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Form
Change of Name
Change of Name
Current
Collection Notice
Confirm Your Identity
Name Change
Complete
This form is to be completed if you wish to change your name with Golden Plains Shire Council.
To change your name, evidence will be required to be provided, this is either a copy of a Marriage Certificate/ Drivers Licence/ or other supporting documentation that may be applicable. This form is not to be used for change of ownership.
Collection Notice
Collection Notice
Personal information collected on this form will be used by Council’s Customer Experience team to update your contact details in Council’s systems. Council may disclose your information to other internal departments who also use your contact details to provide you with services in order to update your contact details and your information may be disclosed to external parties if required or authorised by law. If you do not provide us with all required information Council may not be able to update your contact details, which may have an impact on the services you receive.
Council will comply with its Privacy Policy, the Privacy and Data Protection Act 2014 and the Health Records Act 2001 in relation to the use, storage and disclosure of information.
If you have any queries regarding this collection notice, please contact the Privacy Officer on 03 5220 7111 or via
[email protected]
Confirm Your Identity
What is your full name as listed on your most recent rates notice?
Please include your title.
What is your date of birth?
What is the address of the property you own in Golden Plains Shire?
Address of the property you own within Golden Plains Shire
Town
Post Code
Name Change
New Title
New Given Name
New Surname
Please provide a reason for your name change.
Please upload evidence of your name change (Marriage Certificate, License or other supporting documents)
One file only.
100 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.