Business Name Registration

Proposed business name: *

Do you need another business name?

ABN of the business name holder: *

Information of Individual / Sole Trader

Name: *
Country of birth: *
State of birth: *
Place and date of birth: *

Residential address of Individual / Sole Trader

Country: *
State: *
Address line 1: * (Must not be PO Box)
Address line 2: (optional)
Suburb / City / Town: *
Postcode: *

Applicant’s information

Applicant’s name: *
Contact email address: *
Contact phone number: *

Is the principal place of business the same
as the residential address? *

Yes

Is the address for serving documents the same
as the principal place of business? *

Yes

	I authorise Online Business Registration Pty Ltd trading as New Business Name to lodge the Business Name Registration and make all the necessary declarations to ASIC on behalf of me. I accept the Terms and Conditions.
	I declare that I am the applicant (the proposed business name holder) or I am lodging this application on behalf of the applicant (the proposed business name holder) and am authorised to 1) submit this application for lodgment on behalf of the applicant under the terms and conditions of the ASIC Electronic Lodgment Protocol; and 2) make each of the following declarations on behalf of the applicant after making all due and proper enquiries. (See who may be authorised to lodge an application to register a business name for more information.)
	I am not disqualified from managing corporations under section 206B(1) of the Corporations Act 2001; and within the last 5 years I have not been convicted of, or released from prison after being convicted of, and serving a term of imprisonment for, any of the criminal offences referred to in section 32(1) (c) or (d) of the Business Names Registration Act 2011.
	This application is submitted under, and is compliant with, the terms and conditions of the ASIC Electronic Lodgment Protocol. To the best of my knowledge, the information supplied in this application is complete and accurate (it is an offence to provide false or misleading information to ASIC). ASIC may contact the applicant or the lodging party (if any) if there are any questions regarding this application for registration of a business name.

Applicant’s information

Applicant’s name: *
Contact email address: *
Contact phone number: *

Principal place of business for the business name(s)

Country: *	Australia
State: *
Address line 1: * (Must not be PO Box)
Address line 2: (optional)
Suburb / City / Town: *
Postcode: *

Is the address for serving documents the same
as the principal place of business? *

Yes

	I authorise Online Business Registration Pty Ltd trading as New Business Name to lodge the Business Name Registration and make all the necessary declarations to ASIC on behalf of me. I accept the Terms and Conditions.
	I declare that I am the applicant (the proposed business name holder) or I am lodging this application on behalf of the applicant (the proposed business name holder) and am authorised to 1) submit this application for lodgment on behalf of the applicant under the terms and conditions of the ASIC Electronic Lodgment Protocol; and 2) make each of the following declarations on behalf of the applicant after making all due and proper enquiries. (See who may be authorised to lodge an application to register a business name for more information.)
	I am not disqualified from managing corporations under section 206B(1) of the Corporations Act 2001; and within the last 5 years I have not been convicted of, or released from prison after being convicted of, and serving a term of imprisonment for, any of the criminal offences referred to in section 32(1) (c) or (d) of the Business Names Registration Act 2011.
	This application is submitted under, and is compliant with, the terms and conditions of the ASIC Electronic Lodgment Protocol. To the best of my knowledge, the information supplied in this application is complete and accurate (it is an offence to provide false or misleading information to ASIC). ASIC may contact the applicant or the lodging party (if any) if there are any questions regarding this application for registration of a business name.

1st partner’s type: *

Individual

Organisation

Information of the 1st partner

Name: *
Country of birth: *
State of birth: *
Place and date of birth: *

Residential address of the 1st partner

Country: *
State: *
Address line 1: * (Must not be PO Box)
Address line 2: (optional)
Suburb / City / Town: *
Postcode: *

Information of the 1st partner

ABN of the organisation: *

Please, add a representative to act as a contact for this organisation.
(Must be a member of the governing body or a public officer, e.g. the president, director or secretary.)

Name: *
Country of birth: *
State of birth: *
Place and date of birth: *

Residential address of the representative

Country: *
State: *
Address line 1: * (Must not be PO Box)
Address line 2: (optional)
Suburb / City / Town: *
Postcode: *

2nd partner’s type: *

Individual

Organisation

Information of the 2nd partner

Name: *
Country of birth: *
State of birth: *
Place and date of birth: *

Residential address of the 2nd partner

Country: *
State: *
Address line 1: * (Must not be PO Box)
Address line 2: (optional)
Suburb / City / Town: *
Postcode: *

Information of the 2nd partner

ABN of the organisation: *

Please, add a representative to act as a contact for this organisation.
(Must be a member of the governing body or a public officer, e.g. the president, director or secretary.)

Name: *
Country of birth: *
State of birth: *
Place and date of birth: *

Residential address of the representative

Country: *
State: *
Address line 1: * (Must not be PO Box)
Address line 2: (optional)
Suburb / City / Town: *
Postcode: *

Is there another partner?

Add another partner

Principal place of business for the business name(s)

Country: *	Australia
State: *
Address line 1: * (Must not be PO Box)
Address line 2: (optional)
Suburb / City / Town: *
Postcode: *

Is the address for serving documents the same
as the principal place of business? *

Yes

Applicant’s information

Applicant’s name: *
Contact email address: *
Contact phone number: *

	I authorise Online Business Registration Pty Ltd trading as New Business Name to lodge the Business Name Registration and make all the necessary declarations to ASIC on behalf of me. I accept the Terms and Conditions.
	I declare that I am the applicant (the proposed business name holder) or I am lodging this application on behalf of the applicant (the proposed business name holder) and am authorised to 1) submit this application for lodgment on behalf of the applicant under the terms and conditions of the ASIC Electronic Lodgment Protocol; and 2) make each of the following declarations on behalf of the applicant after making all due and proper enquiries. (See who may be authorised to lodge an application to register a business name for more information.)
	I am not disqualified from managing corporations under section 206B(1) of the Corporations Act 2001; and within the last 5 years I have not been convicted of, or released from prison after being convicted of, and serving a term of imprisonment for, any of the criminal offences referred to in section 32(1) (c) or (d) of the Business Names Registration Act 2011.
	This application is submitted under, and is compliant with, the terms and conditions of the ASIC Electronic Lodgment Protocol. To the best of my knowledge, the information supplied in this application is complete and accurate (it is an offence to provide false or misleading information to ASIC). ASIC may contact the applicant or the lodging party (if any) if there are any questions regarding this application for registration of a business name.

Please, add a representative to act as a contact for this organisation.
(Must be a member of the governing body or a public officer, e.g. the president, director or secretary.)

Name: *
Country of birth: *
State of birth: *
Place and date of birth: *

Residential address of the representative

Country: *
State: *
Address line 1: * (Must not be PO Box)
Address line 2: (optional)
Suburb / City / Town: *
Postcode: *

Is the principal place of business the same
as the representative’s residential address? *

Yes

Is the address for serving documents the same
as the principal place of business? *

Yes

Applicant’s information

Applicant’s name: *
Contact email address: *
Contact phone number: *

	I authorise Online Business Registration Pty Ltd trading as New Business Name to lodge the Business Name Registration and make all the necessary declarations to ASIC on behalf of me. I accept the Online Business Registration Pty Ltd Terms and Conditions.
	I declare that I am the applicant (the proposed business name holder) or I am lodging this application on behalf of the applicant (the proposed business name holder) and am authorised to 1) submit this application for lodgment on behalf of the applicant under the terms and conditions of the ASIC Electronic Lodgment Protocol; and 2) make each of the following declarations on behalf of the applicant after making all due and proper enquiries. (See who may be authorised to lodge an application to register a business name for more information.)
	I am not disqualified from managing corporations under section 206B(1) of the Corporations Act 2001; and within the last 5 years I have not been convicted of, or released from prison after being convicted of, and serving a term of imprisonment for, any of the criminal offences referred to in section 32(1) (c) or (d) of the Business Names Registration Act 2011.
	This application is submitted under, and is compliant with, the terms and conditions of the ASIC Electronic Lodgment Protocol. To the best of my knowledge, the information supplied in this application is complete and accurate (it is an offence to provide false or misleading information to ASIC). ASIC may contact the applicant or the lodging party (if any) if there are any questions regarding this application for registration of a business name.

Collection Notice
Online Business Registration Pty Ltd (ABN 36 618 716 019) collects personal information about you in order to process your payment, and provide you with our business name registration service and for purposes otherwise set out in our Privacy Policy. To obtain further information, you can contact us at support@newbusinessname.com.au.