Application for registration as an Australian company - ASIC Form 201

ASIC Form 201 is used to apply for registration of a company under the Corporations Act 2001. The form requires details of the company, share structure table, and details of members. The share structure table requires details of shares issued by the company. The details of members section requires the name and address of each person who consents to become a member.

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 ment deta il s
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)
[phone]
F irm /organi zat ion
ALL LEGAL SOLUTIONS SERVICES LIMITED
Con t act name / po s ition de scrip t ion
LEGAL ADVISOR T elephone number (during bus ine ss hours)
[phone]
E mail addre ss (opt ional)
[e-mail]
B-34, Goulburn Street
S uburb/Ci ty St at e/T erri tor y P ostc ode
Sydney New South Wales 2000
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
New South Wales
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
PERFECT AND PURE GOLD MINING NL
Name re s erv at ion number (if an y )
564 374 853
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 Limit ed X 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
86388928521
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
limited b y s hare s
limited b y guaran tee
unlimit ed wi t h a s hare c api t al
X 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

Flat No. 44, Bule Bell Commercial Building
St ree t number and St ree t name
12 and Abingdon Street
S uburb/Ci ty St ate/T erri t ory P o stcode
Woolloongabba Queensland 4102
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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
Julie White Julie White
F ormer name

NA
St ree t number and St ree t name:
23 and Aiken Close
S uburb/Ci ty St at e/T erri tor y P ostc ode
South Gladstone/ Gladstone Queensland 4680
Country (if no t Aust ralia)
Dat e o f bir t h
10/03/1995
P la ce of bir th (t own/c ity) (st ate/c ount ry )
Western Australia New South Wales/Australia
A SI C Fo rm 201 28 July 2019 P ag e 3 o f 8

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
Kylie Mauboy
F ormer name
NA
St ree t number and St reet name
23 and Cabarita Road
S uburb/ Ci ty
Cabarita/Sydney
Count ry (i f not Au st ralia)
S ec re t ary
Giv en name s
Kylie Mauboy
St ate/T erri t or y P ostc ode
New South Wales 2137
Dat e o f bir t h
14/05/1993
P lac e o f bir t h (town/c ity) (st ate/c ount ry )
Sydney New South Wales/Australia
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
X Dire ct or S ec ret ary
F amil y name Giv en name s
David Cosentino David Cosentino
F ormer name
NA
St ree t number and St ree t name
56 and Cynthia St
S uburb/Ci ty St at e/T erri tor y P ostc ode
Adamstown/Newcastle New South Wales 2289
Coun try (if no t Aust ralia)
Dat e o f bir t h
23/02/1992
P la c e o f bir t h (town/c ity ) (st ate/c ount ry )
Newcastle New South Wales
3 Con tinued ... A ppoin t a no t her off i ce holder

Dat e o f bir t h
12/07/1990
P lac 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.

ORD 50000 $500000
PRF 50000 $500000
RE D P 100000 $1000000
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
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 .
A SI C Fo rm 201 28 July 2019 P ag e 5 o f 8

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
Julie White Julie White
OR
Company name
ACN /A R B N/ ABN
Off i ce, unit, le v el, or PO B ox number
House No. 12
St ree t number and St ree t name
23 and Aiken Close
S uburb/ Ci ty St ate/T erri t ory P o stcode
South Gladstone/ Gladstone Queensland 4680
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)
ORD 20000 10 200000 NIL NIL Y N
PRF 20000 10 200000 NIL NIL Y N
R E DP 40000 10 200000 NIL NIL Y N
A SI C Fo rm 201 28 July 2019 P ag e 6 o f 8

6 Con tinued ... Deta il s o f a no th er mem ber
F amil y Name Giv en name s
Kylie Mauboy Kylie Mauboy
OR
Company name
ACN /A R B N/ ABN
Off i ce, unit, le v el, or PO B ox number
Flat no. 34A, Delux Prime Apartments
St ree t number and St ree t name
23 and Cabarita Road
S uburb/ Ci ty St ate/T erri t ory P o stcode
Cabarita/Sydney New South Wales 2137
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)
ORD 20000 10 200000 NIL NIL Y N
PRF 20000 10 200000 NIL NIL Y N
R E DP 40000 10 400000 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
David Cosentino David Cosentino
OR
Company name
ACN /A R B N/ ABN
Off i ce, unit, le v el, or PO B ox number
23, Park Avenue, Third Floor
St ree t number and St ree t name
56 and Cynthia St
S uburb/ Ci ty St ate/T erri t ory P o stcode
Adamstown/Newcastle New South Wales 2289
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)
ORD 10000 10 100000 NIL NIL Y N
PRF 10000 10 100000 NIL NIL Y N
RE D P 20000 10 200000 NIL NIL Y N
A SI C Fo rm 201 28 July 2019 P ag e 7 o f 8

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
Julie White
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
[16] [09] [2019]
Lodg ment 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 28 July 2019 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 28 July 2019 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
W eb www. asic. gov .au
Need help? www. asic. go v.au /quest ion
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ASI C Fo rm 201 G uide 28 July 2019 P a g e 2 o f 2