Form 911 - Insolvency Guardian
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1
2911
page 1/1
15 July 2001
ASIC registered agent number
lodging party or agent name
office, level, building name or PO Box no.
street number & name
suburb/city
state/territory
postcode
telephone (
)
facsimile (
)
DX number
suburb/city
911
Australian Securities & Investments Commission
form
Corporations Act 2001
verification or certification of
a document
Regulation 1.0.16
corporation name
A.C.N. or A.R.B.N.
Details of the attached document
document title
relevant section or subsection
of the Corporations Act 2001
Signature
I verify that the attached document marked (
) is the original document.
I certify that the attached document marked (
) is a true copy of the original document.
print name
capacity
sign here
date
/
/
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