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

Name of Business Name to be Transferred

ASIC Key (required for all changes)

My ASIC Key is
Shelfco to apply for an ASIC key for my Business Name

ASIC Key

New Business Addresses

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New Business Addresses

Notice of Service of Documents (can be PO Box)

Principal Place of Business

Business Name Change Type

Please select the following:

Change of Business Owner
Cancel Business Name
Renewal of Business Name

Change of Business Owner

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Change of Business Owner

Current Owner of the Business Name

Individual/s
Company
Trust

Current Owner of the Business Name

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Current Owner of the Business Name

Full Name

ABN (required)

Date of Birth

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

Town/ City of Birth

State/Country of Birth

Residential Address

Want to Add third Individual/ Partner

Yes
No

Third Individual Partner

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Third Individual Partner

Full Name

ABN (required)

Date of Birth

Town/ City of Birth

State/Country of Birth

Residential Address

Current Owner of the Business Name

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Current Owner of the Business Name

Company Name

ACN

ABN (required)

Registered Address

Current Owner of the Business Name

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Current Owner of the Business Name

Trust Name

Trustee/s

ABN (required)

Address

Representative Details

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Representative Details

Full Name

Date of Birth

Town/ City of Birth

State/ Country of Birth

Address

New Owner of the Business Name

Individual/s
Company
Trust

New Owner of the Business Name

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New Owner of the Business Name

Full Name

ABN (required)

Date of Birth

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

Town/City of Birth

State/Country of Birth

Residential Address

New Owner of the Business Name

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New Owner of the Business Name

Company Name

ACN

ABN (required)

Registered Address

New Owner of the Business Name

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New Owner of the Business Name

Trust Name

Trustee/s

ABN (required)

Address

Representative Details

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Representative Details

Full Name

Date of Birth

Town/City of Birth

State/Country of Birth

Address

Email Address for Business Name

Additional Comment

Declaration

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Declaration

Declarations by the applicant of eligibility to hold a Business Name*

I/We declare that I am/we are not disqualified from managing corporations under section 2068(1) of the Corporation 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 321(1)(c) or (d) of the Business Names Registration Act 2011.

Business Name Transfer

Step 1 of 2

Firm or Individual Placing Order

New Business Addresses

Business Name Change Type

Change of Business Owner

Current Owner of the Business Name

Second Individual Partner

Third Individual Partner

Current Owner of the Business Name

Current Owner of the Business Name

Representative Details

New Owner of the Business Name

Second Individual Partner

New Owner of the Business Name

New Owner of the Business Name

Representative Details

Declaration