This service agreement outlines our role in the delivery of your NDIS plan. This agreement is between: Forbes Allied Services and:

Participant Details

Participants Full Name

NDIS Number (FAS referral)

Date of birth

Trusted Person (Service Agreement)

Trusted Person email address (service agreement)

This agreement is valid for the duration of above participants’ NDIS plan dates as follows:

NDIS Start Date (FAS Service Agreement)

NDIS End Date (FAS Service Agreement)

This Agreement is made according to the rules and the goals of the National Disability Insurance Scheme (NDIS). The participant and the service provider agree that this Agreement is in line with the main ideas of the NDIS. Those ideas include things like having more choices, achieving your goals and taking part in the community.

Reasonable and necessary supports to be provided and claimed for:

Support Type 1 (Service agreement) *

Line item 1 *

Frequency & duration 1 *

Total Funding Amount $ (1) *

Do you want to add another support type? (1) *

Yes

Enter 2nd Support type (if required)

Support Type 2 (service agreement)

Line Item 2 (service agreement)

Frequency & duration 2 (Service agreement)

Total Funding Amount $ (2)

Do you want to add another support type? (2)

Yes

Enter 3rd Support Type (if required)

Support Type 3 (Service Agreement)

Line Item 3 (Service Agreement)

Frequency & duration 3 (Service Agreement)

Total Funding Amount $ (3)

Do you want to add another support type? (3)

Yes

Enter 4th Support Type

Support Type 4 (Service Agreement)

Line Item 4 (Service Agreement)

Frequency & Duration 4 (Service Agreement)

Total Funding Amount $ (4)

Do you still want to add another support type? (4)

Yes

Enter 5th Support type

Support Type 5 (Service Agreement)

Line Item 5 (Service Agreement)

Frequency & Duration 5 (Service Agreement)

Total Funding Amount $ (5)

Please read the following and then press "next".

Transport

Transport costs can also be invoiced to your plan provider or directly to you as a participant if this budget is self-managed. This is to be charged at a rate of $0.80 per k/m travelled with participant. Time spent travelling to and from your home can be claimed from your plan provider in line with the NDIS price guide.

Cancelling appointments

In line with NDIS guidelines, 2 clear working days’ notice is required to cancel a scheduled support. If this is not provided, the cost for this scheduled support is able to claimed from your NDIS plan This also applies if you do not show up for a scheduled support within a reasonable time or are not present at an agreed place at the agreed time.

Your Responsibilities

• To discuss any changes to your NDIS plan

• Identify if you no longer wish for support to continue

• Discuss any changes you wish to see in your supports

• Display courtesy and respect

• Display open and honest communication

• To not be substance effected during appointments

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Service provider responsibilities

• Provide the services listed above. Be open and honest about the work completed and the payments claimed

• Explaining things clearly

• Treating you politely and with respect

• Making sure your information is correct and up to date

• Storing your information carefully and making sure it is kept private.

Changing the Agreement

This agreement can be changed at any time. However reasonable time periods to process requests is considered to be 5 business days.

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Ending the Agreement

This agreement can be cancelled by the participant at any time. A notice period of 10 business days is required. The service provider reserves the right to end this agreement at any time if the above participant responsibilities are not met.

Feedback and complaints

It is encouraged to speak openly and honestly regarding any concerns with your supports. This can be done via the following means: Phone: 1300 380 357 Email: [email protected]

Other people you can contact with complaints are your support coordinator (contact details below) or NDIS on 1800 800 110.

Plan Provider Details:

Invoices for services provided (as detailed above) will be invoiced directly to your financial intermediary.

Name of Plan Provider (Service Agreement)

Plan Provider Phone Number (Service agreement)

Plan Provider email address (Service Agreement)