ASIC Form 201 - Application for Registration as an Australian Company

ASIC Form 201 is used to apply for registration of a company under the Corporations Act 2001. The form requires details of the company, appointment of officeholders, and details of members. The completed and signed form must be sent to the Australian Securities and Investments Commission for registration.

Australian S ecu rities &
In vestmen ts Co mmi ssion
Appli cation fo r regi stration as an Australi an
co mpan y
Use this form to apply to ASI C for regis tra tion o f a company under the Corpora tions A ct 2001.
Re late d Fo rms
208 - No tifi cation o f de tails o f shares allo tt ed o ther than for
cash 207 Z - Cer tif ica tion o f compliance with stamp du ty law
Fo rm 201
Corpora tion s Act 2001
117
I f th ere is insu ff i ci en t s p ace in a n y sect ion o f th e fo rm , you may pho to c op y th e re l eva n t p ag e(s) a nd subm it as p art o f thi s lodg emen t
Lodg eme n t d eta ils
A n image o f t his f orm will be av ailable as
par t of the publi c regi st er.
Who should A SI C con tact i f th ere is a qu ery a bou t thi s
fo rm ? ASI C regist ered agent number (if appli c able)
9252521
F irm / organi s a tion
ABBY LEGAL SERVICES LIMITED
Con t act name /po s ition de sc rip tion
LEGAL ADVISOR T elephone number (during bu s ine ss hour s )
( 9828592888 )
E mail address (op tional)
[e-mail]
S uburb/ City St a te /T erri t or y P ostc ode
Adelaide South Australia 5000
1 S tate /terr itory of re gi strat ion
I appl y for regist ra t ion of the c ompany under t he Corpora t ion s Act 2001 and nomina t e t he St at e or T erri tor y in whic h
t he c ompany will be t ak en to be regi st ered .
Giv e St a te or T erri t or y
South Australia
2 Deta il s of t he compa ny
D o es th e co m p an y h ave a p r opo se d c o mp a n y n ame?
X Y es
If y e s, the propos ed c ompany name is
QUELESSGROCERY
Name re s er v at ion number (if an y )
703 452 253
No
T he c ompan y name on regi st ra t ion will be its A ust ralian Company Number (A CN) .
T ick the legal elemen ts tha t appl y
Pty. L td . P roprie tar y Limit ed No liabili ty X NL

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2 Con tinued ... Fu rt her deta ils of t he compa ny
I s th e p ropose d n ame id e n tica l to a re gi stere d bu s in ess n ame(s)?
Y es X No
If y e s, I declare t hat I hold , or am regi st ering the c ompan y for the holder( s ) of, t he iden t ic al
bu s ine ss name(s ), t he regi st ra tion de tail s of whic h are list ed below.
AB N
92532545122
F or busine ss name s regi st ered be f ore
28 May 2018 wi t hout an AB N.
or
P rev iou s bu s in ess nu m b er P rev ious state / terr ito ry o f re gi stration
T yp e o f co m p an y
proprie tar y c ompany
public c ompany
C lass o f c o mp a n y
limit ed b y s hare s
unlimit ed wi th a s hare c apit al
limit ed b y s hare s
limit ed b y guaran tee
unlimit ed wi th a s hare c apit al
X no liabili ty
Sp eci al pu rpo se (if appli c able)
home uni t (HUN T )
s uperannuat ion tru st ee (PST C)
c hari t able purpos e s onl y (P NP C)
X s uperannuat ion tru st ee (UL SS )
c hari t able purpos e s onl y (UL S N)
Sp ec i al pu rpose co m p an y
Ref er t o Guide f or de sc rip tion s o f
special purpo s e c ompanies.
A public c ompany t hat is:
• a superannuation t ru st ee , or
• for charitable purpo s es only,
must ha v e a c onst it ut ion .
If t his is a s pe c ial purpos e c ompany, t ick t he bo x below t o ma k e the dec lara t ion .
I dec lare t ha t thi s c ompany is a s pe c ial purpo s e c ompany a s def i ned under Regula t ion 3 o f t he
Corpora t ion s (Re v iew F ees ) Regula t ion s 2003.
Go ver n an ce o f a publi c c o mp a n y
T he c ompany will rel y ent irel y on repla c eable rule s
X T he c ompany ha s a c on st itu tion
A p r oposed publi c c o mp a n y whi ch h as adop te d a “ C on sti tu tion” mu st lodg e a copy o f th e c on sti tu tion
with thi s a pplicat ion.
If t he propo s ed c ompany is t o be a public c ompany li m ite d b y gu ara n tee , st at e t he amount of the guaran tee tha t
ea c h member agree s to in wri ting .
Regi stere d o ff i ce
Y ou cannot u s e a PO B ox
address
T he amount of the member’s guaran tee is $ 18000 (inser t amoun t)
At t he o ff i c e o f, C/ - (if applic able)
Off i c e, uni t, le v el
32
Avenue number and Avenue name
45 LOVELY AVENUE
S uburb/ City St at e/T erri tor y P o stc ode
Adelaide South Australia 5000

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2 Con tinued ... Fu rt her deta ils of t he compa ny
D o es th e co m p an y o cc up y th e p rem i ses?
X Y es
No
If no , name o f o c cupier
Occupier’s c on s en t (S ele ct bo x to indi c at e t he st a temen t below is c orre ct )
Off ice hou rs
F or a publi c c ompany
T he occ upier of the premis es has c ons en ted in wri ting t o t he us e of the s pec if i ed addre ss as the
address o f t he regi st ered o ff i c e o f t he c ompan y and ha s no t wit hdrawn t ha t c on s ent.
X a . Regi st ered o ff i ce o f a public c ompany is open t o t he publi c ea c h bu s ine ss da y from a t lea st 10 am to 12
noon and 2 pm t o 4 pm .
b . Regi st ered off ice of a publi c c ompany is open to the publi c eac h bus ine ss day f or a t lea st 3 hour s
be tween 9 am and 5 pm .
If b, in s er t hours open from am/pm c lo s e to am/pm
P rin cip al pl ace o f bu s in ess I f same as re gi stere d o ff i ce , wri te “ as abo ve ”.
Off ic e , uni t, le v el
As above
Avenue number and Avenue name
As above
S uburb /Ci ty St at e/T erri tor y P o stc ode
As above As above As above
Coun try (i f no t A u st ralia)
3 A ppoin t off i cehold er
A public compan y mu st hav e a
minimum o f 3 direc tor s (2 re s iden t in
A u st ralia) and 1 secre tar y (re s iden t in
A u st ralia) .
Off i ce h e ld
X Dire ct or S e c re t ary
A proprie t ary c ompany mu st ha v e
a minimum of 1 dire ctor (re s iden t in
A us tralia) . T he o ff i c e o f s e c re t ary is
op tional , but if appoin t ed one mu st
reside in A u st ralia .
Off i ceholder(s ) appoin t men t da te s hall
be effec tive from t he beginning of the
day on whi c h t he c ompany be c omes
regis t ered.
F amil y name Giv en names
SAM BELL SAM BELL
F ormer name

NA
Avenue number and Avenue name
72, Tom Strret
S uburb/ Ci ty St a te /T erri t or y P ostc ode
Adelaide South Australia 5000
Count ry (if not A ust ralia)
Dat e o f bir th
15/11/1885
P la c e o f bir th (town /c ity) (st at e/count ry )
Adelaide South Australia
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3 Con tinued ... A ppoin t ano ther off i cehold er
A public c ompany mu st ha v e a
minimum of 3 dire ct or s (2 re s iden t in
A ust ralia) and 1 s e c re t ary (re s iden t in
A ust ralia).
A proprie tar y c ompany mu st ha v e
a minimum o f 1 dire ct or (re s iden t in
A ust ralia). T he o ff i c e o f s e c re t ary is
opt ional , bu t if appoin ted one mu st
reside in A ust ralia .
Off iceholder( s ) appoin tmen t da t e s hall
be e ff ect iv e f rom the beginning o f t he
day on whi c h the c ompany be c omes
regis tered .
Off i ce h e ld
X Dire ct or
F amil y name
RONALD JONES
F ormer name
NA
Avenue number and Avenue
name
65, MANNAT
HEIGHTS
S uburb /Ci ty
Adelaide
Coun try (i f no t A u stralia)
S e c re t ary
Giv en names
RONALD JONES
St a te /T erri t or y P ostc ode
South Australia 5000
Dat e o f bir th
15/05/1889
P la c e of birt h (t own/c ity) (st at e/c ount ry )
Adelaide South Australia
3 Con tinued ... A ppoin t a no t her off i ceholder
A public c ompany mu st ha v e a
minimum of 3 dire ct or s (2 re s iden t in
A ust ralia) and 1 s e c re t ary (re s iden t in
A ust ralia).
A proprie tar y c ompany mu st ha v e
a minimum o f 1 dire ct or (re s iden t in
A ust ralia). T he o ff i c e o f s e c re t ary is
opt ional , bu t if appoin ted one mu st
reside in A ust ralia .
Off iceholder( s ) appoin tmen t da t e s hall
be e ff ect iv e f rom the beginning o f t he
day on whi c h the c ompany be c omes
regis tered .

Off ice h eld
X Dire ct or X S e c re t ary
F amil y name Giv en names
THOMAS JONES THOMAS JONES
F ormer name
NA
Avenue number and Avenue name
71, BRIGADE WALK
S uburb/ Ci ty St a te /T erri t or y P ostc ode
Adelaide South Australia 5000
Count ry (if not A ust ralia)
Dat e o f bir th
17/12/1889
P la c e of birt h (t own /c ity ) (st at e/count ry )
Adelaide South Australia
4 Id ent ify ul timate holding compa ny

Will th e c o mp a n y h ave a n ul ti mate holding co m p an y upon re gi strat ion?
Y e s
If y e s, pro v ide the following de tail s of the ult ima te holding c ompany
Compan y name
A CN /A R B N/AB N Coun try o f in c orporat ion (if not A ust ralia)
X No
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5 Sh are str uct ure ta bl e
De tails o f s hare s iss ued by t he c ompany. P lea s e s how all det ail s o f s hare s t ha t the c ompany has on iss ue at the time o f t his appli c a tion .
S ta nd ard s h are cod es
Re fer to the table f or t he s hare
c la ss c odes for s ect ion s 5 and 6.

S hare c la ss c ode F ull t itle S hare c la ss c ode F ull t itle
A A
B B ...e tc
E MP employ ee’s
FO U founder’s
LG li fe gov ernor’s
MA N managemen t
ORD ordinar y
RE D redeemable
P R F pre feren c e
CUMP c umulat iv e pre f eren c e
NC P non- c umulat iv e pre f eren c e
R E DP redeemable pre feren c e
NR P non-redeemable pre feren c e
CR P c umulat iv e redeemable pre f eren c e
NCR P non- c umulat iv e redeemable pre f eren c e
PA R P par tic ipa t iv e pre f eren c e
If you are us ing t he st andard s hare c la ss c ode s y ou do no t need to pro v ide the full tit le f or t he s hare s, ju st the s hare c la ss c ode.

If you are no t u s ing the st andard s hare c la ss c ode, en ter a c ode o f no more t han 4 le tt ers and t hen s how the full
t itle . S hare F ull t itle if no t standard T o tal number of
class code s hare s
T ot al amount
paid on t he s e
s hare s
T o tal amoun t
unpaid on the s e
s hare s
A 1400000 14000000
A re an y of the s e s hare s iss ued ot her than f or c a s h?
Y e s
If y es, will s ome or all of the s hare s be iss ued
under a writt en c on t ra ct ?
Y e s
If y e s: P rop r ietary co m p ani es
X No
If no, c ont inue to S ect ion 6 Deta il s o f mem b ers .
Lodge a F orm 207 Z c er tifying t hat all st amp du tie s hav e been paid .
Publi c c o mp a ni es
Lodge a F orm 207 Z and ei ther a F orm 208 or a c op y o f t he c on tra ct.
No
If no : P r op ri etary c o mp a ni es
Continue t o S ect ion 6 Deta il s o f memb ers .
Publi c c o mp a ni es
Lodge a F orm 208.
A SIC Form 201 11 December 2018 Pa g e 5 o f 8

6 Deta il s of mem bers
Use t his se ct ion to not ify the name and addre ss o f ea c h pers on who c on s en ts to bec ome a member.
If shares are join tly owned, pro v ide name s and address es o f all join t-owners on a s eparat e s heet (annex ure), c learl y indic at ing the s hare c la ss and wi t h whom
t he s hares are join tly owned.
Pl ease c o mpl ete a se p arate sect ion b elow fo r eac h mem b er , p r int a ddi tion al copi es o f p a g e 7 if m o re mem b ers are re qui re d.
Mem b er d eta il s and s h are holding
I ndicat e whe t her the member is an
individual or a c ompany and pro v ide the :
• name o f t he indiv idual or c ompany
• address of the indi v idual
or compan y, and
• shareholding .
A ddress of indiv idual or c ompany
F amil y name Giv en names
LUCAS BROWN LUCAS BROWN
OR
Company name
A CN /A R B N/ AB N
Off ic e , unit, le v el, or PO B o x number
723
Avenue number and Avenue name
12 Lost Avenue
Close street
S uburb /Ci ty St at e/T erri tor y P o stc ode
Adelaide South Australia 5000
Coun try (i f no t A u st ralia)
Comple te eac h c olumn f or ea c h s hare c la ss t he abov e member has agreed , in wri ting , to ta k e up .
No te: B enef ic ially held u s uall y means t ha t the owner o f t he s hare s is en tit led to the dire ct benef i t f rom the s hare s. F or e x ample, benef i ts c ould in c lude t he
ent itlemen ts to pay men ts in rela tion t o an y div idend s. S hare s held by a per s on a s tru st ee, nominee or on acc oun t o f anot her pers on are non-benef i c iall y
held .
S hare c la ss Number o f A mount agreed to T ot al $ paid on A mount unpaid T o tal $ unpaid on F ull y paid B enef ic iall y
code s hare s t ak en up pa y per s hare the s e s hare s per s hare t hes e s hare s (y/ n) held (y/ n)
A 14000 140000 140000 NIL NIL Y N
A SIC Form 201 11 December 2012 Pa g e 6 o f 8

6 Con tinued ... Deta ils of a not her mem ber
F amily name Giv en names
OR
Company name
A CN /AR B N/ AB N
Off ic e , uni t, le v el, or PO B o x number
Avenue number and Avenue name
S uburb /Ci ty St at e/T erri tor y P o stc ode
Coun try (i f no t A u st ralia)
S hare c la ss Number o f A mount agreed to T ot al $ paid on A mount unpaid T o tal $ unpaid on F ull y paid B enef ic iall y
code s hare s t ak en up pa y per s hare the s e s hare s per s hare t hes e s hare s (y/ n) held (y/ n)
6 Con tinued ... Deta ils of a not her mem ber
F amil y name Giv en names
OR
Company name
A CN /A R B N/ AB N
Off ic e , unit, le v el, or PO B o x number
Avenue number and Avenue name
S uburb /Ci ty St at e/T erri tor y P o stc ode
Count ry (i f not A ust ralia)
S hare c la ss
code
Number o f
s hare s t ak en up
A mount agreed to
pa y per s hare
T o tal $ paid
on the s e
s hare s
A mount unpaid
per s hare
T ot al $ unpaid
on t he s e s hare s
F ully paid
(y/ n)
B enef i c iall y
held (y/ n)

A SIC Form 201 11 December 2012 Pa g e 7 o f 8

Dec larat ion by appli ca nt
I/w e appl y fo r re gi stration o f a c o mp a n y on th e b asi s o f th e in fo rmat ion in thi s fo rm and a n y attac h me n ts . I/we
h ave th e n ecessary wr itte n con se n ts a nd ag reeme n ts referre d to in th e appli cation c on cer ning th e mem b er
a nd o ff icehold ers and I/we sh a ll gi ve th e c on sen ts and a g reeme n ts to th e co m p an y after th e co m p an y
b ec o mes re gi stere d. Th e in fo rmation p ro v ide d in thi s a ppli cat ion and in an y ann ex u res is tru e and c o rrect at
th e time o f s igning.
Sign at ure of a pplica nt
P rovide famil y and gi v en name s OR
c orpora tion name (in c lude A CN /A R B N if
applicable)
If t he applican t is an indi v idual - 1
s igna t ure required .
If t he applican t is a c orpora tion - a dire ct or
or secret ary to s ign .
If t he agen t f or t he appli c an t is a f irm –
a member/part ner of the f irm to s ign
X P ay men t ha s been att a c hed
Name of applic an t
LUCAS BROWN
Capa c ity of appli c an t
X I ndiv idual
Corpora tion
Name of off ic eholder
A gent f or indiv idual or c orpora t ion
Name of agent
S igna ture o f applic an t
Dat e s igned
[D D] / [M M] / [Y Y]
Lodg eme n t S end c omplet ed and s igned form s t o:
A ust ralian S ec uri tie s and In v est ments Commiss ion ,
PO B ox 4000 , Gipp s land Mail Cen t re VI C 3841
Fo r m o re in fo rmation
Web www.as ic.gov . au
Need help? www .a s ic. gov. au / quest ion
T elephone 1300 300 630

A SIC Form 201 11 December 2012 Pa g e 8 o f 8

Australian S ecu rities &
In vestmen ts Co mmi ssion
Guid e:
Appli cation fo r regi stration as an Australi an
co mpan y
Thi s guid e do es no t fo rm p art o f th e p rescrib ed fo rm . It i s in clud ed b y ASI C to assi st y ou in c o mpl et ing and lodging th e Fo rm
201.
Fo rm 201
Corpora tion s Act 2001
117
Use this form to apply to ASI C for regis tra tion o f a company under the Corpora tions A ct 2001 (C th) (Corporations A ct) .
Re late d Fo rms
208 - No tifi cation o f de tails o f shares allo tt ed o ther than for
cash 207 Z - Cer tif ica tion o f compliance with stamp du ty law
Sign atu re T hi s form mu st be s igned b y:
• t he appli c an t; or
• a per s on who ha s c ons en ted to bec ome a dire ct or or s ec re tar y or member o f t he c ompany; or
• t he agen t f or t he appli c an t, being a pers on who ha s au t hority to s ign the form on behalf of the appli c ant (s ).
Lodg eme n t p eriod Nil – t o be lodged when required .
Lodging fee A lodgemen t f ee applie s to thi s form .
F or in f orma t ion on f ee s re fer to www .a s ic. gov. au/f orm s.
O ff i ce hold er a dd ress Off i c eholder s ’ address es mu st be their u s ual c urren t re s iden t ial addre ss. A n al terna t iv e addre ss ma y onl y be
u s ed where we appro v e an applic at ion under s 205D of the Corpora tion s Act.
Replacea ble r ul es a nd
c on sti tu t ions
T he Corpora tion s Act c on tain s ‘repla c eable rule s ’ whi c h appl y to all c ompanies— exc ept c ompanie s where t he s ole
member is al s o t he s ole dire ct or —and ma y be us ed to gov ern t he in ternal running of the c ompany. Companie s ma y
di s pla c e s ome o f t he repla c eable rule s b y a c on st itu tion and be gov erned by a c ombina tion o f repla c eable rule s f or
s ome t hing s and their own c on st itu tion f or o ther s. W here the propos ed c ompany is to be go v erned b y a c ombina t ion
o f repla c eable rule s and a con st itu tion , plea s e t ick t he bo x tha t s a ys ‘T he c ompany has a c onst it ut ion’.
A c ompany wi th more t han one member /dire ct or ma y adopt a c on st itu tion pro v ided all per s ons who have agreed
t o be c ome a member o f t he c ompany agree to the term s and c ondi t ion s.
If a wri tt en c onst it ut ion gov ern s t he c ompany, a c op y of the c onst it ut ion mu st als o be lodged . A publi c c ompany tha t
is: • a s uperannuation t rus tee , or
• for c hari table purpo s es only,
mu st ha v e a writt en c ons tit ut ion .
Co mp a n y n ames A name is av ailable unle ss it is iden tic al to :
• a name t ha t is c urren t ly re s er v ed or regi st ered under t he Corpora t ion s Act for ano ther body, or
• a name t ha t is held or regi st ered on the bu s ine ss names regi st er in re s pe ct o f ano t her indiv idual or bod y who is
no t t he per s on appl y ing to ha v e the name, or
• is una cc ept able for regist ra t ion under t he Corpora t ion s Regula tion s 2001 .
If it is propos ed to regi st er a name whi c h is iden tic al to a regi st ered bu s ine ss name(s ), we mu st be s a tisf i ed tha t t he
propo s ed c ompany is en tit led to the us e of the name under s 147. T here f ore ei t her the owner, or s omeone regi st ering
t he c ompany f or t he owner of the bu s ine ss name, mu st be t he appli c an t f or regi st ra tion and t he quest ion s regarding
t he bu s ine ss name(s ) s hown on the F orm 201 mu st be c omple ted .
T he in forma tion c onc erning iden t ic al bus ine ss name s on t he F orm 201 ma y in st ead be gi v en in a st at ement
a tt ac hed t o t he F orm 201 (a s an anne x ure) under t he heading ‘De c lara t ion Regarding Regi st ered B u s ine ss
Name( s )’. B e s ure to pro v ide the s ame in f orma t ion a s is required on t he F orm 201 . T he st a temen t mu st be d ate d
a nd sign ed b y the
appli c an t a s being ‘t rue and c orre ct ’ as f ollow s: ‘I de c lare tha t t he in forma tion gi v en in thi s st at ement is true and c orre ct ’.

ASIC Form 201 G uide 1 July 2014 P a g e 1 o f 2

Spec i a l pu r po se c o m p a nies T he differen t ty pes o f s pe c ial purpo s e c ompanie s t hat c an be est abli s hed on regi st ra t ion are :
C h ari ta bl e pu r po ses onl y
A c ompany whos e c onst it ut ion require s it t o purs ue c haritable purpo s es onl y and t o apply its in c ome in promo ting
t ho s e purpos e s; and prohibi ts t he c ompany ma k ing di st ribu tion s t o its member s and pa y ing fee s to its dire ct or s; and
require s its dire ctor s to approv e all o ther pa y men ts the c ompany ma k es t o t hem.
H o me uni t c o mp a n y
A proprie t ary c ompany:
• t hat is the proprie tor of land on whic h a building is ere ct ed and div ided in to s eparat e re s iden tial area s and area s
f or c ommon u s age
• whos e members are en t itled t o e xc lu s iv e o cc upat ion of one or more of tho s e area s and u s e o f t he c ommon
area s, and
• whic h operat es s olel y t o f ac ili ta te the righ ts of tho s e member s in rela tion t o t heir exc lu s iv e occ upation o f
t hos e re s iden t ial area s and main t enanc e of the c ommon area s.
Sup era nnu at ion tr u stee co m p an y
A c ompany t hat acts s olel y a s the tru st ee o f a regulat ed s uperannuat ion fund wi thin t he meaning o f s 19 of the
S uperannuat ion Indu st ry (S uperv is ion) Act 1993 and who s e c on stit ut ion prohibi ts t he di st ribu tion o f its in c ome or
proper ty among its member s.
O th er ty p es o f c o m p a nies A no–liabili ty c ompany (NL) mu st be a public c ompany. T he Corpora t ion s Act limi ts t he a ct iv itie s of a NL c ompany to
mining purpos e s onl y and obliges a NL c ompany ’s c on stitu tion t o st a te , amongst o ther t hing s, tha t its s ole obje cts
are mining purpos e s only.
A c ompany limi ted b y guaran t ee (LM GT ) mu st be a publi c c ompany. I n order for a LM GT c ompan y t o quali fy a s
a ‘s pe c ial purpos e c ompany ’ as def i ned b y t he Corpora tion s (Re v iew F ee s ) Regula t ion s 2003 , its c on st itu tion
mu st c on tain , amongst ot her things, pro v is ion s whic h limi t its act iv it ie s t o c hari t able purpos e s onl y.
Shares i ss u e d o t h er th a n
f o r cas h o r und er a w r itte n
c on tract
Fo r public co m p ani es
If s hare s will be iss ued for ot her than c a s h, then a F orm 208 No tif i c at ion of det ails o f s hare s allo tt ed ot her than f or
c a s h, or a c op y o f t he ‘c on tra ct’ mu st be lodged .
If t he s hare s will be iss ued under wri tt en c on tra ct, t hen a F orm 207 Z Cer tif i c at ion of c omplian c e wi th st amp duty
law mu st al s o be lodged .
Fo r p rop r ietary co m p ani es
If s hare s will be iss ued under wri tt en c on tra ct or iss ued for ot her than c a s h, a F orm 207Z Cert if ic a tion o f
c omplian c e wi t h st amp du ty law mu st be lodged .
How to p r o v id e a ddi t ion a l
in f o rmation
Pho to c opi e d Fo rm 201 p ag es
If t here is in s uff ic ien t s pac e in an y s ect ion o f t he f orm , y ou ma y pho to c opy t he rele v an t page( s ) and s ubmit a s part
o f t his lodgemen t.
A nn exu res
If t here is in s uff ic ien t s pac e in an y s ect ion o f t he f orm , y ou ma y alt erna tel y s ubmit anne x ure s as part of thi s lodgement.
T o ma k e an y annex ure conf orm to the regulat ion s, y ou mu st
1 . u s e A 4 s iz e paper of white or ligh t past el c olour wi th a margin of at lea st 10mm on all
s ide s 2 . s how t he c ompany name and A CN or A RB N
3 . number t he page s c ons e c ut iv ely
4 . prin t or type in B L OCK le tt ers in dark blue or bla ck in k s o tha t t he do c ument is c learl y legible when
pho t oc opied 5. mar k the annex ure wi th an iden t ify ing le tt er or sy mbol eg a ,b ,c or 1 ,2 ,3 etc.
6 . endor s e t he anne x ure wit h t he word s:
T hi s annex ure (mar k ) o f (number) pages re ferred to in f orm (form number and t itle)
7 . s ign and da te the annex ure
T he annex ure mu st be signed b y the s ame per s on(s ) who s igned t he f orm .
P r ivacy T he in forma tion pro v ided t o ASI C in thi s form ma y in c lude pers onal in f orma t ion . P lea s e re f er t o our pri v acy poli cy
(www. as ic.go v.au /pri v acy ) for more in forma tion abou t how we handle y our per s onal in f orma t ion , y our righ ts t o s ee k
acc ess to and c orre ct pers onal in f orma t ion , and t o c omplain abou t brea c he s of y our priv a cy.
Lodg eme n t S end c omplet ed and s igned form s t o:
A ust ralian S ec uri tie s and In v est ments Commiss ion ,
PO B ox 4000 , Gipp s land Mail Cen t re VI C 3841
Fo r mo re info rmat ion
W eb www. as ic.gov .au
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