Solution: ASIC Form 201 - Company Registration Application (Australia)

This document presents a completed ASIC Form 201, which is an application for registration as an Australian company under the Corporations Act 2001. The form includes details such as the proposed company name (Fortune Metal Mining NL), the state of registration (New South Wales), and the legal elements applicable (Pty. Ltd., No liability). It outlines the company's governance structure, indicating reliance on replaceable rules and providing details for the registered office, including the address and office hours. The document also lists the appointed officeholders: Lucy Scott, Robert Horwood, Paul Perry, and Tanja Garcia, with their respective roles as directors and/or secretary. Furthermore, it details the share structure, including share class codes (ORD, PRF, REDP), total shares, and amount paid. The document also includes member details, specifying shareholdings and amounts paid per share for members Lucy Scott, Robert Horwood, and Paul Perry.

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
COMPANY SOLUTION LLP
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]
Flat 12A, Third Floor, Peace Tower
S uburb/Ci ty St at e/T erri tor y P ostc ode
Carlton/Melbourne victoria 3053
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
FORTUNE METAL MINING NL
Name re s erv at ion number (if an y )
897 463 354
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
A SI C Fo rm 201 11 December 2012 P ag e 1 o f 8

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
83627492143
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

12A, 13B, City Plaza
St ree t number and St ree t name
30 and Anderson South Street
S uburb/Ci ty St ate/T erri t ory P o stcode
Chatswood/Sydney New South Wales 2067
A SI C Fo rm 201 11 December 2012 P ag e 2 o f 8

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
Lucy Scott Lucy Scott
F ormer name

NA
St ree t number and St ree t name:
23 and Azalea Street
S uburb/Ci ty St at e/T erri tor y P ostc ode
Aitkenvale/Townsville Queensland 4814
Country (if no t Aust ralia)
Dat e o f bir t h
08/04/1989
P la ce of bir th (t own/c ity) (st ate/c ount ry )
Aitkenvale/Townsville Queensland /Australia
A SI C Fo rm 201 11 December 2012 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
Robert Horwood
F ormer name
NA
St ree t number and St reet name
21 and Munro Street,
S uburb/ Ci ty
Hamilton Valley/Albury
Count ry (i f not Au st ralia)
S ec re t ary
Giv en name s
Robert Horwood
St ate/T erri t or y P ostc ode
New South Wales 2641
Dat e o f bir t h
23/07/1991
P lac e o f bir t h (town/c ity) (st ate/c ount ry )
Hamilton Valley/Albury 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
Paul Perry Paul Perry
F ormer name
NA
St ree t number and St ree t name
113 and Cambourne Street
S uburb/Ci ty St at e/T erri tor y P ostc ode
Lavington/Albury New South Wales 2641
Coun try (if no t Aust ralia)
Dat e o f bir t h
09/01/1991
P la c e o f bir t h (town/c ity ) (st ate/c ount ry )
Lavington/Albury New South Wales/Australia
3 Con tinued ... A ppoin t a no t her off i ce holder

Dat e o f bir t h
10/05/1995
P lac e o f bir t h (town/c ity) (st ate/c ount ry )
Carlton/Melbourne Victoria/Australia
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
A SI C Fo rm 201 11 December 2012 P ag e 4 o f 8

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 100000 $1000000
PRF 100000 $1000000
RE D P 5 0000 $500000
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 11 December 2012 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
Lucy Scott Lucy Scott
OR
Company name
ACN /A R B N/ ABN
Off i ce, unit, le v el, or PO B ox number
House No. 11A
St ree t number and St ree t name
23 and Azalea Street
S uburb/ Ci ty St ate/T erri t ory P o stcode
Aitkenvale/Townsville Queensland 4814
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 40000 10 400000 NIL NIL Y N
PRF 30000 10 300000 NIL NIL Y N
R E DP 10000 10 100000 NIL NIL Y N
A SI C Fo rm 201 11 December 2012 P ag e 6 o f 8