Change of Household Rep (HHR)

Information

Please complete this form if you would like to change your household details for the purposes of General
Health Grant applications or alternatively if you are the household representative you can phone or email
to make changes.

Please complete online form below:

"*" indicates required fields

Are you registered with Tauhara North No.2 Trust?

Are you registered with us?*

Yes

You have selected ‘No’, you are not eligible for a grant unless you successfully register with Tauhara North No.2 Trust. Please click here to register or call us on 0800 828 427 or email info@tauharano2.co.nz.

Personal Details - must be over the age of 18

First Name*

Middle Name

Surname*

Date of Birth*

Gender*

Address

Physical Address Suburb City Postcode Country

Postal Address (if different from above)

Physical Address Suburb City Postcode Country

Email*

Contact Number

Change of HHR (Household Representative)

The Current Household Representative is

The New Household Representative is

Bank Account Details

Bank Account Name

Bank Account Number

Upload Document

Drop files here or

Max. file size: 250 MB.

(e.g. A verified bank deposit slip, bank statement or bank chit)

Changes to Household Members

Members to add

Please list each member's (name, relationship to the HHR and date of birth) each on a seperate line.

Members to remove

Please list each member's (name, relationship to the HHR and date of birth) each on a seperate line.

Declaration

I declare all information provided in this application is true and correct to the best of my knowledge.

Grant Applicant Full Name

Information

Are you registered with Tauhara North No.2 Trust?

Personal Details - must be over the age of 18

Change of HHR (Household Representative)

Bank Account Details

Changes to Household Members

Declaration

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