Qikkids CCS Transition Form

This application form is for clients to request CCS Transition

For information on where to get this information please click on the links below:
- Transitioning To CCS - Task Card
- Where is the key CCS information through transition process?
Primary Contact for Licensee
Primary Contact for Licensee*
First Name Last Name
Email Address*
Phone or Mobile Number*
Company Details
Service/Group Name*
Your Position*
Support ID*
CCS Provider Information
Provider Name*
ABN (11 numbers with no spaces)*
Provider ID (9 digits and 1 letter at the end)*
Organisation ID (10-20 digits)*
Management or Control Person Details
PRODA RA Number (10-20 digits)*
Person ID (10 digits)*
DOB of this person*
MM slash DD slash YYYY
Security Token
Device/Unique Name (Case Sensitive)*
IMPORTANT: The one time security code must be generated immediately before sending this form through as old codes will be invalid and not work and your request will be rejected. Please ensure if you have previously generated the code that you generate a new code and enter it into the field below prior to submitting. For instructions on generating a new code CLICK HERE
One Time Software Activation Code*
Comments
Order confirmation and notes
I authorised QikKids Support personnel to login to my QikKids database and enter the above information as a part of my submission to CCS.*
- I authorised QikKids Support personnel to login to my QikKids database and enter the above information as a part of my submission to CCS.
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