Replacement Card Form

You can fill in the form below to request a replacement National Assistance Card.

First Name (Cardholder):*Surname (Cardholder):*Phone Number:Email Address*National Assistance Card ID number (optional)

(Please enter then number written on the front of your Card under your photo – if known)

Please select one:*I would like to update the information printed on my National Assistance Card. I may also update the information linked to the QR code on my Card. (Payment required: $22.00*) I would like to update the information linked to the QR code on my National Assistance Card ONLY. I do not want to update the information printed on my Card. I would like to order a replacement National Assistance Card with the same information as my previous Card. (Payment required: $22.00*)
Additional Comments

Once you submit this form a National Assistance Card Team member will contact you via email to confirm your updates/replacement. The email will include a link to log into your application. If you do not receive an email in the next week, please check your junk folder or contact us here: info@nationalassistancecard.com.au

Please note: If you are unable to pay for the Card, you can let us know in the payment section of the application when you finalise your update/replacement.

All information is kept confidential in accordance with our privacy policy.
* denotes required field.

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Please note: The National Assistance Card Service is owned by the Brain Injury Association of Tasmania.

Replacement Card Form

Apply For The National Assistance Card