Record Of Lodgement Of Documents
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1104
1/1
14 July 2014
ASIC registered agent number
lodging party or agent name
A BARCODE IS
office, level, building name or PO Box no.
NOT REQUIRED ON
street number and name
THIS DOCUMENT
suburb / city
state/territory
postcode
telephone (
)
ASS.
REQ-A
facsimile (
)
CASH.
REQ-P
PROC.
DX number
suburb / city
104
Australian Securities & Investments Commission
form
Record of
Lodgement of documents
This is not a receipt for documents lodged or cashiers receipt.
Documents enclosed
A.C.N or A.R.B.N
Company Name
Form Number & Title
Fee
Please Note: The time stamp will not
TOTAL
attest or evidence the specific
Time and Date:
lodgement or documents that have
been lodged at that time.
Please place paper in this direction.
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