File Number

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	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL
NOTICE OF NEW CONTACT OR REPRESENTATION DETAILS
		
	*for use when a party, guardian or financial manager changes their contact details or their representative..		

NOTICE GIVEN BY (indicate what applies to you)	
Applicant                                    Respondent                                    Guardian            
 
Financial Manager                     Other           
	
NEW CONTACT DETAILS  (complete all sections)	
Name

Address line 1

 	
Address line 2

 	
Telephone
	                                                                   Fax:           

Email:                            	
NEW REPRESENTATIVES DETAILS  (complete all sections)	
Name	 	
Address line 1

 	
Address line 2

 	
Telephone
	                                                                Fax:                                       

Email:	
DATE CHANGE HAPPENED	

	

Signature		Date