New Application - NSW Farmers

Please take the time to check you have the following information of documents ready.

Evidence of eligibility (for example ABN details)
Current quad bike specifications (make/model/VIN)
I declare that I live in NSW.
Attended an eligible interaction with SafeWork NSW (prior to purchasing equipment).
I confirm that the drone purchased is from the SafeWork NSW eligible list of drones and that I have obtained and/or undertaken any necessary CASA requirements for the operation of the drone. Note: You will not be eligible for the drone rebate if you do not meet this requirement
Paid tax invoice for eligible safety solution(s) being claimed.
I confirm that I have all the documents ready to submit with the application

Please verify that your ABN is valid

ABN*

Employer Consent Letter

Business Details

Dealer's Details

* Required Fields

Is farming your/your employer’s main business activity? Yes No

How long has the business been operating? 0-5 years 6-10 years More than 10 years

Name*

Trading Name

Business Name*

Total Full Time Equivalent Employee*

Farm's E-Mail*

Phone Number

Mobile Number*

Dealer's Business Details

Dealer ABN*

Dealer Trading Name*

Dealer's Address

Dealer Contact Person*

Address Line 1*

Address Line 2

State*

Postcode*

E-Mail*

Phone Number*

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Address Details

Manufacturer Contact Details

Farmer's Details

* Required Fields

Business Address

Address Line 1*

Address Line 2

State*

Postcode*

Manufacturer Address

Manufacturer Name*

Manufacturer Contact Person*

Address Line 1*

Address Line 2

State*

Postcode*

Phone Number*

E-Mail*

Dealer Details

Postal Address

Same as Business Address

Address Line 1

Address Line 2

State

Postcode

Farmer's Business Details

Dealer Validated Eligibility of the Farmer? Yes No

Total Full Time Equivalent Employee*

Farmer's Address

Address Line 1*

Address Line 2

State*

Postcode*

E-Mail*

Phone Number

Mobile Number*

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Current Vehicle and Safety Interaction

Does the employer own a quad bike or SSV that is used when conducting a business? Does the farmer own a quad bike or SSV that is used when conducting a business? Yes No

Please provide details of the current quad bike/SSV that you own in the box below (please note this is not the details of the vehicle you are claiming this rebate for)

Vehicle Make

Vehicle Model

Vehicle Identification Number

Have you attended an eligible interaction with SafeWork NSW prior to the purchase of the eligible safety solution(s)?
Yes
No

Which eligible interaction did you attend?
Farm Safety Day
Field Day
Special Event
Safety Advisory Visit
Webinar
Other

Event Name

Event Date

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Referral

Where did you hear about these rebates?

Are you a member of NSW Farmers Association?
Yes
No

If you are not a member of NSW Farmers Association, would you like to hear more about how to become a member?
Yes
No

NSW Farmers Association Member Number

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Claim Details

Please select the item/items you want to claim?

Helmet

Side by Side

OPD

Drone

HELMET

Purchased?
Yes
No

Helmet Type

Helmet Quantity

Cost

Helmet Purchase Date

Upload Helmet Invoice

SIDE BY SIDE

Purchased?
Yes
No

SSV Quantity

Cost

Make

Model

SSV Identification Number

SSV Purchase Date

Upload SSV Invoice

OPD

Purchased?
Yes
No

OPD Quantity

Cost

OPD Make

OPD Purchase Date

Did you fit the OPD to your existing quad bike in accordance with the manufacturers’ instructions?
Yes
No

Upload OPD Invoice

DRONE

Purchased?
Yes
No

Drone Quantity

Cost

Make

Model

Drone Purchase Date

Upload Drone Invoice

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Bank Account Details

* Required Fields

Account Name*

Account Number*

BSB*

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Declaration

I declare that I have read and agree to the full Terms and Conditions
I declare that I am:
• the owner of a business that is registered in NSW, is producing goods or providing services in NSW, falls within the scope of the NSW Work Health and Safety Act 2011, has 0–20 full-time workers (or equivalent), owns and uses a quad bike or SSV for the main purpose of the farming business and farming is my main source of income, or
• a worker employed by a person that meets the criteria identified in the above bullet point.
I declare that I live in NSW.
I declare that I am not claiming this rebate on behalf of another business/individual. I confirm that I have attended an eligible educative interaction with SafeWork NSW prior to the purchase of eligible safety solutions for my business/myself and ABN as described above, and the safety solutions have been paid for, received, and fitted in accordance with manufacturer’s instructions (if applicable) prior to my application date.
I confirm that the drone purchased is from the SafeWork NSW eligible list of drones and that I have obtained and/or undertaken any necessary CASA requirements for the operation of the drone. Note: You will not be eligible for the drone rebate if you do not meet this requirement
I confirm that the safety solutions purchased are existing manufactured safety items that meet manufacturers’ guidelines, and all relevant standards. I declare that all information contained in this application is true and correct and is not false or misleading. I agree with the terms and conditions as outlined.
I am aware that application processing times may vary and that the timelines provided are indicative only.

Applicant's Comment

I Agree

Level 4, 154 Pacific Highway, St Leonards, NSW, 2065
Head Office: 02 9478 1000
Member Service Centre: 1300 794 000
Fax: 02 8282 4500

Documents Checklist

Business Details

Dealer's Details

Dealer's Business Details

Dealer's Address

Address Details

Manufacturer Contact Details

Farmer's Details

Business Address

Manufacturer Address

Dealer Details

Postal Address

Farmer's Business Details

Farmer's Address

Current Vehicle and Safety Interaction

Referral

Claim Details

Bank Account Details

Declaration