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This is the second page of New Company Instructions.
Please submit this form separately.

Only use if more than 8 officers/members
this form must only be used to add additional entries after first completing the new company instructions. This form allows for further directors/members after the 8 entries allowed for in the new company instructions. Please note that this form will only be accepted after the new company instructions form has been completed & submitted. An additional fee of $55 per entry applies for any entries after 8.
 

When completing this form please use CAPITAL LETTERS.
Names must be entered in full - NO INITIALS.
 
(*) means required field
 
Preferred Company Name:*
The following persons have consented to act as officeholders as shown and hereby apply for the shares as indicated with application monies currently held in trust.

COMPANY MEMBERS AND OFFICE HOLDERS:
please attach an (Additional Members / Officeholders' form) if required.

Surname:
  or Company Name

Given Names:
  ACN if Company

Former Names:

Address:

Suburb:

State:

P/Code:

Occupation:

Date of Birth:

(Suburb) of Birth:

(State) of Birth:

(Country) of Birth:

Director: Secretary: Chairman: Public Officer:
Shareholder: Shareholder ONLY (not a Director/Secretary): Ultimate Holding Company:
This box should only be ticked if this SOLE shareholder is a company and is the Ultimate Holding Company.

1st Class Share Type:

Number:

2nd Class Share Type:

Number:

Beneficially Held?:

Yes: No:

If NO, who is the beneficial owner of these shares?
Full Name (NO initials):

COMPANY MEMBERS AND OFFICE HOLDERS:
please attach an (Additional Members / Officeholders' form) if required.

Surname:
  or Company Name

Given Names:
  ACN if Company

Former Names:

Address:

Suburb:

State:

P/Code:

Occupation:

Date of Birth:

(Suburb) of Birth:

(State) of Birth:

(Country) of Birth:

Director: Secretary: Chairman: Public Officer:
Shareholder: Shareholder ONLY (not a Director/Secretary): Ultimate Holding Company:
This box should only be ticked if this SOLE shareholder is a company and is the Ultimate Holding Company.

1st Class Share Type:

Number:

2nd Class Share Type:

Number:

Beneficially Held?:

Yes: No:

If NO, who is the beneficial owner of these shares?
Full Name (NO initials):

COMPANY MEMBERS AND OFFICE HOLDERS:
please attach an (Additional Members / Officeholders' form) if required.

Surname:
  or Company Name

Given Names:
  ACN if Company

Former Names:

Address:

Suburb:

State:

P/Code:

Occupation:

Date of Birth:

(Suburb) of Birth:

(State) of Birth:

(Country) of Birth:

Director: Secretary: Chairman: Public Officer:
Shareholder: Shareholder ONLY (not a Director/Secretary): Ultimate Holding Company:
This box should only be ticked if this SOLE shareholder is a company and is the Ultimate Holding Company.

1st Class Share Type:

Number:

2nd Class Share Type:

Number:

Beneficially Held?:

Yes: No:

If NO, who is the beneficial owner of these shares?
Full Name (NO initials):

COMPANY MEMBERS AND OFFICE HOLDERS:
please attach an (Additional Members / Officeholders' form) if required.

Surname:
  or Company Name

Given Names:
  ACN if Company

Former Names:

Address:

Suburb:

State:

P/Code:

Occupation:

Date of Birth:

(Suburb) of Birth:

(State) of Birth:

(Country) of Birth:

Director: Secretary: Chairman: Public Officer:
Shareholder: Shareholder ONLY (not a Director/Secretary): Ultimate Holding Company:
This box should only be ticked if this SOLE shareholder is a company and is the Ultimate Holding Company.

1st Class Share Type:

Number:

2nd Class Share Type:

Number:

Beneficially Held?:

Yes: No:

If NO, who is the beneficial owner of these shares?
Full Name (NO initials):
APPLICANT DETAILS

Firm Name:*

Street Address:*

Postal Address:*

Phone:*
NO MOBILE NO's

Fax:*

Email Address:*

All documents will be couriered FREE to your office.
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