Details currently shown on share register:
	Folio Number (if known):	Certificate No. (if known)
	Full name of entity to which shares were issued (as shown on register):
	Name of nominated contact person:
	Current Phone:
	Current Fax:
	Current Mobile phone:
	Address currently shown on register: .
	Unit, Suite or Appt. No
	Street Number and Name
	Suburb
	Town or City
	State	Postcode
	Country (if not Australia)
	Email address:
	New Details   (complete only fields that have changed from above)
	Full name of entity to which shares were issued (as shown on register):
	Reason for name change (ifapplicable)	Married   Divorced  Changed by deed poll    Other
	Name of nominated contact person:
	Unit, Suite or Appt. No
	Street Number and Name
	Suburb
	Town or City
	State	Postcode
	Country (if not Australia)
	New Email address:
	Additional Folio Nos. to be changed:
	Folio Numbers/Names: