Plan Management Online Sign-up Form

Thank you for choosing us and signing up for your Plan Management Service.
To get started simply fill on the form below. Please note all fields marked with an asterisk (*) require an answer to continue.

Need help completing this form? Please contact us on on 1300 946 337.

The documents you will require to complete this form are:

NDIS Plan - if applicable

If Plan Management is already included in your NDIS plan, then there is no cost to you when you use NDIS Plan Management services.

Please read and ensure you understand our Privacy Policy here before completing this form.

By filling out this form, you are selecting Windermere as your NDIS Plan Manager

Thank you and we look forward to working with you and taking the stress out of managing your NDIS plan.

Are you signing up for yourself or on behalf of an NDIS participant? *

Completing for myselfCompleting on behalf of an NDIS participant

Please specify your relationship to the NDIS participant *

Other - please specify* *

Do you have consent to share the participants information? *

YesNo

Unfortunately, you cannot sign up on behalf of a participant without their consent. Please fill out our enquiry form instead and our team will be in touch to confirm next steps. Access our Plan Management Enquiry Form here.

How did you find us? *

Do you have an event code?

Please specify *

Why did you choose Windermere? *

Please specify *

1. Participant's Details

Please provide as many contact details as possible. At least one phone number is required.

Title

Given name(s) *

Surname *

Date of birth *

Gender *

MaleFemaleNon-identified

Street address *

Postcode *

Home phone

Mobile phone

Email address *

My preferred contact method is:

EmailPhoneMobile

Your NDIS Plan

NDIS number *Your NDIS number is the 9 digit reference number located in the top left of your NDIS Plan

NDIS plan start date *Your NDIS start and end date can be found within your NDIS plan.

NDIS plan end date *Your NDIS start and end date can be found within your NDIS plan.

Upload your NDIS plan here

Browse

File types accepted include .pdf, .doc & .docx, Max size 10mb. Upload is not mandatory but strongly encouraged.

How to download your NDIS Plan from MyGov:

Activate your MyGov account as per the directions that your NDIS planer has sent you
Log in to your MyGov account
ACT as the person who has the NDIS plan
Click on participants plan
Click on “View my/participants plan”
Print NDIS plan to PDF (This should now look like the paper copy you received in the mail)
Upload that PDF document here

If you do not have a copy of your NDIS plan or are experiencing difficulty in uploading your plan please contact pmi@windermere.org.au or call 1300 946 337 for assistance.

Please specify *

2. Authorised Contacts

Your contact details

Please provide as many contact details as possible. At least one phone number is required.

Given name(s) *

Surname *

Street address *

Postcode *

Phone Number *

Email address *

My preferred contact method is: *

EmailPhoneMobile

The participant has authorised me to:

Sign on their behalf

Share/discuss their NDIS plan

Enquire on their behalf only

Enquire and update on behalf of the participant

Release information on behalf of the participant

To be an emergency contact for the participant

No consents authorised, sharing information on behalf of the participant only

Authorise invoices on behalf of the NDIS participant

Does the Participant have an Authorised Representative? *

Yes No

Are you the Participant's Authorised Representative? *

Yes No

Authorised representative details

Please provide as many contact details as possible. At least one phone number is required.

Given name(s) *

Surname *

Organisation Name (if applicable)

Relationship to the NDIS Participant

This person is authorised to:

Sign on their behalf

Share/discuss their NDIS plan

Enquire on their behalf only

Enquire and update on behalf of the participant

Release information on behalf of the participant

To be an emergency contact for the participant

No consents authorised, sharing information on behalf of the participant only

Authorise invoices on behalf of the NDIS participant

Does the Participant have a Support Coordinator? *

Yes No

Are you the Participant's Support Coordinator? *

Yes No

Support Coordinator details

Please provide as many contact details as possible. At least one phone number is required.

Title

Given Name(s) *

Surname *

Email Address *

Phone Number *

Organisation Name (if applicable)

3. Invoice Authorisation

This section is for you to notify us who is able to authorise invoices on your behalf.

Please select who will be the primary person authorising all invoices *

ParticipantAuthorised representativeOther

Please specify: *

4. Plan Management Service

Plan Management service information

Plan Management services are charged directly against a Participant’s NDIS Plan and in line with the NDIS Price Guide under the Support Category: Capacity Building - Improved Life Choices and following stated line items.

Fee	NDIS Category	Reference Number
One off set up cost	Improved Life Choices - Plan Management and Financial Capacity Building	14_033_0127_8_3
Ongoing monthly fee	Improved Life Choices – Plan Management - Financial Administration monthly processing	14_034_0127_8_3

*The above support items are subject to price limits.

To view these price limits, please visit the latest NDIS Price Guide on the NDIA Website.

There is no out pocket cost incurred by the participant.

Provider Contact Details

Provider: Windermere Child & Family Services

Phone: 1300 946 337
Email: planmanagement@windermere.org.au
Address: 48 Webb St, Narre Warren VIC 3805

Service Agreement

Thank you again for choosing Windermere as your Plan Management provider, we are so excited to begin working with you!

Our Intake Officer will be in contact with you within the next one (1) to two (2) business days. They will send you your Service Agreement and Plan Management Provider Letter to read, sign and return.

Please email Service Agreement and letter to: *Enter email address here

Name of alternative contact *

Mobile of alternative contact *

5. Declaration

I hereby declare that the information given in this form is true and correct to the best of my knowledge/belief and consent to Windermere being my NDIS Plan Manager *

I have read and understand Windermere's Privacy Policy here *

Please sign here *

Draw signature|Type signatureClear

Type your signature OR use your finger, stylus or mouse to draw your signature in the field above.

Name *

Date *

Save and Complete Later