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Change of application details form
Use this form when you:
· change your mailing address, and/or
· need to update the details of the people in your household, and/or
· want to update your waiting list preference/s.
Please lodge this form at your local Housing Office.
Local housing offices are listed in the government section of the White Pages directory under Human Services — Housing Services and on our website at www.dhs.vic.gov.au
Applicant’s name
Application No.
Update your contact details
Previous address
New address
Telephone
(Home)(Mobile)
Email address
@Update your waiting list preferences
Preference 1
Preference 2
Preference 3
Update your household details
Complete the following only if someone needs to be removed from your application.
Name of removed person
Date of birth
/ /New address, if applicable
Name of removed person
Date of birth
/ /New address, if applicable
Complete the following if someone needs to be added to your application.
Full name
Country of birth
Date of birth
/ /Male Female
Type of income
Gross weekly income
Full name
Country of birth
Date of birth
/ /Male Female
Type of income
Gross weekly income
Update any other details
Type of change (eg. change of surname)
Details of change
Documentation provided
The following documents have been submitted with this form (select as appropriate):
Proof of identity documents for any new member over 15 years of age*
Copies of current bank statements or bank books
Copies of income statements
Signed Authority for Centrelink to release customer information to the Director of Housing
Other relevant documentation
Signature of applicant
Office use only
Date entered on HiiP
/ /All documentation and client data received is managed in accordance with the Information Privacy
Act 2000.
* Your identity is established through the provision of original documents or certified photocopies from the Proof of Identity Fact Sheet available at your local housing office.
© Copyright State of Victoria 2012
Authorised and published by the Victorian Government, 50 Lonsdale St, Melbourne.
Print Managed by Finsbury Green.
September 2012 (0020912)
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