Bankwest Change of Name Statement Form

Bankwest Change of Name Statement
Bankwest, a division of Commonwealth Bank of Australia
ABN 48 123 123 124 AFSL/Australian credit licence 234945
Important Information
• Please complete the below form and take it, along with the required Identification documents (listed under Section 2 of the form),
to your nearest Bankwest Store and we will fulfil your request for a change of name.
• Please print neatly in BLOCK letters.
Bankwest Store
Section 1 – Signatory
This statement may be used in circumstances where the signatory wishes to (please tick appropriate box):
Use the name which the signatory has adopted by marriage
Use a former name (in the case of a woman who no longer wishes to use the surname of her husband or de facto husband)
Use their traditional name (in the case of an Aboriginal person or Torres Strait Islander)
Use the name which the signatory has adopted and registered with Births Deaths and Marriages in the applicable state or territory
Adopt a new name to ensure their safety (in the case of a victim of violence)
Give details about why the signatory wishes to use a new name
Previous name (by which the signatory has been commonly known)
Title
Surname
- select -
Given name/s (no initials)
New name (by which the signatory wishes to be commonly known)
Title
Surname
- select -
Given name/s (no initials)
Occupation
CIF Key (Bank use only)
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Residential address
Suburb
State
Former signature
New signature
✗
✗
Postcode
Date
DD/MM/YYYY
Section 2 – Evidence of change of name
The change of name is supported by the following document (please tick appropriate box):
Registered Marriage Certificate
Divorce papers Decree Nisi or Absolute (showing the name being reverted to)
Revised Birth Certificate (with notations)
Change of Name Certificate issued by the Register of Births, Deaths and Marriages in the applicable state or territory
Issued by
Document number
Document date
DD/MM/YYYY
Section 3 – Bank use only
ChecklistInitials
Staff number
CBS / CustomerOne updated
Copy of change of name document held
Signatures and signing authorities verified
Address checked with customer to CBS records
Cards/cheque books reissued (if applicable)
Change of name document and evidence uploaded to CPS
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