Order Form to Register a Company
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1 Order Form to Register a Company Check Questions Answers Does the company have a proposed name? (If No, Australian Company Number allotted by ASIC will be the Company s name. e.g. " Pty Ltd) (Please circle) What is the company s proposed name? (CAPITAL LETTERS ONLY) Is this company name identical to a registered State Business Name (BN)? (Please circle) If Yes, Provide Australian Business Name (ABN) for business name registered after 28 th May 2012 OR Provide details below of Registered State Business Name registered before 28 th May 2012 : No. of states in which this Business Name is registered Registered Business Number & State in which Business Name is registered. Registered Business Number States (ASIC will review your application manually to check the ownership of the business name before they register your company.)
2 Has this company name already been reserved with ASIC? (If No, go to next Question) (Company registration applications where name is already reserved with ASIC need to be reviewed manually by ASIC with reference to supporting documents. Hence your application is not being lodged for automatic processing. Our office will get in touch with you shortly to proceed further in the matter). ( Please circle) If Yes, provide details of Company Reservation Reservation number Whether Registered by Individual or Entity? Individual / Another entity (Please circle) Provide full name of Individual or entity In which State/Territory should the company be registered? Australian Capital Territory / New South Wales / Northern Territory / Queensland / South Australia / Tasmania / Victoria / Western Australia (Please circle only one) Will this company act only as trustee of Self Managed Super Fund (SMSF)? ( Please circle) If yes, accept below declaration - I DECLARE that this company is a special purpose company as defined under Regulation 3 of the Corporations (Fees) Regulations Accepted / Not Accepted (cannot proceed with your application if circled Not Accepted ) Will the Company have an Ultimate Holding Company? ( Please circle) If Yes, Please provide details of Holding Company: Name of Company ACN or ARBN or ABN ( if Incorporated in Australia) Country of Incorporation What would be the registered office of this company? (A company must have a registered office in Australia and should not be a POST OFFICE BOX address) Suburb State Post Code
3 Is the registered office (above) occupied by an entity other than this new company? If Yes, Please provide Name of the Occupier ( Please circle) Accept below declaration - I agree that the occupier has consented in writing to the company using those premises as the address for its registered office; and has not withdrawn that consent. Accepted / Not Accepted (cannot proceed with your application if circled Not Accepted ) What would be the Principal Place of Business for this company? If same as registered office address, Please write Same as Above (Should not be a POST OFFICE BOX address) Suburb State Post Code Share Structure No. of Shares Allotted Value Per share ($) Total Share Capital If you want different denominations of shares, please add additional sheet
4 No. of Individual Directors in this company (A proprietary company must have at least 1 director. That director must ordinarily reside in Australia). Please provide details of Director 1 First Name Middle Name (optional) Birth Details Date of Birth Is this director born in Australia? Suburb / City of Birth State of Birth Country of Birth Residential Address (Please enter residential (physical) address of the Director / Shareholder. Do not Enter Post Box address. If the address of Director is same as Registered office / Principal Place of Business of the company, write Same as Registered Office address / Principal Place of Business). If the Director of the company is also member of the company, provide details of the shareholding. beneficial owner (If the beneficial owner is a family trust enter the name of the trust.) _
5 Please provide details of Director 2 First Name Middle Name (optional) Birth Details Date of Birth Is this director born in Australia? Suburb / City of Birth State of Birth Country of Birth Residential Address (Please enter residential (physical) address of the Director / Shareholder. Do not Enter Post Box address. If the address of Director is same as Registered office / Principal Place of Business of the company, write Same as Registered Office address / Principal Place of Business) If the Director of the company is also member of the company, provide details of the shareholding. beneficial owner (If the beneficial owner is a family trust enter the name of the trust.) _ For additional Director / Shareholder please copy This PAGE...
6 No. of Individual Shareholders of this company who will not act as Directors Please provide details of Shareholder / Non Director 1 First Name Middle Name (optional) Residential Address (Please enter residential (physical) address of the Director / Shareholder. Do not Enter Post Box address. If the address of Member is same as Registered office / Principal Place of Business of the company, write Same as Registered Office address / Principal Place of Business) Provide details of the shareholding. beneficial owner _ (For Example; If the beneficial owner is a family trust enter the name of the trust.)
7 Please provide details of Shareholder / Non Director 2 First Name Middle Name (optional) Residential Address (Please enter residential (physical) address of the Director / Shareholder. Do not Enter Post Box address. If the address of Member is same as Registered office / Principal Place of Business of the company, write Same as Registered Office address / Principal Place of Business) Provide details of the shareholding. beneficial owner _ (For Example; If the beneficial owner is a family trust enter the name of the trust.) For additional Shareholder please copy This PAGE...
8 No. of companies who will own shares in this company Provide details of Company Shareholder 1 Name of Company (Please enter the exact name as per Certificate of Registration) Is this company registered in Australia? If yes, provide Australian Company Number (ACN) If No, provide Registration number (optional) Registered Address (Please enter residential (physical) address of the Director / Shareholder. Do not Enter Post Box address.) Provide details of the shareholding. beneficial owner (For Example; If the beneficial owner is a family trust enter the name of the trust.) Name of person executing the documents on behalf of this company shareholder First Name
9 Provide details of Company Shareholder 2 Name of Company (Please enter the exact name as per Certificate of Registration) Is this company registered in Australia? If yes, provide Australian Company Number (ACN) If No, provide Registration number (optional) Registered Address (Please enter residential (physical) address of the Director / Shareholder. Do not Enter Post Box address.) Provide details of the shareholding. beneficial owner (For Example; If the beneficial owner is a family trust enter the name of the trust.) Name of person executing the documents on behalf of this company shareholder First Name For additional Shareholder please copy This PAGE...
10 No. of Joint Shareholders who will own shares in this company (Two (Maximum) Individuals or Two (Maximum) Companies can own shares in this company jointly.) Please provide details of Joint holder 1 Is the Joint holder a person or a Company? Person / Company (circle one) Please provide details as below First Name / Company Name Middle Name (optional) Residential Address / Company s registered address (Please enter residential (physical) address of the Director / Shareholder. Do not Enter Post Box address. If the address of Director is same as Registered office / Principal Place of Business of the company, write Same as Registered Office address / Principal Place of Business) Please provide details of Joint holder 2 Is the Joint holder a person or a Company? Person / Company (circle one) Please provide details as below First Name / Company Name Middle Name (optional) Residential Address / Company s registered address (Please enter residential (physical) address of the Director / Shareholder. Do not Enter Post Box address. If the address of Director is same as Registered office / Principal Place of Business of the company, write Same as Registered Office address / Principal Place of Business)
11 Provide details of the shareholding. beneficial owner _ (For Example; If the beneficial owner is a family trust enter the name of the trust.) Provide name of Secretary of this company? (It is not mandatory for proprietary company to appoint a Secretary. However, if one or more secretary is appointed, at least one of them has to be resident of Australia). Name Public Officer of this company (You may name Public Officer in the application) Minutes to incorporate company Name Managing Director of the meeting. (should be one of the directors) What will be the venue of this meeting? (Venue of the meeting can be Registered Office, Principal Place of Business or any other venue) Who will sign the share certificates? (Must be one or maximum two directors or director and secretary if there is one).
12 Please provide details of applicant whom we can contact should ASIC have any queries? NAME ADDRESS PHONE NUMBER Would you like to have your company documents printed, bound & couriered to you? ($50 incl. GST) Special printing or delivery instruction (Please provide special instructions, if any) Consents : I / we apply for registration of a company on the basis of the information in this form. I / we have the necessary written consents and agreements referred to in the application concerning the member and officeholders and I / we shall give the consents and agreements to the company after the company becomes registered. The information provided in this application and in any annexure is true and correct at the time of signing. Accepted / Not Accepted (cannot proceed with your application if circled Not Accepted ) Payment Details Visa Card / MasterCard / American Express (circle one) Please fill in the credit card authority section for making payment by Credit Card Name on Credit Card Credit Card Number Expiry Date CVV Number (month) (Year) I authorise Deed Dot Com Dot Au Pty Ltd to debit my credit card every Week / Fortnight / Monthly / On completion of orders for our orders placed on Trustdeed.com.au website. Signature of card holder
13 Name of Applicant Signature of Applicant Please return this duly filled in and signed Order Form by Fax to (02) or to For any queries, have instant chat with our support team on our website or call (02)
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