Company Registration Application (ASIC Form 201)Primary ContactSome description about this sectionFirst NameMiddle Name (if any)Last NameEmailContact NumberBest time to reach you (optional)Company DetailsSome description about this sectionProposed Company NameAlternative Name (if first is unavailable)Company Type- Select -Proprietary Limited (Pty Ltd)Public CompanyOtherBusiness Activity / DescriptionUltimate Holding Company? Yes NoHolding Company Name / ACNRegistered Office & PPBProvide the registered office and principal place of business addresses.Registered Office AddressAddress Line 1Address Line 2SuburbStatePost CodeCountrySelect CountryAustraliaIs the Principal Place of Business the same as the Registered Office? Yes, same as Registered Office No, provide a different addressPrincipal Place of Business AddressAddress Line 1Address Line 2SuburbStatePost CodeCountryAustraliaAustraliaDirectors Please provide details of all company directors. At least one director must reside in Australia.Director First NameMiddle Name (if any)Director Last NameDirector EmailDirector Contact NumberDirector Residential AddressAddress Line 1Address Line 2Suburb/CityStatePost CodeCountryAustraliaAustraliaDropdown- Select -Option 1Option 2Director’s Role Director Managing Director Alternate DirectorIs this director an Australian resident? Yes NoShare StructureDefine the company’s share structure. Each company must issue at least one share. Ordinary shares are the most common type.Total Number of SharesDefault Share Class- Select -OrdinaryPreferenceRedeemable PreferenceSpecial Rights or Restrictions (if any)ShareholdersPlease provide details of all initial shareholders (members) of the company.Shareholder First NameMiddle Name (if any)Shareholder Last NameShareholder EmailShareholder Contact NumberShareholder Residential AddressAddress Line 1Address Line 2City/SuburbStatePost CodeCountryAustraliaAustraliaNumber of Shares IssuedType of Shares- Select -Ordinary SharesPreference SharesRedeemable Preference SharesIs this shareholder also a director? Yes NoIdentity Documents Each director/shareholder must provide one of the following identity documents for verification (Driver’s Licence, Passport, or Medicare Card).Document Type- Select -Driver’s LicencePassportMedicare CardDocument NumberIdentity DocumentsEach director/shareholder must provide proof of identity. Please email a clear scan or photo of ONE document (Driver’s Licence, Passport, or Medicare Card) to: info@mediumpurple-dotterel-294713.hostingersite.comWhose document is this? Director Shareholder Both (if same person)Declaration & Consents I confirm that I have read and agree to the Terms and Conditions and Privacy Policy. I understand that Xactify Accounts provides administrative bookkeeping support services only (not a registered tax agent) and that my information will be handled in accordance with Australian Privacy Law. I confirm that the information provided is true and complete. I authorise Xactify Accounts to use this data to prepare admin-support documents for company registration. I understand Xactify Accounts is not a registered tax or BAS agent and operates independently of ASIC/ATO/ABR. I accept the Privacy Policy and Terms & Conditions.Additional Notes (if any)Submit Company Registration Application.
