ASIC Lodgement - Change of Officeholders

Company Name*

ACN*

Australian Company Number

Corporate Key

(not required if CorpSec Services is appointed the company's ASIC agent)

Name of Director or Secretary who will sign ASIC form

Name of Chairperson for the Meeting of Directors

If same director as signing ASIC form, please indicate 'as above'

Is an Officeholder of the company resigning?

YesNo

Resignation of Officeholder (more than one role can be selected):

DirectorSecretaryAlternate Director

Name*

First NameMiddle NameLast Name

Date of Birth

Place of Birth

Town / City State / Country

Date Officeholder ceased*

Date Officeholder ceased

Cease another Officeholder?

YesNo

Resignation of Officeholder (2) (more than one role can be selected):

DirectorSecretaryAlternate Director

Name*

First NameMiddle NameLast Name

Date of Birth

Place of Birth

Town / City State / Country

Date Officeholder ceased*

Date Officeholder ceased

Cease another Officeholder?

YesNo

Resignation of Officeholder (3) (more than one role can be selected):

DirectorSecretaryAlternate Director

Name*

First NameMiddle NameLast Name

Date of Birth

Place of Birth

Town / City State / Country

Date Officeholder ceased*

Date Officeholder ceased

A private company requires at least 1 director who must 'ordinarily reside' (live) within Australia. No maximum number of directors is indicated by the Corporations Act 2001. The appointment of a secretary is optional for pty ltd companies, but if appointed one must reside in Australia.

Is an Officeholder being appointed?

YesNo

Name of new Officeholder *

First NameMiddle NameLast Name

Former Name (if applicable)

First NameMiddle NameLast Name

Director ID Number*

Add your 15 digit DIR number issued by the ABRS (no spaces)

Date of Birth *

Place of Birth*

Town / City State / Country

Residential Address of Officeholder*

Unit, Suite or Apartment

Street Number and Street Name

Suburb / CityState / Territory

Postcode Country

Role of Officeholder (more than one can be selected):*

DirectorSecretaryAlternate Director

Date Officeholder appointed*

Effective date of appointment

Appoint another Officeholder?

YesNo

Name of new Officeholder (2)

First NameMiddle NameLast Name

Former Name (if applicable)

First NameMiddle NameLast Name

Director ID Number

Add your 15 digit DIR number issued by the ABRS (no spaces)

Date of Birth

Place of Birth

Town / City State / Country

Residential Address of Officeholder

Unit, Suite or Apartment

Street Number and Street Name

Suburb / CityState / Territory

Postcode Country

Role of Officeholder (more than one can be selected):

DirectorSecretaryAlternate Director

Date Officeholder appointed

Effective date of appointment

Appoint another Officeholder?

YesNo

Name of new Officeholder (3)

First NameMiddle NameLast Name

Former Name (if applicable)

First NameMiddle NameLast Name

Director ID Number

Add your 15 digit DIR number issued by the ABRS (no spaces)

Date of Birth

Place of Birth

Town / City State / Country

Residential Address of Officeholder

Unit, Suite or Apartment

Street Number and Street Name

Suburb / CityState / Territory

Postcode Country

Role of Officeholder (more than one can be selected):

DirectorSecretaryAlternate Director

Date Officeholder appointed

Effective date of appointment

Do these same Officeholder changes relate to another company?

YesNo

Company Name (2)*

ACN*

Australian Company Number

Corporate Key

(not required if CorpSec Services is appointed the company's ASIC agent)

Do these same Officeholder changes relate to another company?

YesNo

Company Name (3)*

ACN*

Australian Company Number

Corporate Key

(not required if CorpSec Services is appointed the company's ASIC agent)

Do you consent to CorpSec Services being appointed as ASIC agent for the company?*

YesNoAlready ASIC AgentNot sure

Additional Notes

Provide any additional instructions or information

Method of Payment*

Direct Bank TransferCredit Card PaymentIssue Invoice for payment

Direct Bank Transfer - Total of $275 (incl GST) is due at time of lodgement per company.

Account Name: CorpSec Services Pty Ltd

BSB: 083 004

Account No: 98 301 7259

Please include your company name as reference.

For 6 or more companies contact us for our discount rates.

Credit Card Payment *

ASIC Form & relevant supporting documents$250.00AUD

Quantity

Subtotal $0.00AUDTax $0.00AUDShipping $0.00AUDTotal $0.00AUD

Credit Card Details
Name on card
Credit Card Number	Security Code
Card Expiration

I hereby declare that:*

The information provided in this form is true and correct.I am authorised to instruct you on behalf of the company/ies.

Your name*

First NameLast Name

Email*

Company / Firm name

Capacity

Role with company/firm

Phone Number*

Area or country code/part mobile Office or mobile number

Thank you for submitting the change of officeholder details using our online form. The information provided will be used to prepare the prescribed ASIC form and applicable supporting documents (if requested) and will be forwarded to you for your review and signature prior to lodgement with ASIC.

In accordance with ASIC's Electronic Lodgement Protocol, we are not able to proceed with ASIC lodgement without the prior signature of a director or secretary of the company. Forms are lodged on the same day returned signed.

If an ASIC late fee is payable in connection with this notification, we will advise you prior to lodgement.

Disclaimer – CorpSec Services Pty Ltd does not provide legal, accounting or financial advice and therefore takes no responsibility for your taxation, legal or other liabilities which may arise from the work we perform on your instructions.

Complete Form

Resigning Officeholder

Appoint an Officeholder

Payment

Declaration