Forms

Forms for our clients, family and whānau, and our providers.

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Application form Number
Appeal against Review Decision [PDF, 376 KB]  
Appointment of a Representative [PDF, 671 KB]  VA55
Approved Travel for Assessments, Treatment, Rehabilitation [PDF, 551 KB]  VA23
Certificate of Appreciation and Lapel Badge [PDF, 532 KB]  
Change of Circumstances [PDF, 536 KB]  VA52
Childcare payment for Children of a Deceased Veteran (Scheme Two) [PDF, 484 KB]  VA48
Children’s Bursary [PDF, 791 KB]  VA08
Children’s Pension [PDF, 617 KB]  VA06
Dependant’s Pension [PDF, 709 KB]  VA07
Disablement Pension [PDF, 1.1 MB]  VA01
Disablement Pension and Lump Sum Payment Maximum rate for terminal condition [PDF, 484 KB]  VA03
Employment and Earnings Declaration [PDF, 532 KB]  VA51
Financial Advice [PDF, 504 KB]  VA49
Funding for Commemorative Event or Project [PDF, 512 KB]  VA24
Funding for Commemorative Travel [PDF, 502 KB]  VA20
Funeral Expenses [PDF, 914 KB]  VA14
Independence Allowance Lump Sum (Scheme Two) [PDF, 496 KB]  VA34
Individual Care Plan for Audiologists [PDF, 289 KB]  
Memorial Contribution (Plaque or Headstone) [PDF, 482 KB]  VA29B
Memorial Order Form (Plaque or Headstone) [PDF, 492 KB]  VA29A
Personal Information and Consent Form [PDF, 497 KB]  VACON
Private Hospital Surgery [PDF, 755 KB]  VA26
Reconsider Decision [PDF, 638 KB]  VA15
Registration of Deceased Spouses and Partners of Viet Nam Veterans’ [PDF, 639 KB]  
Registration of Deceased Viet Nam Veterans [PDF, 451 KB]  
Registration of the Deceased Children of Viet Nam Veterans’ [PDF, 435 KB]  
Registration of Viet Nam Veterans [PDF, 439 KB]  
Registration of Viet Nam Veterans’ Children and Grandchildren [PDF, 442 KB]  
Registration of Viet Nam Veterans’ Spouses and Partners [PDF, 428 KB]  
Retirement Lump Sum [PDF, 583 KB]  VA13
Review of Decision [PDF, 616 KB]  VA16
Statutory Declaration [PDF, 258 KB]  
Surviving Spouse or Partner Pension [PDF, 837 KB]  VA05
Surviving Spouse or Partner Pension—New Relationship (Scheme One) [PDF, 549 KB]  VA18
Survivor’s Grant and Weekly Compensation [PDF, 613 KB]  VA47
Transfer to a Disablement Pension [PDF, 308 KB] VA1A
Travel Concession Payment [PDF, 504 KB]   VA40
Travel Concession Dispensation from the Normal Evidential Requirements [PDF, 238 KB]  
Travel—Long Term Hospital Care [PDF, 527 KB]  VA33
Travel Statutory Declaration [PDF, 282 KB]  
Treatment and Rehabilitation [PDF, 671 KB]  VA30
Treatment Expenses (other) [PDF, 592 KB]  VA22B
Treatment Expenses (vet) [PDF, 587 KB] VA22A
Veteran Support [PDF, 888 KB] VA56
Viet Nam Veterans Annual Medical Assessment (AMA) [PDF, 711 KB]  
Weekly Income Compensation [PDF, 1.1 MB] VA04