Members Area

The Dieri Aboriginal Corporation RNTBC provides Members with a number of payment policies to Improve the Lives of Dieri People. Members can apply here by selecting the form you are applying for below.

Member Policy Applications

Please select which form you are interested in filling out(Required)

Date

Member Details

Title

Mrs

Miss

Other

Date of birth

Name(Required)

First Last

Address(Required)

Street Address Suburb State Postcode

Phone(Required)

Email(Required)

Name of Parent/Guardian if under the age of 18

Have you been selected for State or National

State

National

Elder Details

Title of Dieri Elder

Mrs

Miss

Other

Date of Birth of Dieri Elder

Name of Dieri Elder

First Last

Address(Required)

Street Address Suburb State Postcode

Phone(Required)

Email(Required)

Full Name of Member assisting with this policy application (if applicable)

First Last

Deceased's Details

Date of birth of the deceased

Full name of the deceased

First Last

Your relationship to the deceased

Claim Details

How much are you claiming?(Required)

Where will you be traveling to?(Required)

How many days treatment are you claiming?(Required)

Location of treatment(Required)

Is there any other source of funding you can claim

Yes

Are you applying 14 days prior to June 30th?

Yes

Is this a work related injury?

Yes

Is this your first license or whitecard?

Yes

Is the course/qualification part of a penalty or discipline process?

Yes

Type of supporting documentation(Required)

Supporting documentation

Drop files here or

Max. file size: 128 MB.

Please provide the bank details of the account that the money will be paid to:

Account name

Name of bank

BSB

Account number

Agreements

Please check all that apply. You can only qualify for this application if you meet all of the below criteria

You are a member of the Corporation and are 60 years or over

If you are seeking assistance for maintenance of vehicles, you have provided proof of the registered owner of the vehicle

Please check all that apply. You can only qualify for this application if you meet all of the below criteria

You are a member of the Corporation and are between 18 - 59 years of age

If you are seeking assistance for maintenance of vehicles, you have provided proof of the registered owner of the vehicle

The information in this form is correct and I agree to be bound by the terms of the Policy of the Corporation(Required)

I agree

The details you have provided are all true and correct. The Corporation is also not responsible for any payments made to third parties where incorrect details have been provided by the claimant

Member Forms

Please select which form you are interested in filling out(Required)

Date

Member Details

Name(Required)

First Last

Date of birth

Address(Required)

Address Suburb State Postcode

Phone(Required)

Email(Required)

Name of bank

Account name

BSB

Account number

Please provide the names and date of birth of any Children

Child's name

Child's date of birth

Please also update my children's contact details to the ones above

Yes

Reason for the registered Dieri parent not claiming Policy payment for their own child/children?

Divorce/Separation

Incarceration

IVO in place

Dieri Partner has passed away

Other reason:

For example: Foster Care/Kinship Care, Court Orders or Custody Battles etc.

Family Details

Children's names

Mother's name

Father's name

Grandparent's names

Great grandparent's names

I am descended from the following apical ancestor(s):

Ruby Merrick and Tim Maltalinha (also known as Tim Merrick) who are the parents of the sibling set - Martin, Gottlieb, Rebecca, Selma (or Thelma)

Yes

Kuriputhanha (known as 'Queen Annie') mother of Karlawarru (also known as Annie)

Yes

Mary Dixon (born at Killalpaninna) mother of the sibling set - Dear Dear (known as 'Tear'), Jack Garret, George Mungerannie, Joe Shaw, and Henry

Yes

Bertha mother of the sibling set - Johannes and Susanna

Yes

Walter Kennedy husband of Selma (also known as Thelma) nee Merrick

Yes

Florrie wife of Martin Merrick

Yes

Clara Stewart (nee Murray), the mother of Eddie Stewart

Yes

The man Pinngipania (born at Lake Hope) and the woman Kulibani (born at Kalamarina) who are the parents of Sam Tintibab (or Dindibana Ginjmilina)

Yes

Upload supporting documents

Please upload your supporting documents. See description below for documents you can upload.

Drop files here or

Max. file size: 128 MB.

Please include at least one:
Birth Certificate or Statutory declaration from a TDAC Elder and Family Statement from another TDAC member stating connection

Non-Dieri Spouse Details

Non-Dieri Spouse name

First Last

Non-Dieri Spouse date of birth

Non-Dieri Spouse address

Address Suburb State Postcode

Non-Dieri Spouse phone

Non-Dieri Spouse email

Please provide the names of any Dieri children you share

Non-Dieri Parent/Caregiver Details

Non-Dieri parent/caregiver's name

First Last

Non-Dieri parent/caregiver's phone

Non-Dieri parent/caregiver's email

I declare that I am the Non-Dieri parent/caregiver of the following child/children:

Child's name

Child's date of birth

Third Party Nominee Details

Nominee name

First Last

Nominee date of birth

Nominee's relationship to you

Nominee address

Address Suburb State Postcode

Nominee phone

Nominee email

You authorise the third party nominee to collect your Port Augusta BigW eGift voucher?

Yes

You authorise the third party nominee to receive your information in regards to your TDAC Member Policy Payments

Yes

You authorise the third party nominee to receive your Dieri Medical Policy Payment as the carer who will be assisting to get you to your appointment

Yes

Feedback Details

Please explain your feedback or suggestion below:

Complaint Details

In the space below, please provide a short summary of your complaint. Please include what happened, when, where and who was involved.

Please upload any supporting documents for your complaint

Drop files here or

Max. file size: 128 MB.

Agreement

I, The Dieri member, request The Dieri Aboriginal Corporation RNTBC to remove my Non-Dieri Spouse from the Dieri Register as they are no longer my Spouse.

I agree to their removal.

I understand if I am accepted as a member, that the contact information provided will be held on a contact database.

I agree to my information being held.

I acknowledge that I understand the responsibility and role of Members under the TDAC rule book.

I agree to the responsibilities of Dieri Members.

The registered Dieri Parent declares that they are no longer in contact with their child/children. They authosire the Non-Dieri Parent/caregiver (as listed above), to claim the TDAC Policy Payment entitlements on behalf of your child/children as listed above.

I authorise the parent/caregiver to claim the entitlements.

Signature of Registered Dieri Parent

If the registered Dieri parent is unavailbale to sign, an immediate member will need to provide a signature. In some cases, you may be required to provide a Statutory Declaration form or other forms of verification.

Please sign to acknowledge that the information in this form is correct and you agree to be bound by the terms of the Policy of the Corporation(Required)

I agree to be bound by the Rules of The Dieri Aboriginal Corporation RNTBC, including the Member Responsibilities under Rule 5.2.2: (a) To comply with the Act and these Rules. (b) To notify the Corporation of any change to my address within twenty-eight (28) days. (c) To comply with any Code of Conduct adopted by the Corporation. (d) To treat other members and Directors with respect and dignity. (e) To not behave in a way that significantly interferes with the operation of the Corporation or Corporation meetings.

Members Updated Contact Details Form

Non-Dieri Spouse Updated Contact Details Form

Dieri Membership Application Form

Non-Dieri Spouse Application Form

Complaints Form

Feedback & Suggestion Form

Non-Dieri Parent/Caregiver Form

Non-Dieri Spouse Removal Request Form

Members Third Party Authority Form