Register Access Requirements (New Zealand)

Disabled person's nameThe Access Card will display this person's name exactly as entered here. A $10 charge for changes to a printed card applies.
Your name (if different)
Telephone number

In order for us to be able to make a decision on your entitlement to a card we need to process information related to your medical condition. This is deemed by the Data Protection Act to be sensitive information. We will not do this without your explicit consent. For more information on our Privacy Policy and how we process information please see the website. If you do not give consent we will not process your application and all information will be permanently deleted upon receipt.

About your Disability / Impairment / Health Condition
Standing and queuing
Wheelchair access
Access to toilets
Assistance dogs
Long distances
Personal assistants / additional support
Accessing visual information
Accessing audible information
Anything else
Back Next
Upload a copy of your benefits entitlement or a Dr's letter
Upload photo ID
Upload a photo
Upload anything else you think might be useful
Upload a link to any media about you that you think may help us make a decision