DAVID WILLIAMS FUND

51 Commercial Rd, South Yarra. 3141

2024 Emergency Food Voucher Application Form

Full Name:
Date of Birth:
Phone number:
Email address:
Please  the type of voucher you prefer:
	Coles		Woolies
Please email me a digital voucher (email must be entered above)	
or
I will pick up a printed voucher from PLC	
Vouchers are available after 11 am on the Wednesday of the week following The submission of your application. or
Please mail the voucher to me	
DWF does not take responsibility for vouchers lost in the mail.
Mailing address:
Use address on Penelope	
Checklist:
	I have attached a copy of my current Health Care Card (or there is a copy on Penelope).
	This is my first DWF application in 2024. I have attached a copy of my current Centrelink Income Statement or the DWF has authority.
	I understand that I may be asked to provide a supporting statement or evidence of financial hardship
Client signature:	Date:

Office Use Only:

DWF#
HCC	
CLA	
IS	