Change of Address

Collection Notice:

The Shire of Donnybrook Balingup collects personal information to provide services and carry out its functions.

If you do not provide the requested information, the Shire may be unable to provide the requested service or process your request. Information about how your personal information is collected, used, disclosed and managed, including the Collection Notice applicable to this service or activity, is available on the Shire's PRIS webpage and in the Shire's Privacy Policy.

For information about how your personal information is handled, to request access to your information, or to make a privacy enquiry, please contact Corporate Services.

I acknowledge that I have read and understood the Privacy Collection Notice

First Name*

Last Name*

Second Person Name (If Applicable)

Previous Address*

New Residential Address*

Do you have a separate postal address*

YesNo

If Yes, Please enter your Postal Address

Preferred Contact Number*

Do you have a dog or cat?

YesNo

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Change of Address

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