Correct Address: My/our name & address are correct Name Mis-spelt: My/our name is mis-spelt. I have a new address.: I have a new address. Name: * Shareholder Number: New Address: Previous Address: (This helps with our ensuring we have identified you correctly) Email: Bank Account Number: * Name of Bank: * Bank Branch: * Inland Revenue Number: * Additional Info: Form Complete: * I have completed this form.
