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, identification of ultimate holding company, and share structure table. The completed and signed form must be submitted to Australian Securities & Investments Commission.

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 ment
Lodg men t d eta il s
A n image o f t his f orm will be av ailable as
part of the publi c regi st er.
Who should A SI C contact i f th ere is a qu ery a bou t thi s
fo rm ? ASI C regi st ered agent number (if appli c able)
85556393
F irm / organiz a tion
REGAL LEGAL SERVICES LIMITED
Cont act name /po s ition de sc rip tion
LEGAL ADVISOR T elephone number (during bu s ine ss hour s )
(9351508210 )
E mail address (op tional)
[e-mail]
S uburb/ Ci ty St a te /T erri t or y P ostc ode
PERTH WESTERN AUSTRALIA 6000
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
WESTERN AUSTRALIA
2 Deta il s of t he compa ny
Do es th e c o mp a n y h ave a p ropose d co m p an y n ame?
X Ye s
If y es, t he propo s ed c ompany name is
AMBITION GROUP
Name re s er v a tion number (i f an y )
525 655 824
No
T he c ompany name on regi st ra tion will be its A u st ralian Company Number (A CN).
T ick t he legal elemen ts t hat appl y
Pty. Lt d. P roprie t ary Limited 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
85625433934
F or busine ss name s regi st ered be f ore
28 May 2012 wi t hout an AB N.
Or
P rev iou s bu s in ess nu m b er previous state /terr i to ry o f re gi strat ion
T yp e o f co m p an y
Proprietary c ompany
X public c ompany
C lass o f c o mp a n y
Limited by s hare s
Unlimited wi t h a s hare
c api tal
Limited by s hare s
Limited by guaran t ee
Unlimited wi t h a s hare
c api tal
X no liabili ty
Sp eci al pu rpo se (if appli c able)
Home uni t (HUN T )
Superannuation tru stee (PST C)
Charitable purpos e s only (P NP C)
X s uperannuat ion tru st ee (UL SS )
Charitable purpos e s only (UL S N)
Sp ec i al Purpose Company
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 superannuat ion tru st ee , or
• f or charit able purpos e s only,
Must hav e a c on st itu tion .
If thi s is a s pe c ial purpo s e c ompany, tick the box below to ma k e t he de c lara tion .
I de c lare tha t t his c ompany is a s pe c ial purpos e c ompany as def ined under Regula tion 3 of the
Corpora tion s (Re v iew F ee s ) Regula tion s 2003 .
Go vern a n ce o f a public 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 on st it ut ion
A p ropo se d public co m p an y whic h h as a dop te d a “ Con st itu tion” m u st lodg e a c opy o f th e con st itu tion
wi th thi s appli cat ion.
X If the constitution of public company restrict the director to not to sign a contract for more than share
capital of $10 million without getting approval of shareholder.
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 (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
555

St ree t number and St ree t name
52 BAE STREET
S uburb/ Ci ty St at e/T erri tor y P o stc ode
PERTH WESTERN AUSTRALIA 6000
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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 . registered off ice of a public c ompany is open to the public eac h bus ine 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 off ice of a public c ompany is open to the public 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 if same as re gi stere d o ff ice , wr ite “ as a bo ve ”.
Off ic e , 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 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
LUCID LINGO LUCID LINGO
F ormer name

NA
St ree t number and St ree t name
25 Scene Street
S uburb/ Ci ty St a te /T erri t ory P ostc ode
PERTH WESTERN AUSTRALIA 6000
Count ry (i f not A ust ralia)
Dat e o f bir th
03/08/1983
P la c e o f bir th (town/c ity) (stat e/coun t ry )
Perth Western 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
TOM NICHOLAS
F ormer name
NA
St ree t number and St ree t name
85 New Street
S uburb /Ci ty
St at e/T erri tor y Perth
Western Australia
Coun try (i f no t A u stralia)
S e c re t ary
Giv en name s
TOM NICHOLAS
P o stc ode
6000
Dat e o f bir th
20/05/1989
P la c e of birt h (t own/c ity) (st at e/c ount ry )
Perth Western 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 i ce h e ld
X Dire ct or X S ec re tar y
F amil y name Giv en names
NEIL SON NEIL SON
F ormer name
NA
St ree t number and St ree t name
14 AERROW STREET WESTERN AUSTRALIA
S uburb /Ci ty St at e/T erri tor y P o stc ode
PERTH WESTERN AUSTRALIA 6000
Coun try (i f no t A u st ralia)
Da te of bir t h
01/02/1986
P la c e o f bir th (town /city ) (st a te /country )
PERTH WESTERN AUSTRALIA
4 Id ent ify ul timate holding compa ny

Will th e co m p an y h ave an ul timate holding c o mp a n y upon re gi stration?
Y es
If y es, pro v ide t he f ollowing de t ails o f t he ul tima t e holding c ompany
name
A CN/A RB N /AB N Count ry of in c orpora tion (i f no t A u st 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 life gov ernor’s
MA N management
ORD ordinary
RE D redeemable
P R F pre feren c e
CUMP c umula t iv e pre f eren c e
NC P non- c umula t 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 umula t iv e redeemable pre f eren c e
NCRP non- c umula t 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 100000 1000000 0.00
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.
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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 indiv idual
or compan y, and
• Shareholding .
A ddress of indiv idual or c ompan y
F amily name Giv en names
ROMMI JES ROMMI JES
OR
Company name
A CN /A R B N/ AB N
Off ic e , uni t, le v el , or PO B o x number
41-A
St ree t number and St ree t name
10,Blue Street, Perth
S uburb /Ci ty St at e/T erri tor y P o stc ode
PERTH WESTERN AUSTRALIA 6000
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 ha s agreed , in wri ting , to ta k e up .
No te: B enef ic iall y held u s ually means t hat 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 pa y men ts in rela tion t o an y div idend s. S hare s held by a per s on a s tru stee , nominee or on acc oun t o f ano t her pers on are non-benef i c ially
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 ully paid B enef ic iall y
code s hare s t ak en up pay per s hare the s e s hare s per s hare t he s e s hare s (y/ n) held (y/ n)
A 10000 100000 100000 NIL NIL Y N
A SIC Form 201 22 May 2018 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 /A R B N/ AB N
Off ic e , uni t, le v el , or PO B o x number
St ree t number and St ree t 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 ully paid B enef ic iall y
code s hare s t ak en up pay per s hare the s e s hare s per s hare t he s 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 name s
OR
Compan y name
A CN /A RB N / AB N
Off i c e, unit, le v el , or PO B ox number
St ree t number and St ree t name
S uburb/ City St a te /T erri t ory P ostc 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 22 May 2018 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
ROMMI JES
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 men 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 22 MAY 2018 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 applic an t; or
• a pers 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
• The agen t f or t he appli c an t, being a per s on who ha s aut hori ty to s ign the form on behalf of the appli c ant (s ).
Lodg men t p er iod Nil – t o be lodged when required .
Lodging fee A lodgment fee applie s t o t hi s f orm .
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 cehold er a dd ress Off i c eholders ’ 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 appli c at ion under s 205D of the Corpora tion s Act.
Re placea ble r ul es a nd
c on st i tu t ions
T he Corpora tion s Act c on tain s ‘repla c eable rule s ’ whi c h apply to all c ompanies— exc ep t c ompanies where t he s ole
member is al s o t he s ole dire ctor —and ma y be us ed to go v ern t he in ternal running of the c ompan y. 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 hings 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 on st 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 pers ons who have agreed
t o be c ome a member o f t he c ompany agree to the term s and c ondit ion s.
If a wri tt en c onst it ut ion go v ern s t he c ompany, a c op y of the c onst it ut ion mu st al s o be lodged . A public c ompan y tha t
is: • a s uperannuation t rus tee , or
• For c harit able purpos e s onl y,
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 hat 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 hat is held or regi st ered on the bu s ine ss names regist er in re s pe ct o f ano t her indi v idual or body who is
no t t he pers on apply ing to hav e the name, or
• is unacc 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 eit 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 applic an t f or regist ra tion and t he que st 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 on c erning iden t ic al bu s 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
Applicant as being ‘true and c orre ct ’ a s follow s: ‘I dec lare t ha t the in f orma t ion giv en in t his st a temen t is t rue and c orre ct ’.

ASIC Form 201 G uide 22 May 2018 P a g e 1 o f 2

Spec i a l pu r po se c o m p a ni es T he differen t ty pe s o f s pe c ial purpo s e c ompanies t hat c an be est abli s hed on regi st ra t ion are :
C h ar i ta bl e pur 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 appl y its in c ome in promo ting
t hos 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 ors; and
require s its dire ct or s to approv e all o ther pa y ments 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
• Which 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 nnuat ion tr u stee co m p an y
A c ompany t hat acts s olely 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 uper v is ion) Act 1993 and whos e c on st it ut ion prohibits 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 publi c 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 only and obliges a NL c ompany ’s c on st itu tion t o st a te , amongst o ther t hing s, tha t its s ole obje cts
are mining purpos e s onl y.
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 ompany 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 thing s, pro v is ion s whi c 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 Notif i c at ion of det ail s 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 207Z 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 ropr 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 Cer t if ic a tion o f
c omplian c e wit 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 ubmi t a s part
o f t hi s lodgment .
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 al t erna tel y s ubmi t anne x ure s as par t of thi s lodgment .
T o ma k e an y annex ure conf orm to the regulat ion s, y ou mu st
1 . Use A 4 s iz e paper of white or ligh t pa stel c olor wit h a margin o f a t 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 on s e c ut iv ely
4 . Print or type in B LOC K le tt er s in dark blue or bla ck in k s o t ha t the doc umen t is c learl y legible when
phot oc opied 5. Mark the annex ure wi th an iden t ify ing le tt er or sy mbol egg a, b, c or 1, 2, 3 etc.
6 . endors 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 pers 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 men 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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