Change of name

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This form can be used to change the name that we hold for you.

If you have a joint plan, please ensure all plan holders complete their own form.

All fields are mandatory.

Name we currently hold on record

New name

Your details

Contact Details

By submitting this form, you are happy for us to contact you regarding your enquiry. 

To find out more about how we use your personal information, please read our Privacy Policy Information