ASIC Form 201: Application for Registration of 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, officeholders, members, and share structure. It also includes a declaration by the applicant. The form must be filled accurately and truthfully. Related forms include Form 208 and Form 207Z.

Au strali an S ecu rities &
In vestmen ts Commi ssion
Appli cation for regi stration as an Au strali an
comp an y
Use this f orm to apply to ASIC f or regis tra tion o f a company under the Corpora tions A c t 2001.
Re late d Fo rms
208 - Notif ica tion of de tails of shares allo tted o ther than f or cash
207Z - Cer tif ica tion of compliance wi th stamp duty law
Form 201
Corpora t ions Act 2001
117
I f th ere i s in su ff i cien t sp ace in a n y sect ion o f th e fo rm , you may pho to cop y th e re leva n t p a g e(s) a nd s ubmi t as p art o f thi s lodg eme n t
Lodg emen t d eta ils
An image of t his f orm will be av ailable as
par t of t he publi c regi st er.
Who s hould A SI C con tact i f th ere i s a qu ery abou t thi s fo rm ? ASI C
regi st ered agen t number (i f appli cable)
86485385
F irm /organi sat ion
PTR LEGAL SERVICES LIMITED
Con t act name / po s ition de scrip t ion
LEGAL ADVISOR T elephone number (during bus ine ss hours)
(7612387910)
E mail addre ss (opt ional)
[e-mail]
S uburb/Ci ty St at e/T erri tor y P ostc ode
Brisbane Queensland 4120
1 State /terr it ory o f regi strat ion
I appl y for regi st ra tion o f the c ompany under t he Corpora tion s Act 2001 and nomina t e t he St at e or T erri tor y in whic h the c ompany
will be tak en t o be regi st ered .
Giv e St at e or T erri tor y
Queensland
2 Deta il s o f th e c o mp a ny
D o es th e co m p an y h ave a p ropo sed co mp a n y n ame?
X Y es
If y es, t he proposed c ompany name is
RTZ CONSTRUCTION LIMITED
Name re s erv at ion number (if an y )
474 752 897
No
T he compan y name on regi st rat ion will be its Aust ralian Company Number (ACN).
T ick t he legal elemen ts t hat appl y
Pty. L td . P roprie t ary X Limited No liabili ty NL
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2 Con tinued ... Furt her deta il s of t he c om pa n y
I s th e p ropo sed n ame id en tica l to a re gi stere d bus iness n ame(s) ?
Yes X No
If y es, I declare t hat I hold , or am regi st ering the c ompany for t he holder(s ) o f, t he iden tic al bus iness name(s),
t he regi st rat ion det ails o f which are li st ed below.
AB N
85485368484
F or business names regi st ered be fore 28
May 2012 wit hou t an ABN.
or
P rev iou s bu sin ess numb er P rev iou s state / terr i to ry o f re gi strat ion
T yp e o f co m p an y
propriet ary company
public compan y
C lass o f co m p an y
limited b y s hare s
unlimit ed wi t h a s hare c api t al
X limit ed by share s
limited b y guaran tee
unlimit ed wi t h a s hare c api t al
no liabili ty
Sp eci al pu rpo se (if appli c able)
home unit (HUN T )
s uperannua tion t ru st ee (PSTC)
c hari table purposes only (P N P C)
s uperannua tion t ru st ee (UL SS)
c hari table purposes only (UL S N)
Sp eci al pu rpo se co mp a n y Ref er to
Guide f or desc rip tion s of special
purpo se companie s.
A public c ompany tha t is:
• a superannua tion t ru st ee , or •
for chari t able purpo s es only,
must ha v e a c onst it ut ion.
If thi s is a s pec ial purpo se compan y, tick t he box below t o ma k e the de clara tion .
I de clare t hat t his c ompany is a s pec ial purpo se compan y as def i ned under Regula tion 3 o f the Corpora tion s (Re v iew
F ee s) Regula t ions 2003 .
Go ver n a n ce o f a publi c co m p an y
T he c ompany will rel y en tirel y on repla c eable rule s
X T he Company ha s a c onst it ut ion
A p ropo se d publi c co m p an y whi ch h as a dop te d a “ C on st itu tion” mu st lodg e a cop y o f th e con sti tu tion wi th thi s
appli cation
If the propos ed company is t o be a publi c c ompany li mi ted b y gu ara n tee, st at e t he amount o f the guaran tee t hat ea ch member
agree s t o in wri t ing .
Regi stere d o ff ice
You canno t us e a PO B o x address
T he amount o f the member’s guaran t ee is (inser t amount)
At the o ff i c e o f, C /- (if applic able)
Off i c e, unit, le v el
111
St ree t number and St ree t name
12, Burke Street
S uburb/Ci ty St ate/T erri t ory P o stcode
Brisbane Queensland 4120

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2 Con tinued ... Furt her deta il s of t he c om pa n y
D o es th e co m p an y o cc up y th e p rem i ses?
X Yes
No
If no , name o f oc cupier
Occ upier’s con sen t (S elect bo x to indi c ate the st at emen t below is c orre ct )
Off ice hou rs
F or a publi c c ompany
T he occupier o f the premis es has c on sen ted in writ ing t o the u se of t he spec if i ed addre ss as t he address of t he
regist ered off i ce of t he compan y and has no t wit hdrawn t ha t c ons ent.
X a . Regi st ered o ff i ce o f a publi c c ompany is open t o the public ea ch bu sine ss da y f rom at lea st 10 am t o 12 noon and 2
pm t o 4 pm.
b . Regi st ered o ff i ce o f a publi c c ompan y is open t o the publi c ea ch bu sine ss da y f or at least 3 hour s be t ween 9 am
and 5 pm .
If b , in s ert hours open from am/pm clo se to am/pm
P rin cip al pl ace o f bu s iness I f same as regi stere d o ff ice , write “ as a bo ve ”.
Off i ce, uni t, le v el
As above
St ree t number and St ree t name
As above
S uburb/ Ci ty St at e/T erri tor y P ostc ode
As above As above As above
Count ry (i f not Au st ralia)
3 A ppoin t off i ce holder
A public compan y must hav e a minimum of
3 direc t ors (2 re siden t in Au st ralia) and 1
secre t ary (res iden t in Aust ralia) .
Off i ce h eld
X Dire ct or S ecre tar y
A propriet ar y compan y mu st ha v e a
minimum of 1 dire ct or (re siden t in
Aus tralia) . T he o ff i c e o f sec ret ar y is
op tional , bu t if appoin t ed one mu st
reside in Aust ralia .
Off i ceholder( s ) appoin tmen t da te shall be
effec tive f rom t he beginning o f the day
on whic h the c ompany bec ome s
regis t ered .
F amil y name Giv en name s
Mark Clark Mark Clark
F ormer name

NA
St ree t number and St ree t name:
8, Wendell St.
S uburb/Ci ty St at e/T erri tor y P ostc ode
Brisbane Quneesland 4112
Country (if no t Aust ralia)
Dat e o f bir t h
15/04/1989
P la ce of bir th (t own/c ity) (st ate/c ount ry )
Brisbane Quneesland
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3 Con tinued ... A ppoin t a no t her off i ce holder
A public c ompany mu st hav e a minimum
of 3 dire ct or s (2 res iden t in Aust ralia)
and 1 sec ret ary (res iden t in Aus t ralia) .
A proprie tar y c ompany mu st hav e a
minimum o f 1 dire ct or (res iden t in
Aust ralia) . T he o ff i c e o f sec ret ary is
opt ional , but if appoin ted one mu st
reside in Au st ralia .
Off i ceholder( s) appoin t men t dat e s hall be
eff ec t iv e f rom t he beginning o f the day
on which t he compan y be come s
regis tered .
Off i ce h eld
X Dire ct or
F amil y name
Elex Charls
F ormer name
NA
St ree t number and St reet name
18, Grevell Street
S uburb/ Ci ty
Brisbane
Count ry (i f not Au st ralia)
S ec re t ary
Giv en name s
Elex Charls
St ate/T erri t or y P ostc ode
Queensland 4008
Dat e o f bir t h
25/09/1989
P lac e o f bir t h (town/c ity) (st ate/c ount ry )
Brisbane Queensland
3 Con tinued ... A ppoin t a no th er o ff i ce hold er
A public c ompany mu st hav e a minimum
of 3 dire ct or s (2 res iden t in Aust ralia)
and 1 sec ret ary (res iden t in Aus t ralia) .
A proprie tar y c ompany mu st hav e a
minimum o f 1 dire ct or (res iden t in
Aust ralia) . T he o ff i c e o f sec ret ary is
opt ional , but if appoin ted one mu st
reside in Au st ralia .
Off i ceholder( s) appoin t men t dat e s hall be
eff ec t iv e f rom t he beginning o f the day
on which t he compan y be come s
regis tered .

Off ice h eld
Dire ct or X S ecre tar y
F amil y name Giv en name s
Joy Smith Joy Smith
F ormer name
NA
St ree t number and St ree t name
45, Mcsween Street
S uburb/Ci ty St at e/T erri tor y P ostc ode
Brisbane Quneesland 4118
Country (if no t Aust ralia)
Dat e o f bir t h
14/11/1987
P la c e o f bir t h (town/c ity ) (st ate/c ount ry )
Brisbane Queensland
4 Ide n tify ul timate holding c o mp a ny

Will th e co mp a n y h ave an ul ti mate holding co mp a n y upon regi strat ion?
Yes
If y es, pro v ide the f ollowing de tail s of t he ul t ima te holding compan y
Compan y name
ACN /A R B N/AB N Count ry o f in c orporat ion (if no t Aust ralia)
X No
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5 Sh are str u ct u re ta ble
De tails of s hare s issued by the c ompany. P lea se show all det ail s o f share s t hat t he compan y ha s on iss ue at the t ime o f thi s appli cat ion.
S ta nd ard sh are cod es
Re fer t o the t able f or the s hare c lass
c odes f or sect ion s 5 and 6.

S hare c lass code F ull t itle S hare cla ss c ode F ull t itle
A A
B B ... etc E MP
emplo y ee’s
FO U founder’s
LG li f e go v ernor’s
MAN managemen t
ORD ordinar y
RE D redeemable
SPE spe cial
P R F pre f eren ce
CUMP cumula tiv e pref eren ce NC P
non- cumula tiv e pref eren ce
R E DP redeemable pre feren c e
NR P non-redeemable pre feren c e
CR P cumula tiv e redeemable pre feren c e NCR P
non- cumula tiv e redeemable pre feren c e
PAR P par t icipa tiv e pre f eren ce
If you are us ing the st andard s hare c lass codes y ou do no t need to pro v ide the f ull tit le for t he share s, ju st the s hare c lass code.

If you are no t us ing the st andard s hare c lass code, en t er a c ode of no more than 4 le tt ers and t hen show the f ull tit le. S hare
F ull tit le if not st andard T o tal number o f
class code s hare s
T ot al amoun t
paid on t hes e
share s
T o tal amoun t
unpaid on t hes e
s hare s
A 100000 1000000
Are an y of t hes e s hare s iss ued ot her than f or cas h?
Yes
If y es, will s ome or all o f the s hare s be iss ued under a
wri tt en c on t ract ?
Yes
If y es: P rop rietary co mp a ni es
X No
If no , con tinue to S ect ion 6 Deta il s o f mem b ers .
Lodge a F orm 207Z c ert ify ing t hat all st amp du t ies ha v e been paid .
Publi c co m p ani es
Lodge a F orm 207Z and ei ther a F orm 208 or a c opy of t he con tra ct.
No
If no : P rop rietary co mp a ni es
Continue to S ect ion 6 Deta il s o f mem b ers .
Public co mp a ni es
Lodge a F orm 208 .
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6 Deta il s o f memb ers
Use this se ct ion to no tify t he name and addre ss of ea ch per son who con sen ts t o bec ome a member.
If shares are join tly owned , pro v ide name s and addre sses of all join t -owners on a separa t e s heet (anne x ure) , c learl y indi c ating t he share cla ss and wi th whom t he shares are
join t ly owned .
Pl ease co m pl ete a se p arate sect ion b elow fo r eac h mem b er, p rin t a ddi tion a l copi es o f p a g e 7 i f m o re mem b ers are requi red.
Mem b er d eta il s and sh are holding I ndica te
whe t her the member is an individual or a
c ompan y and pro v ide t he: • name of
t he indi v idual or c ompany
• addre ss of t he indi v idual or
company, and
• shareholding.
Address o f indiv idual or c ompany
F amil y name Giv en name s
Mark Clark Mark Clark
OR
Company name
ACN /A R B N/ ABN
Off i ce, unit, le v el, or PO B ox number
R-85
St ree t number and St ree t name
8, Wendell St
S uburb/ Ci ty St ate/T erri t ory P o stcode
Brisbane Quneesland 4112
Count ry (i f not Au st ralia)
Complet e ea ch c olumn for ea ch s hare c lass the abo v e member ha s agreed , in wri t ing , t o tak e up .
No te: B enef i ciall y held u suall y mean s tha t the owner of t he share s is en tit led to t he dire ct benef i t f rom t he share s. F or ex ample , benef i ts c ould in clude the en tit lemen ts t o
pay men ts in relat ion to an y di v idend s. S hare s held by a per son as t ru st ee , nominee or on acc ount of ano ther per son are non-benef i ciall y held .
S hare cla ss Number o f Amount agreed t o T ot al $ paid on Amount unpaid T o tal $ unpaid on F ull y paid B enef i c iall y
code s hare s tak en up pa y per share the se share s per share t hes e s hare s (y/ n) held (y/ n)
A 10000 100000 100000 NIL NIL Y N
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6 Con tinued ... Deta il s o f a no th er mem ber
F amil y Name Giv en name s
Elex Charls Elex Charls
OR
Company name
ACN /A R B N/ ABN
Off i ce, unit, le v el, or PO B ox number
A-89
St ree t number and St ree t name
18, Grevell Street
S uburb/ Ci ty St ate/T erri t ory P o stcode
Brisbane Qunessland 4008
Count ry (i f not Au st ralia)
S hare cla ss Number o f Amount agreed t o T ot al $ paid on Amount unpaid T o tal $ unpaid on F ull y paid B enef i c iall y
code s hare s tak en up pa y per share the se share s per share t hes e s hare s (y/ n) held (y/ n)
A 90000 900000 900000 NIL NIL Y N
6 Con tinued ... Deta il s o f a no th er mem ber
F amil y name Giv en name s
Joy Smith Joy Smith
OR
Company name
ACN /A R B N/ ABN
Off i ce, unit, le v el, or PO B ox number
T-74
St ree t number and St ree t name
45, Mcsween Street
S uburb/ Ci ty St ate/T erri t ory P o stcode
Brisbane Quneesland 4118
Coun try (if no t Aust ralia)
S hare cla ss
code
Number o f share s
t ak en up
Amount agreed t o
pa y per share
T o tal $ paid on
t he s e s hare s
Amount unpaid
per share
T ot al $ unpaid on
the se share s
F ully paid
(y/ n)
B enef i ciall y
held (y/ n)
- 0 0
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Dec laration by a ppli ca n t
I/we appl y fo r re gi strat ion o f a co mp a n y on th e b as is o f th e in fo rmat ion in thi s fo rm and an y attac h me n ts. I/we h ave th e
n ecessary wri tten conse n ts and ag reeme n ts referre d to in th e appli cation con cer ning th e mem b er and o ff ice hold ers and
I/we sh a ll gi ve th e con se n ts and ag 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 rmat ion
p ro v id ed in thi s a pplicat ion a nd in a n y annex u res is tr u e a nd co rrect at th e ti me o f s igning.
Sign at u re o f a ppli can t
P rovide f amil y and gi v en name s OR
c orporat ion name (in clude ACN/A RB N if
applicable)
If the applican t is an indiv idual - 1 signat ure
required .
If the applican t is a c orporat ion - a dire ct or or
secre t ary to s ign .
If the agen t f or the appli c an t is a f i rm – a
member /par tner o f the f i rm t o sign
X P ay men t ha s been att ac hed Name
o f appli can t
Joy Smith
Capa c ity o f appli can t
X I ndiv idual
Corpora t ion
Name of o ff i c eholder
Agen t f or indiv idual or c orporat ion
Name of agen t
S ignature o f appli can t
Dat e s igned
[22 ] [ 05] [18]
Lodg emen t S end comple ted and s igned f orm s to :
Aust ralian S ecuri tie s and In v est men ts Commi ssion, PO
B ox 4000, Gipp s land Mail Cen tre VI C 3841
Fo r mo re in fo rmat ion
Web www.as ic. gov . au
Need help? www .as ic. gov. au / quest ion
T elephone 1300 300 630
A SI C Fo rm 201 22 May 2018 P ag e 8 o f 8

Au strali an S ecu rities &
In vestmen ts Commi ssion
Guid e:
Appli cation for regi stration as an Au strali an
comp an y
Thi s guid e do es no t fo rm p art o f th e p rescr ib ed fo rm . I t i s in clud ed b y A SI C to ass ist y ou in co mpl et ing and lodging th e Fo rm 201.
Form 201
Corpora t ions Act 2001
117
Use this f orm to apply to ASIC f or regis tra tion o f a company under the Corpora tions A c t 2001 (C th) (Corpora tions Ac t).
Re late d Fo rms
208 - Notif ica tion of de tails of shares allo tted o ther than f or cash
207Z - Cer tif ica tion of compliance wi th stamp duty law
Sign ature T hi s form must be signed by: •
t he applican t; or
• a pers on who ha s con sen ted t o be c ome a dire ct or or sec ret ary or member of t he compan y; or
• t he agen t for t he appli can t, being a per son who ha s au thority to s ign the f orm on behal f o f the applic an t (s).
Lodg emen t p er iod Nil – t o be lodged when required .
Lodging fee A lodgemen t fee applie s t o thi s form .
F or in forma t ion on fee s re f er to www. asic. go v.au /f orm s.
O ff i ce hold er a dd ress Off i c eholders ’ addre ss es mu st be t heir u sual c urren t res iden tial address. An al terna t iv e addre ss may only be us ed where we
appro v e an appli cat ion under s 205D o f the Corpora tion s Act.
Repl acea ble r ul es a nd
c on stit ut ion s
T he Corpora tion s Act c ont ain s ‘repla c eable rule s ’ whi c h appl y t o all companie s—exc ep t companie s where t he sole member is al so
t he sole dire ct or —and ma y be u sed t o gov ern t he in t ernal running o f the c ompany. Companie s ma y di spla ce some of t he
repla c eable rule s b y a con st itu tion and be go v erned b y a combina tion o f repla ceable rule s for s ome t hing s and their own
c on st it ut ion for o ther s. W here t he proposed c ompany is to be go v erned b y a combina tion o f repla ceable rule s and a con st itu tion ,
plea s e t ick the bo x t ha t s ays ‘T he compan y ha s a c onst it ut ion’ .
A compan y wi th more than one member /dire ct or ma y adop t a con st itu tion pro v ided all per son s who have agreed t o bec ome a
member o f the c ompany agree t o the t erm s and condit ions.
If a wri tt en con st itu tion go v ern s t he compan y, a c opy of t he con st itu tion mu st al so be lodged . A publi c c ompan y tha t is: • a
s uperannua tion t rust ee, or
• f or chari t able purpo s es only,
mu st ha v e a writt en c onstit ut ion.
Co m pa ny names A name is av ailable unless it is iden tic al to :
• a name t hat is c urren tly res erv ed or regi st ered under t he Corpora t ion s Act for ano ther body, or
• a name tha t is held or regi st ered on the bu sine ss names regi st er in re spe ct o f anot her indiv idual or bod y who is no t the per son
apply ing t o hav e the name , or
• is unacc ep t able f or regi st rat ion under t he Corpora t ions Regula tion s 2001.
If it is proposed t o regi st er a name which is iden t ical t o a regi st ered bus ine ss name(s), we mu st be s atisf i ed tha t the propos ed
c ompany is en t itled t o the u se of t he name under s147. T here f ore eit her the owner, or s omeone regi st ering t he compan y f or the
owner of t he bus ine ss name, mu st be the appli c an t f or regi st rat ion and the que st ions regarding the bu sine ss name(s ) s hown on t he
F orm 201 mu st be c omplet ed .
T he in format ion con cerning iden t ical bu sine ss names on t he F orm 201 ma y in st ead be gi v en in a st at emen t att ached t o the F orm
201 (a s an anne x ure) under the heading ‘De clara tion Regarding Regist ered B us iness Name( s)’ . B e s ure t o pro v ide t he s ame
in forma t ion as is required on the F orm 201. T he st atemen t mu st be d ate d a nd s ign ed b y t he
appli c an t as being ‘true and c orre ct ’ as f ollow s: ‘I de clare tha t the in forma t ion giv en in thi s st at emen t is true and corre ct ’.
ASI C Fo rm 201 G uide 22 May 2018 P a g e 1 o f 2

Sp ec i al pu r po se c o m p ani es T he di ff eren t types o f spe cial purpos e c ompanie s t ha t c an be est abli shed on regi st ra tion are :
C h ari ta bl e pu rpo ses onl y
A compan y who s e c onst it ut ion requires it t o purs ue chari t able purpo s es only and to apply its in come in promot ing tho se purpo ses;
and prohibi ts t he compan y ma k ing dist ribu t ion s t o its member s and pay ing f ees t o its dire ct or s; and require s its dire ct or s to
appro v e all ot her pay men ts the c ompan y ma k es t o them .
H o me uni t co mp a n y A
proprie tar y c ompany:
• tha t is the proprie tor o f land on whi c h a building is erect ed and di v ided in to s epara te res iden tial area s and area s f or common
u sage
• who se member s are en tit led to exc lu s iv e o cc upat ion of one or more of t hos e area s and us e o f the c ommon area s, and
• whi ch opera t es solel y to f acili tat e t he righ ts o f tho se member s in rela tion t o their exc lu siv e occ upation o f tho se
re siden t ial area s and main t enan ce of t he common area s.
Supera nnu ation tru stee co mp a n y
A compan y t hat acts s olel y as t he tru st ee of a regula ted s uperannua tion f und wi thin t he meaning of s 19 of t he
S uperannua t ion Indust ry (S uperv ision) Act 1993 and who se con st itu tion prohibi ts t he dist ribu t ion of its in c ome or proper ty
among its members.
O th er ty pes o f c o m pa ni es A no–liabili ty c ompany (NL) mu st be a publi c compan y. T he Corpora t ions Act limi ts t he act iv itie s of a NL compan y t o mining
purpo s es only and obliges a NL compan y ’s con st itu tion t o st ate, among st o ther t hing s, t hat its sole objects are mining purpo s es
onl y.
A c ompany limi t ed b y guaran t ee (LM GT ) mu st be a publi c compan y. I n order f or a LM GT c ompany t o quali fy as a
‘s pec ial purpose compan y ’ as def i ned by the Corpora tion s (Re v iew F ee s) Regulat ion s 2003 , its con st itu tion mu st c ont ain ,
among st o ther t hing s, pro v ision s whi ch limit its act iv itie s to c hari table purpo ses only.
Sh ares iss ue d o th er th an fo r
cas h o r und er a w r i tte n
c on tract
Fo r publi c co m p ani es
If share s will be iss ued for o ther t han cas h, t hen a F orm 208 No t if i ca tion o f de t ails o f share s allo tt ed o ther t han f or ca sh , or a c opy
o f the ‘c ont ract ’ mu st be lodged .
If the s hare s will be iss ued under wri tt en c ont ract, t hen a F orm 207 Z Cer tif i c at ion of c omplianc e wi th st amp duty law mu st
al so be lodged .
Fo r p rop rietary co mp a ni es
If share s will be iss ued under wri tt en con tra ct or issued f or ot her than c ash , a F orm 207Z Cer t if i ca tion o f complian ce wi t h
st amp duty law mu st be lodged .
H ow to p r o vid e a ddi t ion al
in f o rmat ion
Pho to copi ed Fo rm 201 p a g es
If there is in su ff i c ien t s pac e in an y s ect ion of t he form , y ou ma y phot oc opy the rele v an t page(s ) and s ubmi t as part o f thi s
lodgemen t.
A nnex u res
If there is in su ff i c ien t s pac e in an y s ect ion of t he form , y ou ma y al terna t ely submi t annex ure s as part o f thi s lodgemen t.
T o ma k e an y annex ure con form to t he regula tion s, y ou mu st
1 . us e A4 s ize paper o f whi te or ligh t pa st el c olour wi th a margin of at lea st 10mm on all s ides 2 .
s how t he compan y name and ACN or ARB N
3 . number the page s c on s ecu tiv el y
4 . prin t or type in B LOC K le tt ers in dar k blue or bla ck in k s o tha t the do cumen t is c learl y legible when photo copied 5.
mar k the anne x 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 se the anne x ure wi th t he word s:
T hi s anne x ure (mar k ) o f (number) page s re ferred to in f orm (f orm number and t itle) 7 .
s ign and dat e t he anne x ure
T he anne x ure mu st be signed b y t he same per s on(s ) who signed the f orm .
P r i vacy T he in f orma tion pro v ided t o ASI C in t his f orm ma y in clude per s onal in forma t ion . P lea se ref er to our pri v acy policy
(www. asic. go v.au /pri v acy ) for more in f orma tion abou t how we handle y our pers onal in forma t ion, y our righ ts to s ee k acc ess t o
and corre ct pers onal in forma t ion , and t o complain abou t brea c he s o f y our priv acy.
Lodg emen t S end comple ted and s igned f orm s to :
Aust ralian S ecuri tie s and In v est men ts Commission, PO
B ox 4000 , Gipps land Mail Cen tre VI C 3841
Fo r m o re in fo rmat ion
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