This online form is used to notify the Resilium Operations team of a change in contact details for any staff in the Practice.  If there are also changes to the general Practice contact details, these can be sent through to the Resilium Operations team by completing the ‘Change of Practice contact details’ form which can be located on Adviser Gateway under Business Support Centre – Practice & AR Changes.


The asterisk (*) indicates that this information is required before submission of the form.



Adviser

 

Practice Name: *

Contact Name: *

Contact Email: *

Resilium Business Manager: *

Effective date for these changes: *

 

 

Change Of Name

 

First Name: *

Last Name: *

Previous Name (if applicable):

Reason for change:

Upload required document as proof of name change:

Please click here to supporting documents.

(EG. Marriage Certificate, Name change certificate)

 
 

 

Change of Staff Details

 

Phone Number:

Mobile:

Email Address:

   

Other Information

  

Please use this box to provide any special instructions or comments in relation to this request:

 
 

 

Acknowledgement

 

Pressing ‘SUBMIT’ will send this request to the Resilium Operations Team for processing.  Following receipt, it will take a maximum of 5 business days to update our internal records and to initiate a request with all external records that need to be updated.

 

I Accept

Date: *