Change Of Postal/residential Address
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1
2Change of Postal/Residential Address
IMPORTANT NOTICE
Western Downs Regional Council is collecting personal information you supply on this form in accordance with the Local Government Act 2009. The personal information collected on
this form will be used to ensure Council has your correct address. Your personal information will be accessed by persons who have been authorised to do so. Some of this
information may be given to other Councils, Debt Collection Agencies, State Government Departments and neighbouring property owners for the purpose of using your address to
contact you, receive notices and correspondence. Your information will not be given to any other person or agency unless required by law. Your personal information is handled in
accordance with the Information Privacy Act 2009.
Please note: Alteration to address will not be effected until this form is completed, signed and returned to Council. Please assist Council in processing your change of postal address by
completing the below questions and providing the relevant information.
In the circumstance where the property is held in more than one name, it is inferred that the request is on behalf all property owners.
If your Change of Address request is for a Trust Fund, use the Change of Company Postal/Residential Address form instead.
Customer Details (1)
(*phone contact details are required for processing purposes)
Title:
Mr
Mrs
Ms
Miss
Other:
Surname:
Given Name/s:
List any other name/s you have
Date of birth:
/
/
been known by:
Old residential address:
Old postal address:
As above
New residential address:
New postal address:
As above
*Phone (h):
*Phone (w):
*Phone (m):
Fax:
Email Address:
Are you a Council employee:
Yes
No
Signature (required): Electronic
Date:
/
/
signature will not be accepted
Customer Details (2)
(*phone contact details are required for processing purposes)
Title:
Mr
Mrs
Ms
Miss
Other:
Surname:
Given Name/s:
List any other name/s you have
Date of birth:
/
/
been known by:
Old residential address:
Old postal address:
As above
New residential address:
New postal address:
As above
*Phone (h):
*Phone (w):
*Phone (m):
Fax:
Email Address:
Are you a Council employee:
Yes
No
Signature (required): Electronic
Date:
/
/
signature will not be accepted
Postal address: Western Downs Regional Council, PO Box 551, DALBY QLD 4405
Fax: 1300FAXWDRC or 07 4679 4099
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