Application Form – Bravery Trust

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Bravery Trust exists solely to support veterans. You served our nation, now it’s our time to serve you when you need us most. It’s always brave to ask for help.

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Confirm you are eligible to receive support.

Serving ADF member/Ex-serving ADF member

Serious illness or injury as a result of service

In financial hardship

Application Form

For any queries, please contact:

1800 BRAVERY

1 Applicant

2 Service Details

3 Family Details

4 Advocate / Support Service

5 Request for assistance

6 Previous Assistance

7 Financial Details

1. Applicant Details

Given Namesub label(a)

Surnameyour surname

Contact Numberyour full name

Emaila valid email

mm (DOB)

Date of Birth (dd/mm/yyyy)your date of birth

Gender

FemaleMaleOther

Marital Statusyour marital status

Addressyour current address

Country of Birth

Do you identify as:

AboriginalTorres Straight IslanderNeither

2. Service Details

Service/PMKeyS no.your marital status

Discharge Typeyour marital status

Period of Service:

Fromof appointment

Toof appointment

Servicepick one!

Impact of Service

PhysicalIllnessMental HealthDeceased

Transition Seminar Attended:

YesNo

If Yes, where and when?

Rank Class:

ORNCOSNCOOFFR

Deployment/s

Number of Deployments

NoneOneTwoThreeFour or more

Deployment Location #1

From1

To1

Deployment Location #2

From2

To2

Deployment Location #3

From3

To3

Deployment Location #4

From4

To4

Last unit servered inyour full name

DVA File Numberyour full name

DVA Liability Accepted:

YesNo

DVA Health Card:

WhiteGoldGold with TPI

Have you received a lump sum payment?

YesNo

Are you currently employed?

YesNo

Details of current and/or planned future DVA applications

0 /

3. Family Details

Spouse/Partner name:your spouse/partner name

Full Address (if different to service member):your spouse/partners address

Contact Number:your spouse/partner's contact number

Number of Children/DependentsNumber of Children

Child / Dependant 1

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 2

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 3

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 4

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 5

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 6

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 7

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 8

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 9

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 10

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 11

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 12

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 13

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 14

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

Child / Dependant 15

Child / Dependant Name:Child Name

Date of BirthChilds Date of Birth

Gender

MaleFemale

4. Advocate/Support Service or contact to assist on your behalf

Name of Contactyour spouse/partner name

Organisation name or UnitOrganisation name or Unit

Contact NumberContact Number

Emaila valid email

5. Request for Assistance

We can call to discuss your request for assistance, if you prefer, please leave this area empty.

How can Bravery Trust assist you?Please advise us how you think Bravery Trust may be able to assist you: (There are some areas that we cannot assist with. E.g. loans, government debt, fines and legal fees)

0 /

6. Previous Assistance

Have you previously applied for assistance from us or any other trust/organisation?

YesNo

If Yes from whom, when and what assistance was provided?

0 /

How did you hear about Bravery Trust (tick all that are appropriate)?

DVAOpen ArmsBravery Trust WebsiteRSLWord of MouthTransition SeminarSocial MediaOther

If Other, please detail

0 /

7. Privacy/Confidentiality Disclaimer and Signature

By submitting this form to Bravery Trust:

I certify that my answers are true and complete to the best of my knowledge

I authorise Bravery Trust to act on my behalf in any dealings as required with Third parties/Agencies. These will be discussed and confirmed with Bravery Trust as part of my application
I acknowledge Bravery Trust is entitled to make any reasonable enquiry to ensure the appropriate use of financial assistance
I acknowledge that this permission will remain in place with this application until written advice is received withdrawing permission
I understand that any false or misleading information in my application may result in withdrawal of assistance and/or recovery of monies paid
I give permission for Bravery Trust to contact me to provide feedback on my application

Do you Agree to the terms?

Yes

Full Nameyour full name

Dateof appointment

Request for Documents

Please attach all required documents.

- Evidence of illness/ injury due to service ( DVA or medical report)

- Served in the Defence Certificate of Service or DVA acceptance

- Evidence of financial hardship (bank statements)

- The bills you wish us to consider

If you do not currently have access to all the required documents, Bravery Trust will contact you at a later date to supply.

Fileupload

Upload Documents

Have you uploaded all documents

YesNo

If you don’t have the required documentation you can email at a later stage to ask@braverytrust.org.au.

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Bravery Trust changes lives by ensuring that injured veterans and their families do not suffer as a consequence of their service and are provided with emergency support and assistance in their time of need.

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T: 1800 BRAVERY
E: ask@braverytrust.org.au

Bravery Trust is a registered business name of the Australian Defence Force Assistance Trust, a nationally registered charity.