ASIC Application for Company Registration: Dakes Limited
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Homework Assignment
AI Summary
This assignment presents a completed ASIC Form 201, the application for registration as an Australian company under the Corporations Act 2001. The form is filled out for a proprietary limited company named Dakes Limited, based in New South Wales. The document includes details such as the registered agent, contact information, and the state of registration. It specifies the company's structure, including the legal elements (Pty. Ltd.), and the registered office address. The form also outlines the appointment of officeholders, including directors Jacky Jan, Bill Luce, and Jenn Dal, and details the share structure, including the number of shares, amounts paid and unpaid, and member information for Jacky Jan and Peter Ash, including their shareholdings. The applicant, Albert Ros, signs the declaration as a director and shareholder.

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 emen t
Lodg eme n t d eta ils
A n image o f t his f orm will be av ailable as
par t of the publi c regi st er.
Who should A SI C con tact i f th ere is a qu ery a bou t thi s
fo rm ? ASI C regist ered agent number (if appli c able)
12312312345
F irm / organization
Avs Pty Ltd
Con t act name /po s ition de sc rip tion
Jony Waker T elephone number (during bu s ine ss hour s )
(986654321)
E mail address (op tional)
jony@gmail.com
S uburb/ City St a te /T erri t or y P ostc ode
Sydney New South Wales 3997
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
New South Wales
2 Deta il s of t he compa ny
A SIC Form 201 11 December 2012 Pa g e 1 o f 8
Do es th e c o mp a n y h ave a p ropo se d co m p an y n ame ?
X Y e s
If y es, t he propo s ed c ompany name is
Dakes Limited
Name re s erv a tion number (i f an y )
NA
No
T he c ompany name on regist ra tion will be its A u st ralian Compan y Number (A CN) .
T ick t he legal elemen ts t ha t appl y
Pty. Lt d. P roprie t ar y Limi ted X No liabili ty X NL
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 emen t
Lodg eme n t d eta ils
A n image o f t his f orm will be av ailable as
par t of the publi c regi st er.
Who should A SI C con tact i f th ere is a qu ery a bou t thi s
fo rm ? ASI C regist ered agent number (if appli c able)
12312312345
F irm / organization
Avs Pty Ltd
Con t act name /po s ition de sc rip tion
Jony Waker T elephone number (during bu s ine ss hour s )
(986654321)
E mail address (op tional)
jony@gmail.com
S uburb/ City St a te /T erri t or y P ostc ode
Sydney New South Wales 3997
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
New South Wales
2 Deta il s of t he compa ny
A SIC Form 201 11 December 2012 Pa g e 1 o f 8
Do es th e c o mp a n y h ave a p ropo se d co m p an y n ame ?
X Y e s
If y es, t he propo s ed c ompany name is
Dakes Limited
Name re s erv a tion number (i f an y )
NA
No
T he c ompany name on regist ra tion will be its A u st ralian Compan y Number (A CN) .
T ick t he legal elemen ts t ha t appl y
Pty. Lt d. P roprie t ar y Limi ted X 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
896754906
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 P rev ious state / terr ito ry o f re gi stration
T yp e o f co m p an y
proprie tar y c ompany
X public c ompany
C lass o f c o mp a n y
limit ed b y s hare s
unlimit ed wi th a s hare c apit al
X limit ed by s hares
limit ed b y guaran tee
unlimit ed wi th a s hare c apit al
no liability
Sp eci al pu rpo se (if appli c able)
home uni t (HUN T )
s uperannuat ion tru st ee (PST C)
c hari t able purpos e s onl y (P NP C)
s uperannuat ion tru st ee (UL SS )
c hari t able purpos e s onl y (UL S N)
Sp ec i al pu rpose co m p an y
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 superannuation t ru st ee , or
• for charitable purpo s es only,
must ha v e a c onst it ut ion .
If t his is a s pe c ial purpos e c ompany, t ick t he bo x below t o ma k e the dec lara t ion .
I dec lare t ha t thi s c ompany is a s pe c ial purpo s e c ompany 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 an ce o f a publi c c o mp a n y
T he c ompany will rel y ent irel y on repla c eable rule s
X The compan y ha s a consti tution
A p r oposed publi c c o mp a n y whi ch h as adop te d a “ C on sti tu tion” mu st lodg e a copy o f th e c on sti tu tion
with thi s a pplicat ion.
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 $ 1000000 (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
07
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
896754906
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 P rev ious state / terr ito ry o f re gi stration
T yp e o f co m p an y
proprie tar y c ompany
X public c ompany
C lass o f c o mp a n y
limit ed b y s hare s
unlimit ed wi th a s hare c apit al
X limit ed by s hares
limit ed b y guaran tee
unlimit ed wi th a s hare c apit al
no liability
Sp eci al pu rpo se (if appli c able)
home uni t (HUN T )
s uperannuat ion tru st ee (PST C)
c hari t able purpos e s onl y (P NP C)
s uperannuat ion tru st ee (UL SS )
c hari t able purpos e s onl y (UL S N)
Sp ec i al pu rpose co m p an y
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 superannuation t ru st ee , or
• for charitable purpo s es only,
must ha v e a c onst it ut ion .
If t his is a s pe c ial purpos e c ompany, t ick t he bo x below t o ma k e the dec lara t ion .
I dec lare t ha t thi s c ompany is a s pe c ial purpo s e c ompany 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 an ce o f a publi c c o mp a n y
T he c ompany will rel y ent irel y on repla c eable rule s
X The compan y ha s a consti tution
A p r oposed publi c c o mp a n y whi ch h as adop te d a “ C on sti tu tion” mu st lodg e a copy o f th e c on sti tu tion
with thi s a pplicat ion.
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 $ 1000000 (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
07

St ree t number and St ree t name
23, Preoria Street
S uburb/ City St at e/T erri tor y P o stc ode
Sydney New South Wales 3997
A SIC Form 201 11 December 2012 Pa g e 2 o f 8
23, Preoria Street
S uburb/ City St at e/T erri tor y P o stc ode
Sydney New South Wales 3997
A SIC Form 201 11 December 2012 Pa g e 2 o f 8
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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 e s
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 . Regi st ered o ff i ce o f a public c ompany is open t o t he publi c ea c h bu s ine ss da y from a t lea st 10 am to 12
noon and 2 pm t o 4 pm .
b . Regi st ered off ice of a publi c c ompany is open to the publi c 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 I f same as re gi stere d o ff i ce , wri te “ as abo 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 Direct 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
Jacky Jan Jacky Jan
F ormer name
D o es th e co m p an y o cc up y th e p rem i ses?
X Y e s
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 . Regi st ered o ff i ce o f a public c ompany is open t o t he publi c ea c h bu s ine ss da y from a t lea st 10 am to 12
noon and 2 pm t o 4 pm .
b . Regi st ered off ice of a publi c c ompany is open to the publi c 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 I f same as re gi stere d o ff i ce , wri te “ as abo 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 Direct 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
Jacky Jan Jacky Jan
F ormer name
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NA
St ree t number and St ree t name
11, Peters street
S uburb/ Ci ty St a te /T erri t or y P ostc ode
Sydney New South Wales 3997
Count ry (if not A ust ralia)
Dat e o f bir th
21/08/1986
P la c e o f bir th (town /c ity) (st at e/count ry )
Sydney New South Wales
A SIC Form 201 11 December 2012 Pa g e 3 o f 8
St ree t number and St ree t name
11, Peters street
S uburb/ Ci ty St a te /T erri t or y P ostc ode
Sydney New South Wales 3997
Count ry (if not A ust ralia)
Dat e o f bir th
21/08/1986
P la c e o f bir th (town /c ity) (st at e/count ry )
Sydney New South Wales
A SIC Form 201 11 December 2012 Pa g e 3 o f 8

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
Dire ct or
F amil y name
Luce Bill
F ormer name
NA
St ree t number and St ree t name
56, Besin Street
S uburb /Ci ty
Sydney
Coun try (i f no t A u stralia)
X S e cre tar y
Giv en name s
Luce Bill
St a te /T erri t or y P ostc ode
Dat e o f bir th
18/04/1976
P la c e of birt h (t own/c ity) (st at e/c ount ry )
Sydney New South Wales
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 .
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
Dire ct or
F amil y name
Luce Bill
F ormer name
NA
St ree t number and St ree t name
56, Besin Street
S uburb /Ci ty
Sydney
Coun try (i f no t A u stralia)
X S e cre tar y
Giv en name s
Luce Bill
St a te /T erri t or y P ostc ode
Dat e o f bir th
18/04/1976
P la c e of birt h (t own/c ity) (st at e/c ount ry )
Sydney New South Wales
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 .
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Off ice h eld
X Dire ct or S e c re t ary
F amil y name Giv en name s
Jenn Dal Jenn Dal
F ormer name
NA
St ree t number and St ree t name
45, Haris Road
S uburb/ Ci ty St a te /T erri t or y P ostc ode
Count ry (if not A ustralia)
Sydney NSW 3145
Dat e o f bir th
P la c e of birt h (t own /c ity ) (st at e/count ry )
Sydney NSW
4 Id ent ify ul timate holding compa ny
X Dire ct or S e c re t ary
F amil y name Giv en name s
Jenn Dal Jenn Dal
F ormer name
NA
St ree t number and St ree t name
45, Haris Road
S uburb/ Ci ty St a te /T erri t or y P ostc ode
Count ry (if not A ustralia)
Sydney NSW 3145
Dat e o f bir th
P la c e of birt h (t own /c ity ) (st at e/count ry )
Sydney NSW
4 Id ent ify ul timate holding compa ny
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Will th e c o mp a n y h ave a n ul ti mate holding co m p an y upon re gi strat ion?
Y e s
If y e s, pro v ide the following de tail s of the ult ima te holding c ompany
Compan y name
A CN /A R B N/AB N Coun try o f in c orporat ion (if not A ust ralia)
X No
A SIC Form 201 11 December 2012 Pa g e 4 o f 8
Y e s
If y e s, pro v ide the following de tail s of the ult ima te holding c ompany
Compan y name
A CN /A R B N/AB N Coun try o f in c orporat ion (if not A ust ralia)
X No
A SIC Form 201 11 December 2012 Pa g e 4 o f 8

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.
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.
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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 li fe gov ernor’s
MA N managemen t
ORD ordinar y
RE D redeemable
P R F pre feren c e
CUMP c umulat iv e pre f eren c e
NC P non- c umulat 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 umulat iv e redeemable pre f eren c e
NCR P non- c umulat 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.
A A
B B ...e tc
E MP employ ee’s
FO U founder’s
LG li fe gov ernor’s
MA N managemen t
ORD ordinar y
RE D redeemable
P R F pre feren c e
CUMP c umulat iv e pre f eren c e
NC P non- c umulat 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 umulat iv e redeemable pre f eren c e
NCR P non- c umulat 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.
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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
B 300 300000
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 , con tinue to Sect 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.
A SIC Form 201 11 December 2012 Pa g e 5 o f 8
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
B 300 300000
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 , con tinue to Sect 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.
A SIC Form 201 11 December 2012 Pa g e 5 o f 8

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 indi v idual
or compan y, and
• shareholding .
A ddress of indiv idual or c ompany
F amil y name Giv en names
OR
Company name
A CN /A R B N/ AB N
Off ic e , unit, le v el, or PO B o x number
100
St ree t number and St ree t name
S uburb /Ci ty St a te /T erri t ory P ostc ode
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 has agreed , in wri ting , to ta k e up .
No te: B enef ic ially held u s uall y means t ha t 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 pay men ts in rela tion t o an y div idend s. S hare s held by a per s on a s tru st ee, nominee or on acc oun t o f anot her pers on are non-benef i c iall y
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 ull y paid B enef ic iall y
code s hare s t ak en up pa y per s hare the s e s hare s per s hare t hes e s hare s (y/ n) held (y/ n)
A 10 1000 10000 NIL NIL Y N
A SIC Form 201 11 December 2012 Pa g e 6 o f 8
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 indi v idual
or compan y, and
• shareholding .
A ddress of indiv idual or c ompany
F amil y name Giv en names
OR
Company name
A CN /A R B N/ AB N
Off ic e , unit, le v el, or PO B o x number
100
St ree t number and St ree t name
S uburb /Ci ty St a te /T erri t ory P ostc ode
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 has agreed , in wri ting , to ta k e up .
No te: B enef ic ially held u s uall y means t ha t 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 pay men ts in rela tion t o an y div idend s. S hare s held by a per s on a s tru st ee, nominee or on acc oun t o f anot her pers on are non-benef i c iall y
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 ull y paid B enef ic iall y
code s hare s t ak en up pa y per s hare the s e s hare s per s hare t hes e s hare s (y/ n) held (y/ n)
A 10 1000 10000 NIL NIL Y N
A SIC Form 201 11 December 2012 Pa g e 6 o f 8
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