Name of client - primary contact First Last Contact telephone/mobile no?Name of proposed company (subject to availability)*- Please provide first preference plus two alternatives. Address of registered office Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Will the company occupy the registered office?*YesNoWho or what is the occupier of the registered office (e.g. Accountant)*Principal place of business (if different to registered office)* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Please fill in all details for Officer 1Full Name:Full name of Officer No. 1 First Last Company Name (if not a person) Residential Address for Officer No. 1 Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date of birth - Officer 1 City & Country of birth of Officer No. 1:Is Officer No. 1 to become a Director?*YesNoIs Officer No. 1 to become a Secretary?*YesNoIs Officer No. 1 to hold shares?*YesNoClass of share?e.g. ordinaryNo. of shares?Amount to be paid per share?Are the shares fully paid for?Are the shares to be beneficially held? (e.g. as trustee for):YesNoHas Officer 1 consented to act as a Director of the Company?*YesNoHas Officer 1 consented to act as a Secretary of the Company?*YesNoHas Officer 1 confirmed the above details and agreed to take up shares as described and agreed to the adoption of the standardised Constitution document as used by LEGAL EASE SERVICES PTY LTD as the Constitution of the proposed new company?*YesNoPlease fill in all details below for Officer 2Full Name:Full name of Officer No. 2 First Last Company Name (if not a person) Residential Address for Officer No. 2: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date of birth - Officer 1 City & Country of birth of Officer No. 2:Is Officer No. 2 to become a Director?*YesNoIs Officer No. 2 to become a Secretary?*YesNoIs Officer No. 2 to hold shares?*YesNoClass of share?e.g. ordinaryNo. of shares?Amount to be paid per share?Are the shares fully paid for?Are the shares to be beneficially held? (e.g. as trustee for):YesNoHas Officer 2 consented to act as a Director of the Company?*YesNoHas Officer 2 consented to act as a Secretary of the Company?*YesNoHas Officer 2 confirmed the above details and agreed to take up shares as described and agreed to the adoption of the standardised Constitution document as used by LEGAL EASE SERVICES PTY LTD as the Constitution of the proposed new company?*YesNoPhoneThis field is for validation purposes and should be left unchanged.
