Membership details update page

In order to maintain accurate membership records, please confirm your current details so we can update the Trust database to ensure we can get in touch with you regarding Trust matters.

1. YOUR PERSONAL DETAILS

Your Name*

First Name Family Name

Your Maiden Name (if applicable)

Your Gender

Male
Female

Postal Address

Street Address Suburb City State / Province / Region ZIP / Postal Code Country

Date Of Birth*

Relationship status

Single
Married
De Facto
Civil Union

Phone Number

Mobile Number

Your Email

Your Preferred Contact Method

Phone
Email
Postal
None

2. YOUR SPOUSE/PARTNER'S DETAILS

Name

First name Family name

Maiden name (if applicable)

Gender

Male
Female

Date of birth

Iwi (if applicable)

3. YOUR CHILDREN/DEPENDANTS (under the age of 18 years)

Number of children/dependents

First dependent

Name

First names Surname

Date of birth

Gender

Male
Female

Relationship to me

Second dependent

Name

First names Surname

Date of birth

Gender

Male
Female

Relationship to me

Third dependent

Name

First names Surname

Date of birth

Gender

Male
Female

Relationship to me

Fourth dependent

Name

First names Surname

Date of birth

Gender

Male
Female

Relationship to me

Fifth dependent

Name

First names Surname

Date of birth

Gender

Male
Female

Relationship to me

Sixth dependent

Name

First names Surname

Date of birth

Gender

Male
Female

Relationship to me

Seventh dependent

Name

First names Surname

Date of birth

Gender

Male
Female

Relationship to me

Eighth dependent

Name

First names Surname

Date of birth

Gender

Male
Female

Relationship to me

Ninth dependent

Name

First names Surname

Date of birth

Gender

Male
Female

Relationship to me

NOTES

Please add any notes or additional dependents that you would like submitted with your registration

Additional info

4. PRIVACY ACT

In accordance with the provisions of the Privacy Act 1993, any information received herein, will be held by Ngāti Rehua Ngātiwai ki Aotea Trust or their respective successors, and will not be made available to any other parties without your consent. As a registered charity, it will be required to retain documents, including the application forms and ID for 7 years.

5. DECLARATION

I do solemnly declare that to the best of my knowledge and belief, that the information that I have provided about me is true.

Signature*

Email

This field is for validation purposes and should be left unchanged.

Update your details

1. YOUR PERSONAL DETAILS

2. YOUR SPOUSE/PARTNER'S DETAILS

3. YOUR CHILDREN/DEPENDANTS (under the age of 18 years)

First dependent

Second dependent

Third dependent

Fourth dependent

Fifth dependent

Sixth dependent

Seventh dependent

Eighth dependent

Ninth dependent

NOTES

4. PRIVACY ACT

5. DECLARATION

Pin It on Pinterest