Do you want to change Firm/Individual Placing Order Details?

Yes
No

Firm/Individual Placing Order

This field is hidden when viewing the form

Firm/Individual Placing Order

Full Name of Firm/Individual

Contact Person

Address

Address Line 1 Address Line 2 City State / Province / Region Postal Code/ZIP Country

Phone Number

Email Address

Company Details

This field is hidden when viewing the form

Company Details

Name of Company to be Registered

Sole Purpose SMSF Trustee Company

Yes
No

Company Registration State

Registered Office details

This field is hidden when viewing the form

Registered Office details

Address as above

Yes
No

Care of

Address

Address Line 1 Address Line 2 City State / Province / Region Postal Code/ZIP Country

Principal Place of Business

This field is hidden when viewing the form

Principal Place of Business

Address as above

Yes
No

Address

Address Line 1 Address Line 2 City State / Province / Region Postal Code/ZIP Country

Office Holders & Shareholders

This field is hidden when viewing the form

Office Holders & Shareholders

Positions Held 1

Director
Secretary
Public Officer
Shareholder/s

Name

Given Name Middle Name 1 Middle Name 2 Surname

Name of Individual(s) or Company

ACN (if applicable)

Is this Shareholder the Ultimate Holding Company?

Yes

If trustee or non-beneficially held

Yes

Name of Trust

Address

Address Line 1 Address Line 2 City State / Province / Region Postal Code/ZIP Country

Date of Birth

Town/City of Birth

State/Country of Birth

Share class

Number of Shares Allotted

Amount Paid per Share

Want to Add second Office Holder

Yes
No

Office Holders & Shareholders

This field is hidden when viewing the form

Office Holders & Shareholders

Positions Held

Director
Secretary
Public Officer
Shareholder/s

Name

Given Name Middle Name 1 Middle Name 2 Surname

Name of Individual(s) or Company

ACN (if applicable)

Is this Shareholder the Ultimate Holding Company?

Yes

If trustee or non-beneficially held

Yes

Name of Trust

Address

Address Line 1 Address Line 2 City State / Province / Region Postal Code/ZIP Country

Date of Birth

Town/City of Birth

State/Country of Birth

Share class

Number of Shares Allotted

Amount Paid per Share

Want to add third Office Holder

Yes
No

Office Holders & Shareholders

This field is hidden when viewing the form

Office Holders & Shareholders

Positions Held

Director
Secretary
Public Officer
Shareholder/s

Name

Given Name Middle Name 1 Middle Name 2 Surname

Name of Individual(s) or Company

ACN (if applicable)

Is this Shareholder the Ultimate Holding Company?

Yes

If trustee or non-beneficially held

Yes

Name of Trust

Address as above

Address

Address Line 1 Address Line 2 City State / Province / Region Postal Code/ZIP Country

Date of Birth

Town/City of Birth

State/Country of Birth

Share class

Number of Shares Allotted

Amount Paid per Share

Want to add fourth Office Holder?

Yes
No

Office Holders & Shareholders

This field is hidden when viewing the form

Office Holders & Shareholders

Positions Held

Director
Secretary
Public Officer
Shareholder/s

Name

Given Name Middle Name 1 Middle Name 2 Surname

Name of Individual(s) or Company

ACN (if applicable)

Is this Shareholder the Ultimate Holding Company?

Yes

If trustee or non-beneficially held

Yes

Name of Trust

Address as above

Address

Address Line 1 Address Line 2 City State / Province / Region Postal Code/ZIP Country

Date of Birth

Town/City of Birth

State/Country of Birth

Share class

Number of Shares Allotted

Amount Paid Per Share

Want to add fifth Office Holder?

Yes
No

Office Holders & Shareholders

This field is hidden when viewing the form

Office Holders & Shareholders

Positions Held

Director
Secretary
Public Officer
Shareholder/s

Name

Given Name Middle Name 1 Middle Name 2 Surname

Name of Individual(s) or Company

ACN (if applicable)

Is this Shareholder the Ultimate Holding Company?

Yes

If trustee or non-beneficially held

Yes

Name of Trust

Address as above

Address

Address Line 1 Address Line 2 City State / Province / Region Postal Code/ZIP Country

Date of Birth

Town/City of Birth

State/Country of Birth

Share class

Number of Shares Allotted

Amount Paid per Share

Want to add Sixth Office Holder?

Yes
No

Office Holders & Shareholders

This field is hidden when viewing the form

Office Holders & Shareholders

Positions Held

Director
Secretary
Public Officer
Shareholder/s

Name

Given Name Middle Name 1 Middle Name 2 Surname

Name of Individual(s) or Company

ACN (if applicable)

Is this Shareholder the Ultimate Holding Company?

Yes

If trustee or non-beneficially held

Yes

Name of Trust

Address as above

Address

Address Line 1 Address Line 2 City State / Province / Region Postal Code/ZIP Country

Date of Birth

Town/City of Birth

State/Country of Birth

Share class

Number of Shares Allotted

Amount Paid per Share

Want to add Seven Office Holder?

Yes
No

Office Holders & Shareholders

This field is hidden when viewing the form

Office Holders & Shareholders

Positions Held

Director
Secretary
Public Officer
Shareholder/s

Name

Given Name Middle Name 1 Middle Name 2 Surname

Name of Individual(s) or Company

ACN (if applicable)

Is this Shareholder the Ultimate Holding Company?

Yes

If trustee or non-beneficially held

Yes

Name of Trust

Address as above

Address

Address Line 1 Address Line 2 City State / Province / Region Postal Code/ZIP Country

Date of Birth

Town/City of Birth

State/Country of Birth

Share class

Number of Shares Allotted

Amount Paid per Share

Want to add Eight Office Holder?

Yes
No

Office Holders & Shareholders

This field is hidden when viewing the form

Office Holders & Shareholders

Positions Held

Director
Secretary
Public Officer
Shareholder/s

Name

Given Name Middle Name 1 Middle Name 2 Surname

Name of Individual(s) or Company

ACN (if applicable)

Is this Shareholder the Ultimate Holding Company?

Yes

If trustee or non-beneficially held

Yes

Name of Trust

Address as above

Address

Address Line 1 Address Line 2 City State / Province / Region Postal Code/ZIP Country

Date of Birth

Town/City of Birth

State/Country of Birth

Share class

Number of Shares Allotted

Amount Paid per Share

Additional Comments

Please Confirm The Following:*

I/we verify that the information provided is true and correct as at the time of submission.
I/we confirm that all officeholders and shareholders have consented to act in the positions that they are named in.
I/We confirm that all Directors have a Director ID as required by Australian Business Registry Services.
I/we authorise Shelf Companies Australia to act as my agent for the lodgement of this information with ASIC for registration of this Company only.

You must acknowledge and confirm the above before proceeding.

Public Company Limited

Step 1 of 2

Firm/Individual Placing Order

Company Details

Registered Office details

Principal Place of Business

Office Holders & Shareholders

Office Holders & Shareholders

Office Holders & Shareholders

Office Holders & Shareholders

Office Holders & Shareholders

Office Holders & Shareholders

Office Holders & Shareholders

Office Holders & Shareholders