Forms Template - Change of name, address and/or contact details - V4

Sep 16, 2026

Uploaded by Bulrr

Form for updating an applicant’s personal and communication information with Murrumbidgee Irrigation Limited. Collects applicant details including full name, email, MI User ID, date of birth, company name, addresses, phone/mobile number, and ABN. Guides required actions for changing name, address, and contact details, including statutory declaration and certified evidence for name changes. Includes options for communication methods and a signing section with confirmation of attached statutory declaration, governed by Australian Privacy Principles.

LanguageEnglish

CategoryForms

FormatPDF

Pages2

Reading Time1 min

AccessFree to download

NOTES

Applicant’s details

Change details

Change of name

Change of address

Change contact details

Communication details

Signing by the applicant(s)

02 6962 0200 [info@mirrigation.com.au](info@mirrigation.com.au) [mirrigation.com.au](mirrigation.com.au) Locked Bag 6010 Griffith NSW 2680 ABN 39 084 943 037 FORM: Change of name, address and/or contact details Use this form to change your name, address and/or contact details (email / mobile number) . NOTES • Unless otherwise stated, the meanings for capitalised terms used but not defined in this application, are the same as those defined in the Water Entitlements and Water Delivery Contracts. • If the Water Entitlements, Rights of Access and/or Shares certificate/s applied to be changed are held jointly by two or more persons, each person must be named as an applicant and each person must sign this application. The applicant’s details must be identical to the details on the Water Entitlements Contract, Water Delivery Contract and/or Share Certificate in respect of the certificate/s being replaced. • The applicant is aware that the updated contact information provided on this form will update all existing contact information within Murrumbidgee Irrigation systems. • Murrumbidgee Irrigation Limited is bound by the Australian Privacy Principles (APPs) in the Privacy Act which regulate how we collect, use, disclose and store your personal information, and how you may access and correct personal information we hold about you. To see how we handle your personal information, please read out complete Privacy Policy, which can be accessed on our website. [www.mirrigation.com.au/sitemap/privacy](www.mirrigation.com.au/sitemap/privacy) 1. Applicant’s details Full name Email MI User ID (Used to access MI Connect) Date of birth Company Name Postal Address Landholding Address Phone or Mobile No. ABN 2. Change details I wish to advise of my name change > Go to Section 3 Name change requires a Statutory Declaration and certified evidence of change of name, correctly completed and signed. change address details change contact details > Go to Section 4 > Go to Section 5 Murrumbidgee Irrigation Limited | Change of name, address and/or contact details | 23.06.2025 Page 1 of 2 3. Change of name A Statutory Declaration and certified evidence of change of name is required. New given name/s New family name 4. Change of address New residential address New postal address 5. Change contact details New Mobile No. New Phone No. New Email 6. Communication details Please indicate your preferred method of receiving communications from MI. Water order confirmation via: Company information releases via: SMS text Email Not required SMS text Email Not required 7. Signing by the applicant(s) Full name Signature Date Agree to Terms and Conditions Statutory Declaration Attached Murrumbidgee Irrigation Limited | Change of name, address and/or contact details | 23.06.2025 Page 2 of 2

FAQs

What information is required in the applicant’s details section?

The form requests full name, email, MI User ID, date of birth, company name, postal address, landholding address, phone or mobile number, and ABN.

What is required to change a person’s name on this form?

A statutory declaration and certified evidence of change of name are required, and the information must be correctly completed and signed.

How can applicants choose their preferred communication method?

Applicants indicate preferred methods for receiving communications, including options such as SMS text or email for order confirmations and company information releases.

Sep 16, 2026

Uploaded by Bulrr