Conversion of Company Order Form
Please PRINT, then fill out and Mail or Fax back to 03 5273 5274
Personal Details
 
Instructing Business:
 ____________________________________
Contact Person:
 ____________________________________
Address:
 ____________________________________
Telephone:
 ____________________________________
Facsimile:
 ____________________________________
Email:
 ____________________________________
        
1. Company Details
 
(a) Company Name:
 ____________________________________

(b) ACN:

 ____________________________________

(c) Corporate Key

____________________________________

(d) Registered Office

 ____________________________________
        
2. Details of Resigning
Office Holders
 

(a) First Office Holder:

  

(a) Full Name:

 ____________________________________

(b) Usual Address:

 ____________________________________

(c) Resigning As:

 ____________________________________

(b) Second Office Holder:

  

(a) Full Name:

 ____________________________________

(b) Usual Address:

 ____________________________________

(c) Resigning As:

 ____________________________________
        
3. Details of Shares
     to be Transferred
 

First Transfer

  

(a) Transferee:

 ____________________________________

(b) Transferor:

 ____________________________________

(c) Number of Shares:

 ____________________________________

(d) Type of Shares:

 ____________________________________

(e) Value of Shares:

 ____________________________________

Second Transfer

  

(a) Transferee:

 ____________________________________

(b) Transferor:

 ____________________________________

(c) Number of Shares:

 ____________________________________

(d) Type of Shares:

 ____________________________________

(e) Value of Shares:

 ____________________________________
        
4. Other Changes
 
(ie Registered Office, Principal Place of Business etc)

First Transfer:

 ____________________________________

Second Transfer:

 ____________________________________
        
      

Please PRINT, then fill out and Mail or Fax back to 03 5273 5274
     Alternatively you can download these forms, fill them in, and fax to 5273 5274.