<h3>Please read this statement carefully and sign.</h3><p><strong>I must tell Social Welfare immediately if:</strong></p><ul><li>I intend to TRAVEL OVERSEAS, whether for holiday or permanently</li><li>My personal details change (such as name, address or bank account)</li><li>I am granted an overseas benefit payment</li><li>My living arrangement and circumstances changes.</li></ul><p><strong>I understand that:</strong></p><ul><li>if I have made a false statement or</li><li>if I have failed to answer all the questions in full or</li><li>If I do not tell Social Welfare about changes that it might affect my entitlement or rate.</li></ul><p><strong>Then</strong>:</p><ul><li>The benefit/ assistance may be reviewed and cancelled and</li><li>I may have to pay back the total amount of any overpayment that I have received and</li><li>I may be prosecuted and fined</li></ul><p><strong>My obligations have been explained to me and I understand my responsibilities</strong></p>