Trustee of the Njamal People’s Trust

First name*

Last name*

Date of birth

Family group

Current address*

Street Address City * State / Province / Region * ZIP / Postal Code * Country

Phone

Email address*

Please provide details of your bank account

BSB	Account number	Account name	Bank

Please provide details of each child in your care.

Full name	Date of birth

I declare that the above information is true and correct. I agree that this information may be made available to other Trusts, Native Title Services within Australia. *

Signature*

Change of Details Form