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Change of Name Form

Please note that supporting documentation must be provided when advising Council of change of name.

Please attach a copy of supporting documentation with your form submission.

Supporting documentation can include:

Marriage Certificate
Drivers Licence
Birth Certificate
Change of Name Certificate

Previous Details

Previous Surname: * (required)

Previous Given Name/s: * (required)

Date of Birth: * (required)

Business Hours Phone Number: * (required)

After Hours Phone Number:

Mobile Phone Number:

New Details

New Surname: * (required)

New Given Name/s:

Supporting Documentation * (required)

Type the characters you see in the image below * (Required)

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Privacy Statement
The personal information in this form is being collected by Council to enable the distribution of rates and charge details to Ratepayers and the preparation of the Municipal Voters Roll. The information will be used by Council for these primary purposes or directly related to municipal purposes only. Council may disclose this information to other authorities including Gippsland Water, South East Water, TXU, Origin Energy and Telstra to enable the provision of services to the property. If these contact details are not kept up to date, rate notices or other municipal information may not reach you and in the case of Rate Notices, interest and legal charges may be incurred if rates are not paid by the due dates. You may apply to Council to gain access to, or for the amendment of personal information held by Council. Information on Council's Privacy Policies can be obtained from Council's Privacy Officer during business hours on 03 5624 2411.

Change of Name Form

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