Change of Ownership
Change of Ownership
Change of Ownership
Please fill out this form if you would like to transfer an amaysim Australia Ltd (amaysim) service from your
name into the name of someone else. Both parties need to fill out this form and read all the Terms and
Conditions on this form before signing. Please ensure that all requested information is supplied otherwise there
will be a delay in the processing of your request. The ID requirements outlined in this document are a regulatory
requirement and must be provided for the transfer to take place.
Please complete this form in blue or black pen, then scan and send the form to: [email protected]. au
Mobile Service
Number(s)
(separate with comma if more
than one)
2. Current account holder details (The person or entity who is transferring the service/s )
You must be the authorised account holder to be able to sign and approve this change of ownership form.
Please ensure the details below contain your details as held by amaysim. These are security questions to be
answered in full
Full Name
Date of Birth
Residential Address
Email Address
I warrant that I am the Current Account Holder or am authorised to make this request on behalf of the Current
Account Holder:
Full Name
Signature
Date
Page 1 of 3
`
amaysim Change of Ownership Form
Full Name
(As appears on identity
document)
Date of Birth
(must be older than 14
years of age)
Contact Number
Email Address
(We will contact you with
instructions)
Residential Address
(PO Box NOT Permitted)
Medicare Number: __ __ __ __ __ __ __ __ __ __ __ (Important This must be 11 digits and include the number
that is next to your name on the card)
Note (We can only accept the use of Green Medicare Cards)
(If your card only shows MM YYYY, leave the DD field blank.
Page 2 of 3
amaysim Change of Ownership Form
Before you agree to accept transfer of ownership, you need to inform yourself about the service, the plan
allowances and fees and the ongoing cost of the service.
I request amaysim to transfer the legal responsibility of the services listed above from the Current Account
Holder, whose details appear in Section 2 of this form to me, the New Account Holder.
1. that if amaysim accepts this request, the above services will be provided by amaysim to me, the New
Account Holder, and in accordance with, and I agree to be bound by, amaysim’s Standard Form of
Agreement (https://www.amaysim.com.au/dms/amaysim/documents/terms -conditions/amaysim-
General-Terms.pdf) and have had the opportunity to review the Critical Information Summary
(https://www.amaysim.com.au/terms-policies/c ritical-information -summaries) applicable to the
services listed above;
2. that acceptance of this request by amaysim is subject to amaysim’s ordinary ID verification process
and amaysim’s standard terms and conditions (see below);
3. to start a new account with amaysim using the Pre-paid billing option;
4. to organise a payment method for the use of the service via an approved payment method via My
Amaysim (https://www.amaysim.com.au/my -account/my -amaysim/login );
5. that amaysim may not be able to retain the existing plan structure on the services listed above and
may need to transfer the services to the As You Go plan in which case a new plan will need to be
added by me via My Amaysim;
6. to amaysim’s privacy policy (https://www.amaysim.com.au/dms/amaysim/documents/terms-
conditions/amaysim-Privacy-Policy.pdf);
7. I will be liable for all debts incurred on the services listed above on and from the date of transfer;
8. I consent to my identity information being checked with the Issuer or Official Record Holder; and
9. that I will not seek to recover any direct or indirect loss or damage I have suffered or may suffer
(either directly or indirectly) as a result of the transfer.
Full Name
Signature
Date / /
Form may take up to 7 days to be processed by amaysim. Please scan and send the form to:
[email protected]
Page 3 of 3