Notification of Change in Details

Please complete and submit the following form to notify us of changes in your registration details:

	Personal Details
*	Email:		Your email address
*	Family Name:		Your family name
	Middle Name:		Your middle name
	Known As:		Name you are known as
*	Given Name:		Your given name
*	Effective Date:	/ /	dd/mm/yyyy

	Address Details
	House/Blk:
	Street:
	Floor/Unit No:
	Building Name:
	City:
	Post Code:
	Country:

	Contact Details
*	Home Tel No:
*	HP No:		Your Mobile No.
	Work Tel No:
	Fax No:

	Next of Kin
	Name:
	NRIC / Fin No:
	Date of Birth:	/ /	dd/mm/yyyy
	Relationship:		Their relationship to you
	Contact:		How to contact your next of kin

	Other
	Comments:		Any other information


		* Mandatory field