details

NDIS Participant First Name/Last Name *

NDIS number *

Date of Birth *

Gender

Address, including state and postcode *

Street address *

City *

State *

Postcode *

Participant Phone Number (nominee/primary contact details completed further down the form)

Email Address (this address will receive a copy of this completed form and signed service agreement) *

NDIS Plan Details

Plan start date (if known)

Plan end date (if known)

Send us a copy of your NDIS plan

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I am new to Plan ManagementI am changing from another Plan ManagerI am changing from NDIA-managed or Self-managed

I am:

The participant, completing the form for myselfA parent, i am the parent of the participant who is under 18 years of agePlan nominee/guardian, I am the plan nominee/guardian of the participant and i am authorised to make decisions on their behalf

NDIS Nominee or Child Representative

Nominee Name

Nominee phone number

Nominee email address

Service Agreement and Consent

I confirm I have downloaded and read First Choice Plan Management’s Service Agreement and Consent. By ticking this box I am giving consent for First Choice Plan Management to go ahead with NDIS plan management. Read and Download First Choice Plan Management’s Service Agreement & Consent Document *

Name of the NDIS participant, nominee or legal decision maker who is signing this form *

Signature *

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Date *

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