test form

test form

Headline test

Form intro sample text

PART 1: Your contact information
Last name: (required)*
First name: (required)*
Your date of birth (Year / Month / Day):
Your phone number during the day:*
Any other phone number where you can be called (if you have one you want to give):
Email address (if you have one you want to give):
Are you requesting changes or corrections to someone else’s personal information?*
- YES. Go to PART 2.
- NO. Go to Part 3.
PART 2: Changing someone else’s personal information:

Requests to change someone else’s information are not allowed unless you have the authority to access the information. CLBC may ask you for a copy of the Representation Agreement or Committeeship order (a court-appointed guardian) or a written consent signed by the individual.
Confirmation:
- Yes. I will provide a copy of legal representation or consent.
Fill in the information of the person whose information you wish to change or correct.
Last name of person:
First name of person:
Person’s date of birth (Year / Month / Day):
PART 3: Information to be changed or corrected
Describe the information you want changed. Give the new, updated information. Ask for your local CLBC office for help if you are not sure what information fits your request. (required)*