Telecommunications Industry Ombudsman

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Complete the relevant sections of this form to register a change of name or other details for a TIO member.

•Name of TIO Member:	Required Field
Trading Name (if applicable):
ACN/ABN/Business Number:
Change of Member Contact Details
Steet Address
Postal Address
Telephone Number
Facsimile Number
Email address for general TIO correspondence
Email address for TIO Level 1 complaints
Web Address
Change of Staff Contact Details
Change of CEO/MD/Proprietor
Title:
Surname Name:
First Name:
Job Title:
Email address
Change of TIO Complaints contact
Title:
Surname Name:
First Name:
Job Title :
Phone Number for customer referrals:
Phone Number for TIO Staff:
Facsimile:
Change of Accounts Contact for TIO billing
Title:
Surname Name:
First Name:
Job Title:
Phone Number:
Facsimile:
Email Address:
Termination of TIO Membership
Why do you require the TIO to terminate your organisation's TIO membership?
Has your customer base been acquired by another organisation? If yes, by who and on which date did the acquisition take place?	No Yes
Other information
Is there any other membership information you wish to pass on to the TIO at this time?
•Name of person submitting this form:	Required Field
•Job Title:	Required Field
•Email address:	Required Field
•Phone Number:	Required Field