Change of details of positive notice/card or positive exemption notice/card holder (Form 10-4)

Purpose

For use by a person holding a positive notice or positive exemption notice who changes their name, starts to use a different name or changes their contact details.

• Change of details of positive notice/card or positive exemption notice/card holder (PDF, 245 KB) Change of details of positive notice/card or positive exemption notice/card holder (DOC, 155 KB)

Checklist

1. Check that your details are correct
2. Ensure that the applicant has completed the declaration
3. Complete the payment details section (Part H) if required as the replacement notice and card is due to a change of name
4. If payment is by credit card, please pay online via:
   Make a Yellow Card Application payment
5. Ensure all signatures are on the form.

Submitting your request

• Mail: Department of Communities, Disability Services and Seniors
  PO Box 10179, Adelaide Street Brisbane QLD 4000
• Email: criminalhistoryscreening@disability.qld.gov.au

Further information

If you have any questions please email Criminal History Screening or phone the criminal history screening hotline: 1800 183 690.