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Authorisation of a 3rd Party

You have the right to nominate a 3rd party who you may elect to act on your behalf. The information contained in the form below is required by us to satisfy the requirements of the Privacy Act 1988. All electronic forms on this website are protected by SSL technology.

Alternatively you may download, print and complete the form below and return to our office by mail. Our mailing details are here.

Authority To Operate (30 KB)

The information you supply may be provided to 3rd parties or as required or permitted by law. You may correct or update these details by contacting us.

* Denotes a required field

Your Full Name *	Your Date of Birth *
Your Daytime Phone Number *	Your Email Address *
Your Street Address (include Suburb and Postcode) *
I understand that this authority remains in place until I advise otherwise *
I authorise the person named below to act on my behalf with LCollect *
Authority Full Name *	Authority Date of Birth *
Authority Daytime Phone Number *	Authority Email Address
Authority Street Address (include Suburb and Postcode) *

Enter Word Verification in box below *

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Authorisation of a 3rd Party