$ Authorisation to Setup a New Company Preferred Company Name: Office Address: SHAREHOLDER / DIRECTOR / SECRETARY / PUBLIC OFFICER: (Delete whichever is not applicable) Given Name: Family Name: Type of Shares: No. of Shares: Residential Address: Date of Birth: Place of Birth: Beneficially Held: Y/N Y N TFN: Director's ID: Mobile No: Signature: Authorisation to register the Company Company Name: State of Incorporation: New Business (Y/N): Y N Business Activity: ABN Registration (Y/N): Y N (Registration Date): TFN Registration (Y/N): Y N GST Registration (Y/N): Y N (Registration Date): GST Turnover: $ Cash/Accrual: Cash Accrual Activity Statement Cycle (Monthly/Quarterly/Annually): Monthly Quarterly Annually PAYG Registration (Y/N): Y N (Registration Date): Number of Employees: Email: I confirm my order for the setup of the Company and that the Shareholders and Officers named have applied for shares & consented to act, in writing. I also acknowledge that I am primarily responsible for settlement of your quoted charges. Signature: Date: Instructing Person: Submit
