APPLICATION TO CHANGE ADDRESS IN GCLCA

APPLICATION TO CHANGE ADDRESS

IN THE GWICH’IN COMPREHENSIVE LAND CLAIM AGREEMENT
Full Name

First NameMiddle Name(s)Last Name
Enrolment Number
1234
Date of Birth

MonthDayYear
Date
Please provide either a Phone Number or Email Address (preferably both) so that we can contact you.
Phone Number
Format: (000) 000-0000.
Email
example@example.com
New Home Address
P.O. Box
Apt./Unit
Street No.
Street Name
City/Town/Community
Province/State
Country
Postal / Zip Code
New Mailing Address
P.O. Box
Apt./Unit
Street No.
Street Name
City/Town/Community
Province/State
Country
Postal / Zip Code
Applicant Signature
I certify that the information provided is, to the best of my knowledge, true, correct and complete.
I acknowledge that I am submitting this information voluntarily to update my enrolment file.
Print Name of Applicant
Date

MonthDayYear
Date
Signature of Applicant (If 19 years of age or older).
Date received

MonthDayYear
Date
Date reviewed by Officer

MonthDayYear
Date
Date Processed

MonthDayYear
Date
Please verify that you are human
Should be Empty: