Essential Medical Equipment Payment - Equipment User Declaration form (SA450)

Use this form to consent to your carer receiving the Essential Medical Equipment Payment instead of you.

This declaration form is part of the claim for Essential Medical Equipment Payment. To claim the Essential Medical Equipment Payment you’ll also need the Essential Medical Equipment Payment – Medical confirmation form.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 9 April 2018