Change of Details form - Change of Details

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					Change of Details
   Member Services Centre 13 43 72       Facsimile 1800 300 067
   PO Box J 755, Perth WA 6842     Level 4 Central Park, 152 St Georges Terrace, Perth

This form allows you to update the following details:                                                Section 3          change of aDDreSS
  your name your address other contact details
                                                                                                     Please complete this section if you wish to change your address.
Did you know that you can also change address and contact details
via Member Online at anytime? If you visit Member Online, there                                      Previous Residential Address
is no need to complete this form.
To change any other information, please contact our Member
Services Centre on 13 43 72.                                                                                                                Postcode

Section 1 Your DetailS                                                                               New Residential Address
Please provide your GESB Member Number and personal details.
GESB Member Number

                     WIN No. Office Use Only                                                         Postal Address (if different from new residential address)

Mr            Mrs            Miss              Ms           Other                                                                           Postcode

Surname (Family Name) please print                                                                   Date New Address effective from                 /    /
                                                                                                     Section 4 change of contact DetailS
Given Names                                                                                          Please complete this section if you wish to change your
                                                                                                     contact details.
                                                                                                     Telephone – Home                       Telephone – Work
Date of Birth                 /      /                Male                  Female                    (    )                                 (   )
Employer (if applicable)                                                                             Telephone – Mobile

Section 2 change of name                                                                             Email Address
Complete this section if you wish to inform us of your change
of name. Please provide GESB with a certified* copy of the
documentation that supports your change of name (eg. Marriage                                        Section 5 Declaration
Certificate, deed poll).
                                                                                                     I declare that the information supplied on this form is true
Mr           Mrs             Miss              Ms          Other                                     and correct.
                                                                                                     Your Signature                                      Date
Surname (Family Name) please print
                                                                                                                                                                  /   /

Given Names                                                                                          Section 6 poSt to geSb
                                                                                                     Post your form, and your original certified proof of identity (if
*See over for more information                                                                       GESB
                                                                                                     PO Box J 755
                                                                                                     Perth WA 6842
                                                                                                     Facsimile 1800 300 067 (if no proof of identity needed)

                                                                                                                                                     FOR OFFICE USE ONLY
                                                                                                                                                                           GESB 1287 fggcon4 05/10

Note: GESB has a Privacy Statement to ensure that it handles private information about individuals responsibly.
Our Privacy Statement is available on our website or can be obtained by contacting our Member Services Centre.
Government Employees Superannuation Board ABN 43 418 292 917
proof of identity
have you changed your name?
If you have changed your name, you will need to provide a certified linking document. A linking document is a document that proves a
relationship exists between two (or more) names.
The following table contains information about suitable linking documents.

 purpose                                          Suitable linking document
 Change of name                                      Marriage certificate
                                                     Deed poll
                                                     Change of name certificate from Births, Deaths and Marriages Registration Office

completing proof of identity
1. finD Someone to certifY Your DocumentS
The following people can certify copies of your original documents as true and correct copies:
       A permanent employee of Australia Post with five or more               A person enrolled on the roll of a State or Territory
       years of continuous service who is employed in an office               Supreme Court or the High Court of Australia, as a legal
       supplying postal services to the public                                practitioner
       An officer with, or authorised representative of, a holder             A notary public
       of an Australian Financial Services Licence (AFSL), having
                                                                              A registrar or deputy registrar of a court
       five or more years continuous service with one or
       more licensees                                                         An Australian consular officer or an Australian
                                                                              diplomatic officer
       A police officer
                                                                              A magistrate
       A Justice of the Peace
                                                                              A Chief Executive Officer of a Commonwealth court
       A judge of court
2. how to certifY Your DocumentS
All copied pages of original proof of identification documents (including any linking documents) need to be certified as true copies
by any individual approved to do so.
The authorising person must sight the original document and include the following details on the copies:
1. Stamp or write “I certify this is a true copy of the original document” on each page
Followed by their:                                                                                  I c ertify t his is a t ru e co p y
                                                                                                    of t h e o rigin a l doc u m en t.
2. Printed name

                                                                          A MP
3. Signature
4. Qualification (eg Justice of the Peace) and
5. Date
                                                                         S                          Ju l i e Presto n
                                                                                                    Jus ti c e of t h e Pea c e

If you require further information please contace our Member Services Centre on 13 43 72