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Change of Company Details Order Form ABN: 47 002 604 088
Shareholding - Allotment/Cancellation/Buy-back/Transfer
E-mail to: pliance@.au Phone: 1300 139 001 Fax to: 1300 139 013
|Please complete all mandatory fields (*). Reckon Docs can not be held responsible for illegible forms. By completing this form, you agree to Reckon Docs |
|Trading Terms & Conditions on reckon-.au, and the customer confirms that all officeholders and shareholders have consented to their appointments |
|under section 117(5) of the Corporations Act 2001 and confirms Reckon Docs Pty Ltd to act as the lodging agent on their behalf. |
|Contact Details* Date of Order: |
|Practice Name: |
|Contact Name: E-mail: |
|Shipping Address: Level/St.: |
|Shipping Address Suburb: State: Postcode: |
|Telephone: Fax: |
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|Special Instructions: |
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|Payment Details* (if no method selected, the order will be placed on a 30-day account) |
|Reckon Docs holds a Direct Debit Authority Direct Deposit (fax or e-mail receipt) On Account |
|Credit Card Details: (discount for payment with order) Visa MasterCard AMEX Diners |
|Name on Card: CCV/AMEX ID: |
|Card Number: Expiry Date: (mm/yyyy) |
| |
|Print Options* (If no option is selected, a Print & Delivery will be provided) | |
|Print & Delivery DIY Print (e-mail) | |
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|Company Details* |
|Company Name: |
|Company ACN: |
|Registered Office Address: Level/St.: |
|Registered Office Address: Suburb: State: Postcode: |
| |
|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |
|Date of Change: if Transfer, this shareholder is the Transferor Transferee |
|Surname/ACN: Given Names/Company: |
|Address: Level/St.: |
|Address: Suburb: State: Postcode: |
|Class of Shares: No. of Shares: Amt p/ Share: $ |
|(all Shares are held beneficially) OR as Trustee for: (e.g. trust/ super fund) |
| |
|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |
|Date of Change: if Transfer, this shareholder is the Transferor Transferee |
|Surname/ACN: Given Names/Company: |
|Address: Level/St.: |
|Address: Suburb: State: Postcode: |
|Class of Shares: No. of Shares: Amt p/ Share: $ |
|(all Shares are held beneficially) OR as Trustee for: (e.g. trust/ super fund) |
| |
|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |
|Date of Change: if Transfer, this shareholder is the Transferor Transferee |
|Surname/ACN: Given Names/Company: |
|Address: Level/St.: |
|Address: Suburb: State: Postcode: |
|Class of Shares: No. of Shares: Amt p/ Share: $ |
|(all Shares are held beneficially) OR as Trustee for: (e.g. trust/ super fund) |
| |
|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |
|Date of Change: if Transfer, this shareholder is the Transferor Transferee |
|Surname/ACN: Given Names/Company: |
|Address: Level/St.: |
|Address: Suburb: State: Postcode: |
|Class of Shares: No. of Shares: Amt p/ Share: $ |
|(all Shares are held beneficially) OR as Trustee for: (e.g. trust/ super fund) |
| |
|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |
|Date of Change: if Transfer, this shareholder is the Transferor Transferee |
|Surname/ACN: Given Names/Company: |
|Address: Level/St.: |
|Address: Suburb: State: Postcode: |
|Class of Shares: No. of Shares: Amt p/ Share: $ |
|(all Shares are held beneficially) OR as Trustee for: (e.g. trust/ super fund) |
| |
|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |
|Date of Change: if Transfer, this shareholder is the Transferor Transferee |
|Surname/ACN: Given Names/Company: |
|Address: Level/St.: |
|Address: Suburb: State: Postcode: |
|Class of Shares: No. of Shares: Amt p/ Share: $ |
|(all Shares are held beneficially) OR as Trustee for: (e.g. trust/ super fund) |
| |
|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |
|Date of Change: if Transfer, this shareholder is the Transferor Transferee |
|Surname/ACN: Given Names/Company: |
|Address: Level/St.: |
|Address: Suburb: State: Postcode: |
|Class of Shares: No. of Shares: Amt p/ Share: $ |
|(all Shares are held beneficially) OR as Trustee for: (e.g. trust/ super fund) |
| |
|What to do next: Submit form with the following items: |Please forward copies to: |
|copy of a current company extract; OR |e: pliance@.au; OR |
|copy of the company’s annual review statement |f: 1300 139 013. |
| |
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