Change of details
If you would like to change the details we have on record for you, you can do so by filling out this form.
Please select all options below that apply.
*
I am a member of CCS Disability Action
I am supported by CCS Disability Action
I donate to CCS Disability Action
I have a Mobility Parking Permit
Other changes of details enquiry
Notification of deceased relative
How many selections?
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Members
In this section, you can request a change of details relating to your membership.
Membership number (if known):
Name currently on our files:
*
First Name
Last Name
Which branch are you a member of?
*
Please Select
Auckland
Bay of Plenty
Blenheim
Canterbury & West Coast
Manawatu
Nelson
North Taranaki
Northland
Otago
South & Central Taranaki
South Canterbury
Southland
Tairawhiti/Hawkes Bay
Waikato
Wairarapa
Waitaki
Wellington
Whanganui
Email CCS Disability Action branch for members
What would you like to change?
*
Name and/or title
Phone number
Email
Address
Title (please select):
Master
Mr.
Miss
Ms.
Mrs.
Other
New name:
First Name
Last Name
Old phone number:
-
Area Code
Phone Number
New phone number:
-
Area Code
Phone Number
Old email:
example@example.com
New email
example@example.com
Old address
Street Address
Street Address Line 2
City
State / Region
Post Code
New address
Street Address
Street Address Line 2
City
State / Region
Post Code
Add any comments you want to share with the membership team:
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People supported by CCS Disability Action
In this section, you can request a change of details relating to the support you are receiving from us.
Name currently on our files:
First Name
Last Name
Please select the CCS Disability office that supports you from the following drop down menu:
*
Please select
Alexandra
Ashburton
Auckland
Blenheim
Christchurch
Dunedin
Gisborne
Greymouth
Hamilton
Hāwera
Invercargill
Masterton
Napier
Nelson
New Plymouth
Oamaru
Palmerston North
Rotorua
Tauranga
Timaru
Wellington
Westport
Whakatāne
Whanganui
Whangārei
Email CCS Disability Action office
What would you like to change?
Name and/or title
Phone number
Email
Address
Title (please select):
Master
Mr.
Miss
Ms.
Mrs.
Other
New name:
First Name
Last Name
Old phone number:
-
Area Code
Phone Number
New phone number:
-
Area Code
Phone Number
Old email:
example@example.com
New email
example@example.com
Old address
Street Address
Street Address Line 2
City
State / Region
Post Code
New address
Street Address
Street Address Line 2
City
State / Region
Post Code
Add any comments you want to share with the support team:
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Donors
In this section, you can request a change of details relating to your donation.
Supporter code (if known):
Name currently on our files:
*
First Name
Last Name
What would you like to change?
Name and/or title
Phone number
Email
Address
Title (please select):
Master
Mr.
Miss
Ms.
Mrs.
Other
New name:
First Name
Last Name
Old phone number:
-
Area Code
Phone Number
New phone number:
-
Area Code
Phone Number
Old email:
example@example.com
New email
example@example.com
Old address
Street Address
Street Address Line 2
City
State / Region
Post Code
New address
Street Address
Street Address Line 2
City
State / Region
Post Code
Add any comments you want to share with the donations team:
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Mobility Parking
In this section, you can request a change of details relating to your mobility parking permit.
NHI number (if known):
Permit number (if known):
Name currently on our files:
*
First Name
Last Name
Date of birth:
*
-
Day
-
Month
Year
Date Picker Icon
What would you like to change?
Name and/or title
Phone/Mobile number
Email
Address
Title (please select):
Master
Mr.
Miss
Ms.
Mrs.
Other
New name:
First Name
Last Name
Old home phone number:
-
Area Code
Phone Number
New home phone number:
-
Area Code
Phone Number
Old mobile phone number:
-
Area Code
Phone Number
New mobile phone number:
-
Area Code
Phone Number
Old email:
example@example.com
New email
example@example.com
Old address
Street Address
Street Address Line 2
City
State / Region
Post Code
New address
Street Address
Street Address Line 2
City
State / Region
Post Code
Add any comments you want to share with the Mobility Parking team:
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Other change of details
In this section you can request the change of details that do not fit any of the criteria listed.
Name currently on our files:
First Name
Last Name
Please outline your connection to CCS Disability Action, so we can direct your enquiry to the right place:
What would you like to change?
Name and/or title
Phone number
Email
Address
Title (please select):
Master
Mr.
Miss
Ms.
Mrs.
Mx.
Other
New name:
First Name
Last Name
Old phone number:
-
Area Code
Phone Number
New phone number:
-
Area Code
Phone Number
Old email:
example@example.com
New email
example@example.com
Old address
Street Address
Street Address Line 2
City
State / Region
Post Code
New address
Street Address
Street Address Line 2
City
State / Region
Post Code
Add any comments you want to share with the team:
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Notification of deceased relative
In this section you can notify us of a person who has passed away. We will remove them from all relevant databases.
Name of person completing this form:
*
First Name
Last Name
Phone/mobile number of person completing this form:
*
-
Area Code
Phone Number
Email of person completing this form:
*
example@example.com
Name of deceased person:
*
First Name
Last Name
Date of birth of deceased person
*
-
Day
-
Month
Year
Date Picker Icon
Please outline the deceased person’s relationship to CCS Disability Action, so we can ensure we update the correct information on our database.
Do you need any further information from us?
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Submission
Click 'submit' to complete your request.
Do you want a copy of your submission?
Yes
Please add the email you want to receive the copy of your submission:
example@example.com
Submit
Should be Empty: