Change of Address, Name & Email Form

If you've had a change of address, name or email address please use this form to update your details with the City.

Please note that the "new email address" will be used to send you a confirmation of this form submission.

The City of Busselton collects personal information to process this form and provide the requested services. Information may be used for related City business purposes or disclosed where authorised by law. To learn how your personal information is handled, access the City’s Privacy Statement or contact the Privacy Officer at privacy@busselton.wa.gov.au.

Current Information

First Name*

Surname*

Date of Birth

Phone Number*

Email Address*

Existing Property Address

Existing Mailing Address

New Information

First Name

Surname

Phone Number

New Email Address (a confirmation email will be sent to this address)*

New Property Address

New Mailing Address

I am the owner/agent of the property and make the following Rate Notice declarations

Are all rate notices for the property to be sent to the new mailing address?

YesNo

If NO then where are the rate notices to be sent?

The new address is to apply to

All owners of the propertyJust me

I am a... (please tick all of the relevant options)

Property owner
Tenant
Owner of a cat or dog registered with the City
Library member
Creditor of the City
Debtor
Subscriber to the Bay 2 Bay eNewsletter
Other

Please provide any further comments (if required)

Please upload any documentation supporting this application i.e. Certificate of Title, Death Certificate, Power of Attorney

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Declaration

I agree that the information is true and correct and that I am authorised to request these changes.*

I Agree

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