Reimbursement Form

Our easy online tool to lodge your claim with EPSS

You can also print and fill out the form and email back to us at admin@essentialplan.com.au.

Participant Reimbursement Claim Form

Essential Plan Support Services

Use this form to claim reimbursement for an NDIS support you have paid for out of pocket.
Reimbursement claims are processed in the same way as provider invoices — in line with your NDIS plan and NDIS requirements.
You will need to attach a receipt and proof of payment for each item claimed. Claims cannot be processed without these.
This form can be submitted online at essentialplan.com.au or completed and emailed to admin@essentialplan.com.au.

Participant Details

Full Name(Required)

NDIS Number(Required)

Child representative or plan nominee (if applicable)

Complete this section if you are submitting this claim on behalf of the participant.

I am submitting this claim as:

Child representative — a person with parental responsibility for a participant under 18

NDIS plan nominee — formally appointed by the NDIA for a participant aged 18 or over

Full name

Bank Details

Only complete this section if your bank details have changed or have not yet been provided to EPSS.

Account Name(Required)

BSB(Required)

Account Number(Required)

Details of the claim

Receipts and proof of payment: Attach a receipt and proof of payment for each item claimed. Claims cannot be processed without these. Email completed form and receipts to admin@essentialplan.com.au. Include the participant’s name in the subject line.

Brief Description(Required)

Support Provided and/or Items Purchased

Service Date(Required)

Support Category(Required)

Provider(Required)

Amount(Required)

Receipt attached(Required)

Yes

Service Date

Support Category

Provider

Amount

Receipt attached

Yes

Service Date

Support Category

Provider

Amount

Receipt attached

Yes

Service Date

Support Category

Provider

Amount

Receipt attached

Yes

TOTAL VALUE $ (AUD)(Required)

File(Required)

Drop files here or

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 50 MB.

By signing below, I declare that:

- The supports claimed have been received and paid for by me
- The supports meet NDIS requirements and are in line with the participant’s NDIS plan
- I understand that if the NDIA finds a claim is not allowable under the plan following an audit, I may be required to repay the funds

I am signing as:(Required)

Participant

Child representative — a person with parental responsibility for a participant under 18

NDIS plan nominee — formally appointed by the NDIA for a participant aged 18 or over

Representative/Plan Nominee Name if Claimant is not the Participant

First Last

Full name(Required)

Signature(Required)

Date Signed(Required)

What happens next

Once we receive your completed form and receipts, we’ll review and process your claim in line with your NDIS plan and NDIS requirements.
If anything needs to be addressed before the claim can be submitted, we’ll let you know what’s needed.
Once the claim is processed and funds are released by the NDIS, reimbursement will be made to your nominated bank account within 1–2 business days.
If you have any questions, contact us on 0474 329 544 or at admin@essentialplan.com.au.