* Denotes that the field is mandatory.

Title

Given Names

Surname/Company Name *

E-Mail Address *

Home Telephone

Mobile Telephone

Work Telephone

Previous Postal Address *

New Postal Address: eg PO Box or the street number and street name *

Town/Suburb *

State *

Post Code *

Is this new postal address for all Council correspondence? *

Is the new postal address only for your Rates Account?

Is the new postal address only for your Water Account?

Is the new postal address only for your Debtors Account?

List any applicable Assessment/Account Numbers and/or property addresses you own? *

Council's Policy requires that you to supply your current address of where you live.

Address of where you live *

Town/Suburb *

State *

Please attach any related images or documents. Attachments must be no larger than 5MB. Accepted file formats include .doc, .docx, .jpg and .pdf, ie Power of Attorney

Attachment File 1

Attachment File 1 Description

Attachment File 2

Attachment File 2 Description