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Uncategorised
Business Name Registration
$
235.00
add in a trading name
Step
1
of
2
50%
Name for Registration
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Name for Registration
Name of Business Name to be Registered
Firm or Individual Placing Order
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Firm or Individual Placing Order
Full Name of Firm or Individual
Contact Person
Address
Phone Number
Email Address
Business Address
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Business Address
Notice of Service of Documents (can be PO Box)
Principal Place of Business
Owner of the Business Name
Individual/s or Partnership
Company
Trust
Owner of Business Name if Individual/s or Partnership
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Owner of Business Name if Individual/s or Partnership
Full Name
ABN (required)
Date of birth
DD slash MM slash YYYY
Town/ City of Birth
State/ Country of Birth
Residential Address
Want to Add second Individual/Partner
Yes
No
Second Individual/ Partner
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Second Individual/ Partner
Full Name
ABN (required)
Date of birth
DD slash MM slash YYYY
Town/ City of Birth
State/ Country of Birth
Residential Address
Want to Add third Individual/Partner
Yes
No
Third Individual/ Partner
This field is hidden when viewing the form
Third Individual/ Partner
Full Name
ABN (required)
Date of birth
DD slash MM slash YYYY
Town/ City of Birth
State/ Country of Birth
Residential Address
Owner of Business Name if Company
This field is hidden when viewing the form
Owner of Business Name if Company
Company Name
ABN (required)
ACN
Registered Address
Owner of Business Name if Trust
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Owner of Business Name if Trust
Trust Name
ABN (required)
Address
Trustee/s
Representative details
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Representative details
Full Name
Date of Birth
DD slash MM slash YYYY
Town/ City of Birth
State/ Country of Birth
Address
Declaration by the applicant of eligibility to hold a business name
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Declaration by the applicant of eligibility to hold a business name
I/we declare that I am not disqualified from managing corporations under section 206B(1) of the Corporations Act 2001. Within the last 5 years I have not been: a) convicted of, or b) released from prison after being convicted of, and serving a term of imprisonment for, any of the criminal offences referred to in Section 32(1)(c) or (d) of the Business Names Registration Act 2011.
Signed By
Full Name
Dated
DD slash MM slash YYYY
Signed By
Full Name
Dated
DD slash MM slash YYYY
Additional Comments
{all_fields}
Business Name Registration quantity
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