Incorporation Ia

Document Sample
Incorporation Ia Powered By Docstoc
					    DEPARTMENT OF JUSTICE                                                   www.nt.gov.au

 LICENSING, REGULATION AND ALCOHOL STRATEGY
 Application for Incorporation of an Association

 Applicant Details

Title (Mr, Ms, Mrs, Dr etc)                   Surname


Given Name(s)                                                    Date of birth


Street Address


                                                               Postcode

Postal Address


                                                               Postcode

Telephone                                          Fax


Mobile                                             Email


 Association Details

Name of Association


Postal Address


                                                               Postcode




                   LICENSING, REGULATION AND ALCOHOL STRATEGY

 Darwin                                     Katherine                                Alice Springs
                                                                         st
 Level 1, Enterprise House        18 Katherine Terrace, Katherine       1 Floor Belvedere House
 28-30 Knuckey Street, Darwin    GPO Box 2138, Katherine, NT 0850             Cnr Parsons/Bath Sts
 GPO Box 1154, Darwin, NT 0801         Ph: 08 8972 8906        GPO Box 8470, Alice Springs NT 0871
 Ph: 08 8999 1800                     Fax: 08 8972 8910                           Ph: 08 8951 5195
 Fax: 08 8999 1888                                                               Fax: 08 8951 8591

                                      Email: lr.doj@nt.gov.au
                                   www.nt.gov.au/justice/licenreg
                             form_ia_application_incorporation_assn V2
Location activities are carried out:
   Darwin
    Katherine
    Tennant Creek
    Alice Springs
    East Arnhem
    Regional (e.g. Palmerston, rural areas, islands)

Number of members                         Date association formed


Is the Association formed for the purpose of trading or securing a pecuniary profit
to its members?
     Yes
    No
Please note, where the answer to the above question is yes, a written statement
must be attached outlining the ethnic community to which members of the
Association belong and how the persons came to have management of the
committee.

 Association Member Details

President / Chairperson
 Full legal name


 Residential Address
                                                                 Postcode
 Telephone
 Mobile
 Email

Vice President / Vice Chairperson
 Full legal name


 Residential Address
                                                                 Postcode
 Telephone
 Mobile
 Email



                     form_ia_application_incorporation_assn V2
Treasurer
Full legal name


Residential Address
                                                                                Postcode
Telephone
Mobile
Email

Secretary
Full legal name


Residential Address
                                                                                Postcode
Telephone
Mobile
Email

Names of Other Committee Members




Fees and Lodgement

Please refer to the relevant schedule of fees.

Please note: Documents are not able to be lodged or processed until payment is
received. An additional fee*may apply should ministerial consent for the name of
the association be required. Forms should be lodged with Territory Business
Centres.

                                   TERRITORY BUSINESS CENTRES
                             TOLL FREE LINE: 1800 193 111 (Australia Wide)
 Darwin               Katherine           Tennant Creek       Alice Springs               Postal Address
 Development Hse      1 Randazzo Bldg     Shop 2, Barkly Hse Peter Sitzler Bldg           GPO Box 9800
 76 The Esplanade     18 Katherine Tce    Cnr Paterson &      67 Nth Stuart Hwy           Darwin NT 0801
 Darwin NT 0800       Katherine NT 0850   Davidson Sts        Alice Springs               territory.businessc
 Phone:               Phone:              Tennant Creek       NT 0870                     entre@nt.gov.au
 (08) 8982 1700       (08) 8972 8906      NT 0860             Phone:
                                          Phone:              (08) 8951 8524
                                          (08) 8962 4411
 General Disclaimer: The material contained in this publication is intended for use as a guide and for
 general information only. It is not intended to be a substitute for independent professional advice. The
 Northern Territory Department of Justice accepts no responsibility or liability for the correctness, accuracy
 and completeness of any of the material contained in this publication and recommends that users of this
 publication exercise their own skill, care and judgment in the application of the information contained in
 the publication.
                            form_ia_application_incorporation_assn V2
                           Northern Territory of Australia
                                   OATHS ACT
                     STATUTORY DECLARATION

(1)                I, (1)………………………………………………………….…… … …
Insert name
& address of
person making      of
the declaration    ……………………………………………………………………………
                   do solemnly and sincerely declare:
(2)
Insert name
of entity
                   On ………/………/20……… the committee of the association
                   known as
(3)                (2)…………………………………………………………………
Delete whichever
statement does
not apply.         authorised me to apply for incorporation of the said association
                   under the Associations Act.

                   I am a resident of the Northern Territory, have attained the age of
                   18 years and consent to being the first public officer.

                   The document marked “A” annexed hereto is a true and complete
                   copy of the constitution of the association referred to in this
                   declaration.

                   I make this solemn declaration by virtue of the Oaths Act and
                   conscientiously believing the statements contained in this
                   declaration and accompanying application to be true in every
                   particular.

4)                 Declared at……………..…on the………day of…………….. 20….…
Signature of the
person making
the declaration
                                                                 (4) …………………………

(5)
Signature of
person before      Before me                                     (5) …………………………
whom the
declaration is
made.
                                                                 (6) …………………………
(6)
Full contact                                                       …………………………
details of
person before
whom the                                                            …………………………
declaration is
made, legibly
written, typed                                                      …………………………
or stamped



                   NOTE: This declaration may be made before any person who has attained
                         the age of (18) eighteen years.
                         A person wilfully making a false statement in a statutory declaration
                         is liable to a penalty of $2000 or imprisonment for 12 months, or
                         both.




                   form_ia_application_incorporation_assn V2

				
DOCUMENT INFO
Description: Incorporation Ia document sample