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Consent to Act as Public Officer

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Please enter the name of the company which the public officer is going to represent. If any suffixes such as "Pty Ltd" apply, include those suffixes here. Do not include the Australian Company Number (ACN), as this will be included at the next step.

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CONSENT TO ACT AS PUBLIC OFFICER
________ (ACN................................................)



The Director
________
________


To the Director,


I hereby consent to being appointed to the position of Public Officer of the Company in accordance with faa Fbacaa Fca Baaaaaaabf Baf 1338 (Dcaacbaacffa) ("faa Baf").

For the purposes of this role as Public Officer, I hereby provide the following information:

Full name: ________

Address for service of notices:

________

Date of birth: ________

Tax file number: ________


SIGNED BY ________ on this........................ day of............................................. 20...........


..................................................
________


In the presence of:


................................................
Witness Signature

................................................
Witness Name

................................................
Witness Occupation

................................................

................................................
Witness Address

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CONSENT TO ACT AS PUBLIC OFFICER
________ (ACN................................................)



The Director
________
________


To the Director,


I hereby consent to being appointed to the position of Public Officer of the Company in accordance with faa Fbacaa Fca Baaaaaaabf Baf 1338 (Dcaacbaacffa) ("faa Baf").

For the purposes of this role as Public Officer, I hereby provide the following information:

Full name: ________

Address for service of notices:

________

Date of birth: ________

Tax file number: ________


SIGNED BY ________ on this........................ day of............................................. 20...........


..................................................
________


In the presence of:


................................................
Witness Signature

................................................
Witness Name

................................................
Witness Occupation

................................................

................................................
Witness Address