ASIC Form 201 - Application for Registration as an Australian Company

Au strali an S ecu ri ti es &
In vestmen ts Co mmi ssion
Appli cation fo r regi stration as an Au strali an
co mp an y
Use this form to apply to ASI C for regis tra tion o f a company under the Corpora tions Ac t 2001 .
Rel ate d Fo rms
208 - No tif i cation o f details o f shares allo tt ed o ther than for
cash 207Z - Cer tif i cation o f compliance wi th s tamp duty law
Fo rm 201
Corpora t ion s Act 2001
117
I f th ere i s in s u ff i c i e n t s p ace in a n y section o f th e fo rm , y ou may pho to c op y th e rel eva n t p a g e(s) a nd s ub m i t as p art o f thi s lodg emen t
Lodg emen t d etail s
A n image o f t hi s f orm will be a v ailable a s
par t o f t he public regi ster.
Who s hould A SI C c on tact i f th ere i s a qu ery a bou t thi s
fo rm ? ASI C regi stered agen t number (i f applic able)
9252521
F irm/ organi s a t ion
ABBY LEGAL SERVICES LIMITED
Con t a ct name / pos it ion desc ript ion
LEGAL ADVISOR T elephone number (during bus ine ss hours )
( 9828592888 )
E mail addre ss (op t ional)
[e-mail]
S uburb / Ci ty St a t e /T erri t or y P o stc ode
Adelaide South Australia 5000
1 S tate/territ ory of re gi strat ion
I apply f or regi stra t ion o f t he c ompan y under t he Corpora t ion s Act 2001 and nomina t e t he St a t e or T erri t or y in whi c h
t he c ompan y will be t a k en t o be regi stered.
Giv e St a t e or T erri t or y
South Australia
2 Deta il s of t he company
D o es th e c o m p a n y h ave a p r opo sed c o m p a n y n ame?
X Y e s
If y e s, t he propo s ed c ompan y name is
QUELESSGROCERY
Name re s er v a t ion number (i f any )
703 452 253
No
T he c ompan y name on regi stra t ion will be its A u stralian Compan y Number (A CN) .
T ick t he legal elemen ts t hat apply
Pty. L t d . P roprie t ar y Limi t ed No liability X NL

ASI C Fo rm 201 11 December 2012 Pa g e 1 o f 8

2 Con tinued ... Fu rt her detail s of t he company
I s th e p r opo sed n ame id e n ti cal to a regi stere d bu s in ess n ame(s) ?
Y e s X No
If y e s, I declare t hat I hold, or am regi stering t he c ompan y f or t he holder( s ) o f, t he ident ic al
bus ine ss name( s ), t he regi stra t ion det ail s o f whi c h are listed below .
AB N
92532545122
F or business name s regi stered bef ore
28 May 2018 wi t hou t an AB N .
or
P rev iou s bu s in ess nu m b er P rev iou s state / terr i to ry o f regi strat ion
T y p e o f c o m p a n y
proprie t ar y c ompany
public c ompan y
C l ass o f c o m p a n y
limit ed b y s hares
unlimi t ed wi t h a s hare c api t al
limit ed b y s hares
limit ed b y guaran t ee
unlimi t ed wi t h a s hare c api t al
X no liability
Sp eci a l pu r po se (i f applic able)
home uni t (HUNT )
s uperannua t ion t ru stee (PST C)
c hari t able purpo s e s onl y (P N P C)
X superannua t ion t ru stee (UL SS )
c hari t able purpo s e s onl y (UL S N)
Sp eci a l pu r po se c o m p a n y
Ref er t o Guide f or desc ript ion s o f
special purpo s e c ompanies.
A public c ompan y t hat is:
• a superannua t ion t ru stee, or
• f or charit able purpo s e s onl y,
mus t hav e a c onstit u t ion .
If t hi s is a s pec ial purpo s e c ompan y, t ick t he box below t o ma k e t he dec lara t ion .
I dec lare t hat t hi s c ompan y is a s pec ial purpo s e c ompan y 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 a n ce o f a publi c c o m p a n y
T he c ompan y will rely ent irely on repla c eable rule s
X T he c ompan y has a c onstit u t ion
A p r opo sed publi c c o m p a n y whi c h h as a dop te d a “ C on st i tu tion” m u st lodg e a c op y o f th e c on st i tu tion
wi th thi s a ppli cat ion.
If t he propo s ed c ompany is t o be a public c ompan y li m i te d b y gu ara n tee , sta t e t he amoun t o f t he guaran t ee t hat
eac h member agree s t o in writ ing .
Regi stere d o ff i ce
Y ou canno t u s e a PO B o x
addre ss
T he amoun t o f t he member’s guaran t ee is $ 18000 (inser t amount)
At t he o ff i c e o f, C / - (i f applic able)
Off i c e , uni t, le v el
32
Avenue number and Avenue name
45 LOVELY AVENUE
S uburb / Ci ty St a t e /T erri t or y P o stc ode
Adelaide South Australia 5000

ASI C Fo rm 201 11 December 2012 Pa g e 2 o f 8