ASIC Form 484 – Fill Out and Use This PDF

Under Company details, enter the Company name and the ACN/ABN.

If you are not lodging changes online, you must include your corporate key on the cover sheet.

The corporate key is an eight-digit number uniquely associated with a company's ACN. You will ind your corporate key on the front page of your annual statement.

Under Lodgement details, who should ASIC contact if there is a query about this form: ASIC registered agent number (if applicable), Firm/organisation, Contact name/position description, Telephone number (during business hours), Email address (optional), Postal address, Suburb/City, State/Territory and Postcode.

An image of this form will be available as part of the public register.

You certify that the information in this cover sheet and the attached sections of this form are true and complete.

Enter the Name, then under Capacity, Director or Company secretary, then the Signature and the Date signed.

A resigning oficer's signature is not acceptable.

Ensure you complete the date of change where required, as well as provide the date the form was signed.

Use this section to notify if a company oficeholder has ceased to be a company oficeholder. You need to notify details separately for each ceased oficeholder.

Under Role of ceased oficeholder, select one or more boxes: Director, Secretary, Alternate director Person alternate for.

Date oficeholder ceased: Date of change.

Name: the name of the ceased oficeholder is Family name and Given names. Then the Date of birth and the Place of birth (town/city) (state/country).

Cease company oficeholder (Section B1): use this section to notify ASIC if a person has ceased to be an oficeholder of the company. Notiications must be received within 28 days after the change occurring.

A company does not have to notify ASIC that an oficeholder has ceased if the oficeholder has already notiied ASIC by lodging a Form 370 Notiication by oficeholder of resignation or retirement.

B1 Continued... Cease another company oficeholder.

Use this section to notify appointment of a company oficeholder. You need to notify details separately for each new oficeholder.

Under Role of appointed oficeholder, select one or more boxes: Director, Secretary, Alternate director.

Date of appointment.

Name: the name of the appointed oficeholder is (provide full given names, not initials) Family name and Given names.

Date of birth, Place of birth (town/city) (state/country).

Former name: their previous name was (provide full given names, not initials) Family name and Given names, eg change by deed poll or marriage.

Residential address: the residential address of the appointed oficeholder is Street number and Street name, Suburb/City, State/Territory, Postcode, Country (if not Australia).

Provide the full address including the street number, name and type, suburb, city, state or territory, postcode and country of residence if not in Australia.

A registered ofice address, principal place of business address or oficeholder residential address must be a physical or street address, a post ofice box is not acceptable.

The street address must include a street number, ie 'Corner of Smith St and Jones Rd' is not acceptable.

If an 'Alternate director', for whom: the appointed 'Alternate director' is alternate for (person alternate for) Family name and Given names. Note: Where an Alternate director is appointed, please attach the terms of appointment to this change form.

Expiry date (if applicable). Alternate director terms of appointment attached.

You can only notify a future date of change for registered ofice address, principal place of business address and an expiry date (if any) for an alternate director.

B2 Continued... Appoint another company oficeholder.

Use this section to notify if the company has commenced or ceased status as one of the special purpose company designations.

Note: If you indicate that your company has commenced status as one of the special purpose company designations listed, ASIC will send a declaration for you to complete and return.

The change is Commence or Cease: Home unit company, Superannuation trustee company, For charitable purposes only.

For new registrations, use the date of registration as the 'date of change'.

Form 484 (Corporations Act 2001) of the Australian Securities & Investments Commission is Change to company details. Use the Form 484 to notify ASIC of: A1 Change of address, A2 Change of name - oficeholders and proprietary company members, A3 Change - ultimate holding company, B1 Cease company oficeholder, B2 Appoint company oficeholder, B3 Special purpose company, C1 Cancellation of shares, C2 Issue of shares, C3 Change to share structure, C4 Changes to the register of members for proprietary companies.

The cover sheet for this form must be signed by a current company oficeholder.

Within 28 days after the date of change, and within 28 days after the date of issue of your annual company statement.

Send completed and signed forms to: Australian Securities and Investments Commission, PO Box 4000, Gippsland Mail Centre VIC 3841. Or lodge the form electronically by visiting the ASIC website www.asic.gov.au.