Update Parent Organisation Details Form

This form is used to notify the Department of Education(the department) of changes to the details of the parent organisation of a child care service. The parent organisation is the legal entity (company or organisation) that applied for Child Care Benefit approval. Use this form if details about that organisation have changed, but if the organisation itself changes (e.g. a new company takes over the service operation) then the new organisation will need to seek a new CCB approval. If this describes your situation, please contact the department approvals team for your state on 1800 670 305.

Complete the relevant section(s) below only for details that need updating and return to your department state office upon completion (see attachment A for details).

Parent Organisation Name:______

Parent Organisation ABN:______

CCB Approval ID for your most recently approved service:______

Date changes take effect:______

Name Change

Complete this section if you are changing the name(s) of your organisation.

 Legal Name Trading Name Both

Current Name:______

New Name:______

If you are changing a trading name, please attach a copy of the Certificate of Registration of a Business Name from the relevant state government department. If the Certificate of Registration of a Business Namedoes not contain the organisation’s name, also attach a copy of the Business Name Extract.

Please also attach a copy of your new provider approval issued by the state regulatory authority.

Organisation Location

Complete this section if you are changing the business address of your organisation.

Reason

 Sale of premises

 Termination of the lease of the premises

 Other

Current Organisation Location

Street:______

Suburb:______

City:______State:______Postcode:______

New Organisation Location

Street:______

Suburb:______

City:______State:______Postcode:______

Please also attach a copy of your new provider approval issued by the state regulatory authority.

Change of Postal Address

Complete this section if you have changed the postal address of your organisation.

Current Postal Address

Street/PO Box:______

Suburb:______

City:______State:______Postcode:______

New Postal Address

Street/PO Box:______

Suburb:______

City:______State:______Postcode:______

General E-mail Address

If you have changed the general email address of your organisation, enter the new general e-mail address for the organisation here.

General Email: ______

Telephone and Facsimile Contact Details

If you have changed your telephone and/or fax numbers, enter the new numbers for your organisation here.

Telephone Number:______Fax Number:______

Authorised Persons

As the authorised persons for this service, we confirm the above details are correct. We acknowledge that providing false or misleading information is a serious offence.

Name:______

Position:______

Signed:______Date:______

Name:______

Position:______

Signed:______Date:______

This form needs to be signed by two Authorised Persons from your organisation.

Authorised Persons are those persons from your organisation that have previously been identified to the department as having the authority to make changes to organisation or service details.

Attachment A

Addresses for State and Territory Offices

This form should be sent to your local state or territory office. Addresses for these offices are below. Should you wish to send these from electronically, please contact your state or territory office on 1800 670 305 and ask to speak with the Child Care Benefit Approvals team in your state or territory.

State / Address
New South Wales & Australian Capital Territory / Child Care Benefit Approvals Team
Department of Education
GPO Box 9880, Sydney NSW 2001
Victoria / Child Care Benefit Approvals Team
Department of Education
GPO Box 9880, Melbourne VIC 3001
Queensland / Child Care Benefit Approvals Team
Department of Education
GPO Box 9880, Brisbane QLD 4001
Western Australia / Child Care Benefit Approvals Team
Department of Education
GPO Box 9880, Perth WA 6848
South Australia / Child Care Benefit Approvals Team
Department of Education
GPO Box 9880, Adelaide SA 5001
Tasmania / Child Care Benefit Approvals Team
Department of Education
GPO Box 9880, Hobart TAS 7001
Northern Territory / Child Care Benefit Approvals Team
Department of Education
GPO Box 9880, Darwin NT 0801