Apply for help If you are in need of Urgent Support click here for a list of services. 1. Applicant DetailsGiven name *Surname *Phone number *Email *Date of birthGenderMaleFemaleOtherStreet AddressCityStateZIP / Postal Code *CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweDo you identify asAboriginalTorres Straight IslanderNeither2. Period of ServiceService PMKeyS NumberCurrent Serving MemberYesNoDischarge TypeDischarge TypeMedicalAdminVoluntaryFrom DateTo DateArea of Service *Area of ServiceNavyArmyAir ForceImpact of Service *PhysicalIllnessMental HealthOtherIf Other, please provide detailsTransition Seminar Attended *YesNoRank Class *ORNCOSNCOOFFROtherOther3. Deployment/sNumber of DeploymentsNoneOneTwoThreeFour or moreLast unit served inDVA File NumberDVA Liability Accepted *YesNoDVA Health Card *WhiteGoldGold with TPIHave you received a lump sum payment? *YesNoAre you currently employed? *YesNoDetails of current and/or planned future DVA applications4. Family DetailsMarital StatusMarital StatusSingleMarried / DeFactoDivorcedSeparatedWidowedSpouse/Partner NameFull Address (if different to service member)Contact NumberNumber of Children/DependentsNumber of Children/DependentsNo Children1234567891011121314155. Advocate/Support Service (If applicable)Contact to assist on your behalf.Name of ContactOrganisation Name or UnitContact NumberContact Email6. Request for AssistanceHow can Bravery Trust assist you?We can call to discuss your request for assistance, if you prefer, please leave this area empty.7. Previous AssistanceHave you previously applied for assistance from us or any other trust/organisation? *YesNoHow did you hear about Bravery Trust? *DVAOpen ArmsBravery Trust WebsiteRSLWord of MouthTransition SeminarSocial MediaOtherADF MemberTick all that are appropriate.If Other, please provide details8. Privacy/Confidentiality Disclaimer and SignatureBy 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 I understand that disrespectful or offensive behaviour toward our staff will not be tolerated, and could result in withdrawal of service Do you Agree to the terms? *YesFull Name *Date *Request for DocumentsIn order to progress your application, it is necessary for Bravery Trust to have the following documents: DVA card, Discharge Certificate or Certificate of Service Evidence of illness/ injury due to service (DVA accepted conditions or medical report) Evidence of financial hardship (last 90days bank statements) The bills you wish us to consider (if applicable) Please email any documents you have available to applications@braverytrust.org.au along with your name in the subject line. If you require support accessing bank statements or your DVA accepted conditions, please let us know. Submit ApplicationSave as DraftPlease do not fill in this field.