ASIC Application for Registration of an Australian Company Form 201

This document presents a filled-out ASIC Form 201, which is used to apply for the registration of a company under the Corporations Act 2001 in Australia. The form details various aspects of the company, including the proposed name (ARROW CARE), state of registration (Victoria), legal structure (Proprietary Limited), and type of company (Proprietary). It also outlines the registered office address, the appointment of officeholders (Robert Andrew, John Ray, and Mene Zell as directors), and the share structure, including the total number of shares and details of members like Sandy Methew. The application also includes declarations and signatures, confirming the accuracy of the information provided. The form covers all necessary sections, from lodgment details to share structure and member information, ensuring compliance with Australian regulatory requirements for company formation. The document is a comprehensive example of the application process, showcasing the required information and declarations for successful company 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 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)
84648926
F irm / organiz a tion
APEX 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 )
(9451280102 )
E mail address (op tional)
[e-mail]
S uburb/ Ci ty St a te /T erri t or y P ostc ode
MELBOURNE VICTORIA 3002
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
VICTORIA
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
ARROW CARE
Name re s er v a tion number (i f an y )
588 338 968
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
82584784549
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
211

St ree t number and St ree t name
24 Wall Town street
S uburb/ Ci ty St at e/T erri tor y P o stc ode
Melbourne Victoria 3002
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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
ROBERT ANDREW ROBERT ANDREW
F ormer name

NA
St ree t number and St ree t name
19 Mount Street
S uburb/ Ci ty St a te /T erri t ory P ostc ode
Melbourne Victoria 3002
Count ry (i f not A ust ralia)
Dat e o f bir th
19/05/1986
P la c e o f bir th (town/c ity) (stat e/coun t ry )
Melbourne Victoria
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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
JOHN RAY
F ormer name
NA
St ree t number and St ree t name
45 Wayland Street
S uburb /Ci ty
St at e/T erri tor y
Melbourne Victoria
Coun try (i f no t A u stralia)
S e c re t ary
Giv en name s
JOHN RAY
P o stc ode
3002
Dat e o f bir th
22/09/1988
P la c e of birt h (t own/c ity) (st at e/c ount ry )
Melbourne Victoria
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
MENE ZELL MENE ZELL
F ormer name
NA
St ree t number and St ree t name
50 RENOWNED STREET VICTORIA
S uburb /Ci ty St at e/T erri tor y P o stc ode
Melbourne Victoria 3002
Coun try (i f no t A u st ralia)
Da te of bir t h
07/02/1984
P la c e o f bir th (town /city ) (st a te /country )
Melbourne Victoria
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
Company 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 ... etc.
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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