Change of address

Personal details

First name:

Last name:

Contractor/Business name: ( If applicable?)

Date of birth:

Contact phone:

Email:

Old address

Existing address on licence:

Suburb:
State/Territory and Postcode:

New address

New address:

Suburb:
State/Territory and Postcode:

Type of licences

Please note the applicable licence/certificate or registration numbers in the right column which align with the type of licence you are referring to

Accredited medical practitioner (Tas Med Provider No.)

Automotive gasfitter

Building practitioner accreditation

Certificate of competency (Natural Gas) Type A or B

Dangerous goods bulk driver licence

Electrical practitioners and contractors

Licence to perform high risk work

Plumber/Gasfitter registration

Registered assessors for high risk work

Shot firer