Request for Confirmation of Enrolment
Please supply written confirmation of my enrolment details. Particulars of my request are
as follows:
Details:
Family name
Given Names
Date of Birth
/ /
Enrolled Address:
Note: If you require confirmation of your
enrolment at previous addresses, attach a
list of these addresses and the dates you
believe you were enrolled there.
Locality/Suburb State/Territory
Post
Code
Delivery Details:
Confirmation of enrolment details will be mailed to your current enrolled address or
provided in person on production of photographic proof of identity. If you wish to have the
confirmation mailed to another address please provide details below.
Mailing Address:
(If different from your enrolled
address)
Locality/Suburb State/Territory
Post
Code
........................................................ ........... / ........./ ........... ............................................
Signature of person making request
Date of request
Contact phone number
(where
convenient)
Office use only
RMANS ID
Signature
POI Date
of
Enrolled
Alternate
In
match
response
address
address
person
Y/N
Y/N
/ /
Y/N Y/N Y/N
08/07