RCNP

RESIGNATION OR CHANGE OF NOMINATED PERSON
FOR AN UNINCORPORATED BODY

IMPORTANT INFORMATION
Applicants should be aware of their responsibilities under the Charitable Collections Act 2003.  You can view the legislation and its regulations or download them from www.legislation.act.gov.au.  You may also obtain access to the Charitable Collections Practice Manual at and relevant forms at www.ors.act.gov.au - This form can be used for the purposes of a resignation of change of nominated person a Charitable Collection Licence under Section 32 and 33 of the Act.

Send completed applications to:  OFFICE OF REGULATORY SERVICES, PO BOX 225, CIVIC SQUARE, ACT 2608

 Resignation   		 Change	DATE RESIGNATION OR CHANGE EFFECTIVE		LICENCE NUMBER	
 Licence Attached					     	

DETAILS OF RESIGNATION OR CHANGE OF NOMINATED OFFICER	

TITLE
(eg. Ms, Mr, Dr)	FULL NAME OF NOMINATED PERSON RESIGNING	POSITION HELD WITHIN ORGANISATION 
(eg. Exec Officer)	
     	     	     	
NOMINATED PERSON ADDRESS (Property Name, Unit, Flat, Room No, Street Number, Street Name, City/Suburb/Town, Postcode)	
     	
NOMINATED PERSON RESIGNING SIGNATURE (if original licence is attached to the application)	

Applicants Name in Full

Applicant Signature                                      Dated	Signed in my presence

Witnesses Name in Full

Witness Signature                                                   Dated

DETAILS OF NEW NOMINATED OFFICER	

TITLE
(eg. Ms, Mr, Dr)	FULL NAME OF NEW NOMINATED PERSON	POSITION HELD WITHIN ORGANISATION 
(eg. Exec Officer)	
     	     	     	
NOMINATED PERSON ADDRESS (Property Name, Unit, Flat, Room No, Street Number, Street Name, City/Suburb/Town, Postcode)	
     	
PHONE CONTACT	FAX CONTACT	EMAIL CONTACT	
     	     	     	
NEW NOMINATED PERSON SIGNATURE (if original licence is attached to the application)	

Applicants Name in Full

Applicant Signature                                      Dated	Signed in my presence

Witnesses Name in Full

Witness Signature                                                   Dated
	
EXECUTIVE OFFICER OF UNINCORPORATED BODY SUPPORTING CHANGE OF NOMINATED PERSON	

Executive Officer’s Name in Full

Executive Officers Signature                                      Dated	Signed in my presence

Witnesses Name in Full

Witness Signature                                                   Dated