Authority to release information (education)

This form gives us permission to collect information about your education. It also enables us to disclose information to other parties so we can manage your claim.

We treat your personal information in confidence and in line with the TAC privacy policy.

Please note: We will never ask you to disclose passwords or transfer funds into an unknown bank account. Please contact us if you have any concerns.

1. Client details

First name *

Last name *

Date of birth *

TAC claim number *

Date of accident *

Address *

Street address *

City *

State *

Postcode *

2. Information about schools, learning centres or child nurses

Please list the names, addresses and contact details of the child’s primary and secondary schools.

For pre-school children, please provide the details of their maternal health nurse, childcare, early learning centre or kindergarten.

Place name *The name of the school, learning centre, maternal child health nurse etc.

Address *

Street address *

City *

State *

Postcode *

Contact name

Contact number

Add another place? *

YesNo

Second school, learning centre or maternal child health nurse

Place name *The name of the school, learning centre, maternal child health nurse etc.

Address *

Street address *

City *

State *

Postcode *

Contact name

Contact number

Add another place? *

YesNo

Third school, learning centre or maternal child health nurse

Place name *The name of the school, learning centre, maternal child health nurse etc.

Address *

Street address *

City *

State *

Postcode *

Contact name

Contact number

3. Authorisation

For the attention of the Principal and the Department of Education

Please provide to the TAC of 60 Brougham Street, Geelong, any information required by it in relation to my education and scholastic achievement before and after the transport accident in which I sustained injuries.

In particular, please provide to the TAC:

School reports and assessments for the named academic years
Any school vocational or careers assessments/advice during the above academic years
Reports of attendance, sick leave and absenteeism during the named academic years

Are you the TAC client? *

YesNo

Your relationship to the client? *For example, parent, guardian, administrator, power of attorney etc.

Please sign in the box below *

Clear

Use your mouse, your finger or a stylus on a touch screen to sign.

Name *

Your name *

Date *

Important information

The TAC will retain the information provided and may use or disclose it to make further inquiries or assist in the ongoing management of the claim or any claim for common law damages. The TAC may also be required by law to disclose this information.

The Transport Accident Act 1986 (the Act), states that when requested to by the TAC, a person must sign an authority to release information form. The Act also says that an authority to release information form cannot be revoked until a claim is finally determined.

The TAC will only use this form to collect relevant information for processing, assessing or managing your claim, and we will always advise you when we use the form to seek relevant information.

If you do not sign the authority to release information form, the TAC may not be able to make a decision about your entitlement to TAC benefits.

If you require further information about the TAC’s privacy policy, or if you have any questions about how we collect or share your information, please call us on 1300 654 329 or visit our website at tac.vic.gov.au