GOODS/SERVICES. Tax (GST) For the purposes of GST legislation, the parties confirm that: A supply of supports under this Service Agreement is a supply of one or more of the reasonable and necessary supports specified in the statement included, under subsection 33(2) of the National Disability Insurance Scheme Act 2013 (NDIS Act), in the Participant’s NDIS plan currently in effect under section 37 of the NDIS Act Alpha Plan Management will pay GST as per specified in the National Disability Insurance Scheme Xxx 0000 (xxxxx://xxx. xxxxxxxxxxx.xxx.xx/Xxxxxxx/X0000X00000) (NDIS Act) Schedule of Supports – Improved Life Choices Support Item Support Item Ref No Description Price Limit Plan Management and Financial Capacity Building - Set Up Costs Plan Management – Financial Administration 14_033_0127_8_3 14_034_0127_8_3 A one-off (per plan) fee for setting up the financial management arrangements A monthly fee for the ongoing maintenance of the financial management arrangements. $232.35 non remote $325.29 remote $348.54 very remote $104.45 per month TOTALS Based on 12 Total 12 months + $1485.75 months of plan $232.35 setup fee management Total 12 months + $1578.69 $325.29 setup fee Total 12 months + $1601.94 $348.54 setup fee CB and Training in Plan and Financial Man- agement by a Plan Manager 14_031_0127_8_3 Capacity Building and Training in Plan and Financial Management by a Plan Manager $63.21 non remote $88.49 remote $94.82 very remote Provider travel - non-labour costs 14_799_0127_8_3 TBA Prices are current as per the NDIS Price Guide 2020-21 and Support Catalogue. Prices may change over the life of this agreement and Alpha Plan Management will automatically adjust all pricing in line with any NDIS Price Guide updates/changes. Contact A. NDIS Participant Details Title First Name Surname NDIS Number NDIS Plan Dates From To Primary Disability Date of Birth Phone Number Street Address Suburb State Postcode Email Contact B. Primary Nominated Representative Details e.g. parent or guardian Title First Name Surname Email Phone Number Relationship To Participant Organisation (if applicable) Contact C. Secondary Nominated Representative Details e.g. parent or guardian Title First Name Surname Email Phone Number Relationship To Participant Organisation (if applicable) Contact D. Support Coordinator (optional/if applicable) Full Name Email/Phone Organisation (if applicable) I consent for Alpha to discuss the details of my plan with this person I consent for Alpha to provide this person with a login to my Alpha Dashboard Preferred Contact Please Contact First Contact A Contact B Contact C Contact D Preferred Contact Method Email Phone Bank Details for Reimbursement of Upfront Payments (optional) Account Name Account Number BSB Current Providers I understand that for the purpose of receiving appropriate and timely services from Alpha Plan Management, I consent to its representatives obtaining and releasing information about myself, between your services, and with the organisations and individuals listed below: Organisation Email/Phone Service I consent for Alpha to discuss relevant details of my plan with this provider Organisation Email/Phone Service I consent for Alpha to discuss relevant details of my plan with this provider Current Providers Cont. Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider In addition, I agree to the following: • To advise Alpha Plan Management of changes or additions to the contract details listed above. • Alpha Plan Management may obtain or release information with other organisations or individuals as specified above. • Alpha Plan Management may provide information necessary for Quality and Audit requirements to Government funding bodies and their agents or contractors. I understand that I can look at information held about me and check for its accuracy. I also expect Alpha Plan Management to manage my information confidentially and to ensure that its storage is secure. This consent is for the purpose explained to me by Alpha Plan Management staff and is valid (ongoing) from the date it is signed. I understand that I may revoke this consent at any time in writing. I have been informed and understand how this information will be used and that this information will not be passed onto other third parties. Additional Helpful Information How did you hear about Alpha Plan Management? e.g. from friends and family, social media, searching online Do you have access to the NDIS myplace portal? Would you like a login to the Alpha Dashboard? Yes No I’m not sure Yes No I’m not sure Approval by Participant/Plan Nominee I understand that this agreement must be completed by the NDIS Plan Nominee. The Plan Nominee may be either yourself (the participant) or an individual who is legally appointed to act on your behalf regarding your NDIS plan (for example a parent, guardian or carer). I am the Participant Plan Nomine Support Coordinator (I have consent from the participant/nominee to complete this form on their behalf.) Title First Name Surname Approval I consent for Alpha to provide plan management services for the nominated NDIS participant. Date Xx XxXxxxx Signature of Authorised Alpha Plan Management Staff Member: Ready to submit? You MUST save your changes to this PDF first. Click the ‘Save Form’ button below save in a safe place on your computer before clicking the ‘Send Via Email’ button to email this Agreement back to Alpha Plan Management. Step 1: Click Here to Save Form Step 2: Click Here to Send via Email Disclaimer Alpha Plan Management information is provided in good faith, to the best of our knowledge and is considered to be correct at the time of communication, however, changes may affect this accuracy therefore Alpha Plan Management gives no assurances of any information or advice given. Any advice given by Alpha Plan Management outside of ffinancial intermediary advice shall be considered general in nature. Alpha Plan Management shall not be liable for any failure of, or delay in the performance of this service agreement for the period that such failure or delay is; • Beyond the reasonable control of the party • Materially affects the performance of any of its obligations under this agreement, and • Could not reasonably have been foreseen or provided against
Appears in 1 contract
Samples: Parties
GOODS/SERVICES. Tax (GST) For the purposes of GST legislation, the parties confirm that: A supply of supports under this Service Agreement is a supply of one or more of the reasonable and necessary supports specified in the statement included, under subsection 33(2) of the National Disability Insurance Scheme Act 2013 (NDIS Act), in the Participant’s NDIS plan currently in effect under section 37 of the NDIS Act Alpha Plan Management will pay GST as per specified in the National Disability Insurance Scheme Xxx 0000 (xxxxx://xxx. xxxxxxxxxxx.xxx.xx/Xxxxxxx/X0000X00000) (NDIS Act) Schedule of Supports – Improved Life Choices Support Item Support Item Ref No Description Price Limit Plan Management and Financial Capacity Building - Set Up Costs Plan Management – Financial Administration 14_033_0127_8_3 14_034_0127_8_3 A one-off (per plan) fee for setting up the financial management arrangements A monthly fee for the ongoing maintenance of the financial management arrangements. $232.35 non remote $325.29 remote $348.54 very remote $104.45 per month TOTALS Based on 12 Total 12 months + $1485.75 months of plan $232.35 setup fee management Total 12 months + $1578.69 $325.29 setup fee Total 12 months + $1601.94 $348.54 setup fee CB and Training in Plan and Financial Man- agement by a Plan Manager 14_031_0127_8_3 Capacity Building and Training in Plan and Financial Management by a Plan Manager $63.21 non remote $88.49 remote $94.82 very remote Provider travel - non-labour costs 14_799_0127_8_3 TBA Prices are current as per the NDIS Price Guide 2020-21 and Support Catalogue. Prices may change over the life of this agreement and Alpha Plan Management will automatically adjust all pricing in line with any NDIS Price Guide updates/changes. Contact A. NDIS Participant Details Title First Name Surname NDIS Number NDIS Plan Dates From To Primary Disability Date of Birth Phone Number Street Address Suburb State Postcode Email Contact B. Primary Nominated Representative Details e.g. parent or guardian Title First Name Surname Email Phone Number Relationship To Participant Organisation (if applicable) Contact C. Secondary Nominated Representative Details e.g. parent or guardian Title First Name Surname Email Phone Number Relationship To Participant Organisation (if applicable) Contact D. Support Coordinator (optional/if applicable) Full Name Email/Phone Organisation (if applicable) I consent for Alpha to discuss the details of my plan with this person I consent for Alpha to provide this person with a login to my Alpha Dashboard Preferred Contact Please Contact First Contact A Contact B Contact C Contact D Preferred Contact Method Email Phone Bank Details for Reimbursement of Upfront Payments (optional) Account Name Account Number BSB Current Providers I understand that for the purpose of receiving appropriate and timely services from Alpha Plan Management, I consent to its representatives obtaining and releasing information about myself, between your services, and with the organisations and individuals listed below: Organisation Email/Phone Service I consent for Alpha to discuss relevant details of my plan with this provider Organisation Email/Phone Service I consent for Alpha to discuss relevant details of my plan with this provider Current Providers Cont. Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider In addition, I agree to the following: • To advise Alpha Plan Management of changes or additions to the contract details listed above. • Alpha Plan Management may obtain or release information with other organisations or individuals as specified above. • Alpha Plan Management may provide information necessary for Quality and Audit requirements to Government funding bodies and their agents or contractors. I understand that I can look at information held about me and check for its accuracy. I also expect Alpha Plan Management to manage my information confidentially and to ensure that its storage is secure. This consent is for the purpose explained to me by Alpha Plan Management staff and is valid (ongoing) from the date it is signed. I understand that I may revoke this consent at any time in writing. I have been informed and understand how this information will be used and that this information will not be passed onto other third parties. Additional Helpful Information How did you hear about Alpha Plan Management? e.g. from friends and family, social media, searching online Do you have access to the NDIS myplace portal? Would you like a login to the Alpha Dashboard? Yes No I’m not sure Yes No I’m not sure Approval by Participant/Plan Nominee I understand that this agreement must be completed by the NDIS Plan Nominee. The Plan Nominee may be either yourself (the participant) or an individual who is legally appointed to act on your behalf regarding your NDIS plan (for example a parent, guardian or carer). Xx XxXxxxx Signature of Authorised Alpha Plan Management Staff Member: Date Approval I am consent for Alpha to provide plan management services for the Participant Plan Nomine nominated NDIS participant. Surname First Name Title Support Coordinator (I have consent from the participant/nominee to complete this form on their behalf.) Title First Name Surname Approval Plan Nomine Participant I consent for Alpha to provide plan management services for am the nominated NDIS participant. Date Xx XxXxxxx Signature of Authorised Alpha Plan Management Staff Member: Ready to submit? You MUST save your changes to this PDF first. Click the ‘Save Form’ button below save in a safe place on your computer before clicking the ‘Send Via Email’ button to email this Agreement back to Alpha Plan Management. Step 1: Click Here to Save Form Step 2: Click Here to Send via Email Disclaimer Alpha Plan Management information is provided in good faith, to the best of our knowledge and is considered to be correct at the time of communication, however, changes may affect this accuracy therefore Alpha Plan Management gives no assurances of any information or advice given. Any advice given by Alpha Plan Management outside of ffinancial financial intermediary advice shall be considered general in nature. Alpha Plan Management shall not be liable for any failure of, or delay in the performance of this service agreement for the period that such failure or delay is; • Beyond the reasonable control of the party • Materially affects the performance of any of its obligations under this agreement, and • Could not reasonably have been foreseen or provided against
Appears in 1 contract
Samples: Parties
GOODS/SERVICES. Tax (GST) For the purposes of GST legislation, the parties confirm that: A supply of supports under this Service Agreement is a supply of one or more of the reasonable and necessary supports specified in the statement included, under subsection 33(2) of the National Disability Insurance Scheme Act 2013 (NDIS Act), in the Participant’s NDIS plan currently in effect under section 37 of the NDIS Act Alpha Plan Management will pay GST as per specified in the National Disability Insurance Scheme Xxx 0000 (xxxxx://xxx. xxxxxxxxxxx.xxx.xx/Xxxxxxx/X0000X00000) (NDIS Act) Schedule of Supports – Improved Life Choices Support Item Support Item Ref No Description Price Limit Plan Management and Financial Capacity Building - Set Up Costs Plan Management – Financial Administration 14_033_0127_8_3 14_034_0127_8_3 A one-off (per plan) fee for setting up the financial management arrangements A monthly fee for the ongoing maintenance of the financial management arrangements. $232.35 non remote $325.29 remote $348.54 very remote $104.45 per month TOTALS Based on 12 Total 12 months + $1485.75 months of plan $232.35 setup fee management Total 12 months + $1578.69 $325.29 setup fee Total 12 months + $1601.94 $348.54 setup fee CB and Training in Plan and Financial Man- agement by a Plan Manager 14_031_0127_8_3 Capacity Building and Training in Plan and Financial Management by a Plan Manager $63.21 non remote $88.49 remote $94.82 very remote Provider travel - non-labour costs 14_799_0127_8_3 TBA Prices are current as per the NDIS Price Guide 20202021-21 22 and Support Catalogue. Prices may change over the life of this agreement and Alpha Plan Management will automatically adjust all pricing in line with any NDIS Price Guide updates/changes. Contact A. NDIS Participant Details Title First Name Surname NDIS Number (required) NDIS Plan Dates From To Primary Disability Date of Birth (required) Phone Number Street Address Suburb State Postcode Email Contact B. Primary Nominated Representative Details e.g. parent or guardian Title First Name Surname Email Phone Number Relationship To Participant Organisation (if applicable) Contact C. Secondary Nominated Representative Details e.g. parent or guardian Title First Name Surname Email Phone Number Relationship To Participant Organisation (if applicable) Contact D. Support Coordinator (optional/if applicable) Full Name Email/Phone Organisation (if applicable) I consent for Alpha to discuss the details of my plan with this person I consent for Alpha to provide this person with a login to my Alpha Dashboard Preferred Contact Please Contact First Contact A Contact B Contact C Contact D Preferred Contact Method Email Phone Bank Details for Reimbursement of Upfront Payments (optional) Account Name Account Number BSB Current Providers I understand that for the purpose of receiving appropriate and timely services from Alpha Plan Management, I consent to its representatives obtaining and releasing information about myself, between your services, and with the organisations and individuals listed below: Organisation Email/Phone Service I consent for Alpha to discuss relevant details of my plan with this provider Organisation Email/Phone Service I consent for Alpha to discuss relevant details of my plan with this provider Current Providers Cont. Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider In addition, I agree to the following: • To advise Alpha Plan Management of changes or additions to the contract details listed above. • Alpha Plan Management may obtain or release information with other organisations or individuals as specified above. • Alpha Plan Management may provide information necessary for Quality and Audit requirements to Government funding bodies and their agents or contractors. I understand that I can look at information held about me and check for its accuracy. I also expect Alpha Plan Management to manage my information confidentially and to ensure that its storage is secure. This consent is for the purpose explained to me by Alpha Plan Management staff and is valid (ongoing) from the date it is signed. I understand that I may revoke this consent at any time in writing. I have been informed and understand how this information will be used and that this information will not be passed onto other third parties. Additional Helpful Information How did you hear about Alpha Plan Management? e.g. from friends and family, social media, searching online Do you have access to the NDIS myplace portal? Would you like a login to the Alpha Dashboard? Yes No I’m not sure Yes No I’m not sure Approval by Participant/Plan Nominee I understand that this agreement must be completed by the NDIS Plan Nominee. The Plan Nominee may be either yourself (the participant) or an individual who is legally appointed to act on your behalf regarding your NDIS plan (for example a parent, guardian or carer). Xx XxXxxxx Signature of Authorised Alpha Plan Management Staff Member: Date Approval I am consent for Alpha to provide plan management services for the Participant Plan Nomine nominated NDIS participant. Surname First Name Title Support Coordinator (I have consent from the participant/nominee to complete this form on their behalf.) Title First Name Surname Approval Plan Nomine Participant I consent for Alpha to provide plan management services for am the nominated NDIS participant. Date Xx XxXxxxx Signature of Authorised Alpha Plan Management Staff Member: Ready to submit? You MUST save your changes to this PDF first. Click the ‘Save Form’ button below save in a safe place on your computer before clicking the ‘Send Via Email’ button to email this Agreement back to Alpha Plan Management. Step 1: Click Here to Save Form Step 2: Click Here to Send via Email Disclaimer Alpha Plan Management information is provided in good faith, to the best of our knowledge and is considered to be correct at the time of communication, however, changes may affect this accuracy therefore Alpha Plan Management gives no assurances of any information or advice given. Any advice given by Alpha Plan Management outside of ffinancial financial intermediary advice shall be considered general in nature. Alpha Plan Management shall not be liable for any failure of, or delay in the performance of this service agreement for the period that such failure or delay is; • Beyond the reasonable control of the party • Materially affects the performance of any of its obligations under this agreement, and • Could not reasonably have been foreseen or provided against
Appears in 1 contract
Samples: Parties
GOODS/SERVICES. Tax (GST) For the purposes of GST legislation, the parties confirm that: A supply of supports under this Service Agreement is a supply of one or more of the reasonable and necessary supports specified in the statement included, under subsection 33(2) of the National Disability Insurance Scheme Act 2013 (NDIS Act), in the Participant’s NDIS plan currently in effect under section 37 of the NDIS Act Alpha Plan Management will pay GST as per specified in the National Disability Insurance Scheme Xxx 0000 (xxxxx://xxx. xxxxxxxxxxx.xxx.xx/Xxxxxxx/X0000X00000) (NDIS Act) Schedule of Supports – Improved Life Choices Support Item Support Item Ref No Description Price Limit Plan Management and Financial Capacity Building - Set Up Costs Plan Management – Financial Administration 14_033_0127_8_3 14_034_0127_8_3 A one-off (per plan) fee for setting up the financial management arrangements A monthly fee for the ongoing maintenance of the financial management arrangements. $232.35 non remote $325.29 remote $348.54 very remote $104.45 per month TOTALS Based on 12 Total 12 months + $1485.75 months of plan $232.35 setup fee management Total 12 months + $1578.69 $325.29 setup fee Total 12 months + $1601.94 $348.54 setup fee CB and Training in Plan and Financial Man- agement by a Plan Manager 14_031_0127_8_3 Capacity Building and Training in Plan and Financial Management by a Plan Manager $63.21 61.76 non remote $88.49 86.46 remote $94.82 92.64 very remote Provider travel - non-labour costs 14_799_0127_8_3 TBA Prices are current as per the NDIS Price Guide 2020-21 and Support Catalogue. Prices may change over the life of this agreement and Alpha Plan Management will automatically adjust all pricing in line with any NDIS Price Guide updates/changes. Contact A. NDIS Participant Details Title First Name Surname NDIS Number NDIS Plan Dates From To Primary Disability Date of Birth Phone Number Street Address Suburb State Postcode Email Contact B. Primary Nominated Representative Details e.g. parent or guardian Title First Name Surname Email Phone Number Relationship To Participant Organisation (if applicable) Contact C. Secondary Nominated Representative Details e.g. parent or guardian Title First Name Surname Email Phone Number Relationship To Participant Organisation (if applicable) Contact D. Support Coordinator (optional/if applicable) Full Name Email/Phone Organisation (if applicable) I consent for Alpha to discuss the details of my plan with this person I consent for Alpha to provide this person with a login to my Alpha Dashboard Preferred Contact Please Contact First Contact A Contact B Contact C Contact D Preferred Contact Method Email Phone Bank Details for Reimbursement of Upfront Payments (optional) Account Name Account Number BSB Current Providers I understand that for the purpose of receiving appropriate and timely services from Alpha Plan Management, I consent to its representatives obtaining and releasing information about myself, between your services, and with the organisations and individuals listed below: Organisation Email/Phone Service I consent for Alpha to discuss relevant details of my plan with this provider Organisation Email/Phone Service I consent for Alpha to discuss relevant details of my plan with this provider Current Providers Cont. Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider Organisation Service Email/Phone I consent for Alpha to discuss relevant details of my plan with this provider In addition, I agree to the following: • To advise Alpha Plan Management of changes or additions to the contract details listed above. • Alpha Plan Management may obtain or release information with other organisations or individuals as specified above. • Alpha Plan Management may provide information necessary for Quality and Audit requirements to Government funding bodies and their agents or contractors. I understand that I can look at information held about me and check for its accuracy. I also expect Alpha Plan Management to manage my information confidentially and to ensure that its storage is secure. This consent is for the purpose explained to me by Alpha Plan Management staff and is valid (ongoing) from the date it is signed. I understand that I may revoke this consent at any time in writing. I have been informed and understand how this information will be used and that this information will not be passed onto other third parties. Additional Helpful Information How did you hear about Alpha Plan Management? e.g. from friends and family, social media, searching online Do you have access to the NDIS myplace portal? Would you like a login to the Alpha Dashboard? Yes No I’m not sure Yes No I’m not sure Approval by Participant/Plan Nominee I understand that this agreement must be completed by the NDIS Plan Nominee. The Plan Nominee may be either yourself (the participant) or an individual who is legally appointed to act on your behalf regarding your NDIS plan (for example a parent, guardian or carer). Xxxxxx Xxxxxxx Signature of Authorised Alpha Plan Management Staff Member: Date Approval I am consent for Alpha to provide plan management services for the Participant Plan Nomine nominated NDIS participant. Surname First Name Title Support Coordinator (I have consent from the participant/nominee to complete this form on their behalf.) Title First Name Surname Approval Plan Nomine Participant I consent for Alpha to provide plan management services for am the nominated NDIS participant. Date Xx XxXxxxx Signature of Authorised Alpha Plan Management Staff Member: Ready to submit? You MUST save your changes to this PDF first. Click the ‘Save Form’ button below save in a safe place on your computer before clicking the ‘Send Via Email’ button to email this Agreement back to Alpha Plan Management. Step 1: Click Here to Save Form Step 2: Click Here to Send via Email Disclaimer Alpha Plan Management information is provided in good faith, to the best of our knowledge and is considered to be correct at the time of communication, however, changes may affect this accuracy therefore Alpha Plan Management gives no assurances of any information or advice given. Any advice given by Alpha Plan Management outside of ffinancial financial intermediary advice shall be considered general in nature. Alpha Plan Management shall not be liable for any failure of, or delay in the performance of this service agreement for the period that such failure or delay is; • Beyond the reasonable control of the party • Materially affects the performance of any of its obligations under this agreement, and • Could not reasonably have been foreseen or provided against
Appears in 1 contract
Samples: Parties
