CHANGE OF FUNERAL PROVIDER REGISTRATION DETAILS FUNERAL ACT

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Change of funeral provider registration details

Funeral Act 2006 Section 10(2)

Warning: Enter text in spaces provided only. Consumer Affairs Victoria will not accept your form, nor consider it lodged, if you remove or change any questions or other text.

Reference number

The information provided on this form may be displayed on the public register.

A Funeral Provider must notify the Director of Consumer Affairs Victoria of a change in any of the registration information relating to the funeral provider within 14 days of the change.

  1. Registration number of funeral provider


  1. Do you want to notify of a change to:

Previous funeral provider name


New funeral provider name


Postal address of funeral provider

Previous address


Postcode


New address


Postcode


Principal place of business of funeral provider

Previous address


Postcode


New address


Postcode


Name of legal owner of funeral provider

Previous legal owner


New legal owner


Address and/or phone numbers of other places of business of funeral provider in Victoria

Place of business to be removed


Postcode


Telephone number


Place of business to be added


Postcode


Telephone number


Funeral provider business name registration number

Previous business name


Previous registration number


New business name


New registration number


Name and contact details for the current manager of funeral provider

Previous name


Address


Postcode


Telephone number


New name


Address


Postcode


Telephone number


Name and contact details for person lodging this notification


Address


Postcode


Telephone number


Privacy

Consumer Affairs Victoria is bound by laws that protect your privacy concerning the collection, use and disclosure of your personal information. Where you do not provide the information required by this form, we may refuse or be unable to process this transaction. We may need to disclose your personal information to other State and Commonwealth agencies. You can request access to your personal information by contacting us. For more information, view the Privacy statement page on the Consumer Affairs Victoria website (consumer.vic.gov.au/privacy).



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