Change of Details Form

NAME:*
FIRST NAME: MIDDLE NAME: SURNAME:
DATE OF BIRTH:*
ADDRESS:*
STREET: SUBURB: POSTCODE:
EMAIL:*
MOBILE:*
PHOTO ID*
Please upload some photo identification. Either a Drivers Licence, Passport or Student ID. You can upload a PDF, JPEG or Microsoft Word document.
Drop files here or

Accepted file types: pdf, jpg, doc, docx, Max. file size: 10 MB.
Bank Account Details
For elders 65 years and over
ACCOUNT NAME:
BSB NUMBER:
ACCOUNT NUMBER:
BANK ACCOUNT VERIFICATION (Only required if you are 65 years & Over)
Please provide Bank account verification (Top section of bank statement with Name, Address, BSB number and Account number). You can upload a PDF, JPEG or Microsoft Word document.
Drop files here or

Accepted file types: pdf, jpg, doc, docx, Max. file size: 10 MB.
Application Declaration
I have read and understand the Policy and I declare all information supplied to be true and correct. I agree that my typed name below can be used as a digital representation of my signature to that fact.
TO ACCEPT, TYPE YOUR NAME BELOW*
For any application enquiries please contact the office on 08 9997 3444 or email members@wajarri.com.au

Bank Account Details