ASIC Form 201 11 December 2012 Page 1 of 8
Application for registration as an Australian
Corporations Act 2001
Use this form to apply to ASIC for registration of a company under the Corporations Act 2001.
An image of this form will be available as
part of the public register.
Who should ASIC contact if there is a query about this form?
ASIC registered agent number (if applicable)
Contact name/position description Telephone number (during business hours)
Email address (optional)
Suburb/City State/Territory Postcode
1 State/territory of registration
I apply for registration of the company under the Corporations Act 2001 and nominate the State or Territory in which the
company will be taken to be registered.
Give State or Territory
2 Details of the company
Does the company have a proposed company name?
If yes, the proposed company name is
Name reservation number (if any)
The company name on registration will be its Australian Company Number (ACN).
Tick the legal elements that apply
Pty. Ltd. Proprietary Limited No liability NL
If there is insufcient space in any section of the form, you may photocopy the relevant page(s) and submit as part of this lodgement
Australian Securities &
208 - Notication of details of shares allotted other than for cash
207Z - Certication of compliance with stamp duty law