Business Name *

Trading as Name *

Business Phone *

Business Mobile *

Business Email *

ABN

ACN

I would like to change:

Business AddressBusiness Name

New Business Address Details

This form cannot be used to change ownership of a property.

The personal information requested on this form is being collected by Council to maintain an accurate Name and Address Register. The personal information will be used solely by Council for that primary purpose or directly related purposes. The applicant understands that the personal information provided is for Council records and that they may apply to Council for access and or amendment of their information.

Rates Assessment Number

OLD Residential Address

OLD Postal Address (If different from above)

NEW Residential Address

NEW Postal Address (If different from above)

Is this new address for all account/correspondence? *

YesNo

Please provide an explanation of change required: *

Property Address *

Assessment Number *

New Business Name Details

This form cannot be used to change ownership of a property.

The personal information requested on this form is being collected by Council to maintain an accurate Name and Address Register. The personal information will be used solely by Council for that primary purpose or directly related purposes. The applicant understands that the personal information provided is for Council records and that they may apply to Council for access and or amendment of their information.

NEW Business Name

NEW Trading Name

Business ABN

Business ACN

Other Council Accounts/Applications

Do you have current accounts or applications with Wellington Shire Council for:

Health/Food Premises Registration *

Current or Unpaid Infringements *

Active Planning Applications *

An Account with Council for Accounts Payable/Receivable *

Business Contacts

If you would like individual contacts listed for your business, please complete the Business Contacts section/s below:

Contact 1

Contact 1 Name

Contact 1 Position

Contact 1 Date of Birth

Contact 1 Business Phone

Contact 1 Home Phone

Contact 1 Mobile Phone

Contact 2

Contact 2 Name

Contact 2 Position

Contact 2 Date of Birth

Contact 2 Business Phone

Contact 2 Home Phone

Contact 2 Mobile Phone

Supporting Documents

You must supply copies of legal documentation before Council will alter their records.

Please select which documentation is supporting this application

Change of Name CertificateCompany Letterhead with new Company NameExtract from Australian Securities Investments Commission (ASIC)Other

Other

File Upload (1)

Browse

File Upload (2)

Browse

File Upload (3)

Browse

File Upload (4)

Browse

File Upload (5)

Browse

Declaration

Name of person completing this form *

Position of person completing this form *

Additional Comments

I have completed all required sections on this form. I declare that all the information provided on this form is true and understand that it is an offence to provide false or misleading information. *

I acknowledge that if I have an active BPAY View or email delivery registration, I am responsible for altering/cancelling this service. *

I acknowledge Wellington Shire Council's Privacy Statement. *