Department Of Human Services Business Application Electronic Verification Of Rent Page 7
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Is the Business an unincorporated association?
Unincorporated associations – Individual Undertaking
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No
30
Please read this before completing this question.
Yes
Go to 30
If you enter into the contract with the Department of Human
Services as the representative of an unincorporated
29
Authorised officer – Signatures
association and subsequently circumstances change so that
Signature of authorised officer
you are no longer in a position to make sure that all of the
obligations of a Business are complied with (for example, you
On completion of this form,
may cease to be a member of the association) it is
please print and sign by hand
recommended that you should terminate the contract. In those
circumstances, you will continue to have some obligations
Print
name
(for example, in relation to records relating to EVoR) that arose
during the period of your contract.
Position
Agreement
Signature of witness
• I have made this EVoR application for the Business
Name of Business
On completion of this form,
please print and sign by hand
Print
which is an unincorporated association.
name
• I am entering into the EVoR contract in my personal capacity
and as a representative of the Business.
Date
/
/
• I will, and will make sure the Business does, comply with the
EVoR Policy and EVoR Terms if the Business is approved to
Signature of second authorised officer (optional)
use EVoR, even if the membership of the Business changes,
I cease to be a member of the Business or the Business
On completion of this form,
becomes insolvent, ceases to trade or is wound up.
please print and sign by hand
I understand that:
Print
• I may withdraw from representing the Business at any time
name
by notifying the Department of Human Services that I no
longer wish to represent the Business in respect of EVoR.
Position
In those circumstances, the approval for the Business to use
EVoR will be withdrawn.
Signature of witness
Signature
On completion of this form,
On completion of this form,
please print and sign by hand
please print and sign by hand
Print
Print
name
name
Date
/
/
Position
Affix common seal of Company or Incorporated Association
Signature of witness
below, if applicable.
On completion of this form,
please print and sign by hand
Print
name
Date
/
/
Print
Clear
SA436.1508
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