NDIS Service Agreement (SA)
Following the completion of this NDIS Service Agreement, we will process your order and contact you within 3 business days. Please contact us on info@mydiffability.com.au if you have any further questions.
Email address *
This Service Agreement is for: (participant full name) *
NDIS Number *
The participant's Date of Birth (DOB): *
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This Service Agreement is made between My Diffability Australia PTY LTD and: (Participant name / Participant's representative) *
This Service Agreement will commence on (today's date) for a period of 12 months *
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We request to order items from online quote # *
The total cost of the supports, including shipping charges are: *
I am (tick the box that applies): *
I would like to use the following budget from my NDIS plan: *
I confirm that the resources I have selected are reasonable and necessary supports that are related to the participant's / my disability and are likely to be beneficial to me / the participant *
I give consent for a representative of My Diffability to view my plan online through the Myplace portal if required, to help with processing this application / service agreement (optional)
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