Participant details

NDIS Plan dates

Contact Person/Participant's Representative Details

Delivery address

Address*

Apartment, suite, etc. (optional)

Suburb*

State or territory* Select state NSW VIC QLD WA SA TAS NT ACT

Postcode*

Provider (Livingstone International Pty Ltd) Responsibilities

• Support Participant / Participant's Representative in a honest, open and respectful manner
• Consult Participant / Participant's Representative on how products and services will be provided
• Engage Participant / Participant's Representative on any feedback and work collaboratively to resolve issues
• Respect Participants / Participant's Representative rights to confidentiality and privacy

Participant / Participant's Representative Responsibilities

• the provider (Livingstone International Pty Ltd) what products/ service are to be provided for the Participant
• Provide 14 days' notice by email to terminate Service Agreement with Provider
• Inform Provider immediately if the Participants NDIS plan is suspected / replaced / ended
• Provide sufficient information to the provider so that services can be provided and funds can be claimed in a timely manner

Payment conditions

• The Participant has nominated the NDIA to manage funding for products and services under this Service Agreement with Livingstone International Pty Ltd as a provider. Livingstone International Pty Ltd will claim payment for products and services provided to the Participant from NDIA.
• In the event that Livingstone International Pty Ltd is unable to claim payment for services / products provided from NDIA, the Participant will be liable for any outstanding balance.

GST

• A supply of support under this Service Agreement is a supply of one or more reasonable and necessary supports specified in the statement of supports included, under subsection 33 (2) of the National Disability Insurance Scheme Act 2013 (NDIS Act) in the participant's NDIS Plan currently in effect under section 37 of the NDIS Act. I certify that the above information is true and correct. I have read and understand the Service Agreement Plan and agree to be bound by these conditions.

Signature of Participant/Participant Representative

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