CO-OPERATIVES REGULATION 2005

New South Wales Consolidated Regulations

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CO-OPERATIVES REGULATION 2005 - SCHEDULE 7

SCHEDULE 7 – Forms

Form 1 - Annual report

(Clause 17)

Annual report

Part A

Annual report

Co-operatives Act 1992 (Section 252 (1) (e))

Co-operative name:

A.R.B.N. (if applicable):Telephone:

Address of registered office:

Co-operative No:

* Signature

Date

	Financial year ended 20	Last year 20		Financial year ended 20	Last year 20
ANZSIC	%	ANZSIC	%		LGA	%	LGA	%

		Financial year ended 20	Last year 20
NUMBER OF DIRECTORS:	Active member directors
	Employee directors
	Other independent directors
EXPORTS:	Value of exports
	% of total sales

Total turnover (including ancillary income)
Cost of goods sold
Total interest paid or provided
Number of members
Number of employees

Does the co-operative have an exemption from any of the provisions of clause 13 of the Co-operatives Regulation 2005 ?
If yes, please specify details

Yes/No

* May be signed by secretary, director or principal executive officer

Co-operative name:

Financial year ended:

Annual report

ANNUAL REPORT-MOVEMENT-SHARE VALUES (WHOLE DOLLARS)

	SHARES
Section of Act		Section 151	Sections 151 (4) (a), 156, and 282 (1) (b)	Section 154	Section 155
Narration	Shares	Issue of shares at a premium	Bonus shares issue	Issue of shares to active members in exchange for property	Members may be required to take up additional shares	Total
$	$	$	$	$	$	$
Balance at beginning of year
Additions
Transfers In
Sub-total
		Forfeiture
	Re-purchase non-active
	Re-purchase active
	Transfers out
	Sub-total out
	This figure must agree with the total share capital in the Balance Sheet	Balance end of year

Annual report

ANNUAL REPORT-MOVEMENT-LOANS & CCUs (WHOLE DOLLARS)

	DEPOSITS & DEBENTURES	LOANS	CCUs
Section of Act	Section 263A	Section 266	Section 266A	Section 268	Part 10, Division 2
Narration	Deposits	Debentures	Debentures	Loans	CCUs to members	CCUs to non- members
	$	$	$	$	$	$
Balance at beginning of year
Additions
Transfers In
Sub-total In
Repayment
Transfers Out
Sub-total Out
Balance at end of year

Co-operative name:

Annual report

BALANCE SHEET

		Financial year ended 20	Last year 20
	$	$
CURRENT ASSETS
Cash and cash equivalents
Trade and other receivables
Inventories
Financial assets
Other current assets
Total current assets
NON-CURRENT ASSETS
Trade and other receivables
Assets held for sale
Financial assets
Property, plant & equipment
Deferred tax assets
Intangible assets
Other non-current assets
Total non-current assets
TOTAL ASSETS
CURRENT LIABILITIES
Trade and other payables
Short-term borrowings
Current tax liabilities
Short-term provisions
Other current liabilities
Total current liabilities
NON-CURRENT LIABILITIES
Trade and other payables
Long-term borrowings
Deferred tax liabilities
Long-term provisions
Other non-current liabilities
Share capital
Co-operative capital units
Total non-current liabilities
TOTAL LIABILITIES
NET ASSETS
EQUITY
Co-operative capital units
Other reserves
Retained earnings
Parent entity interest
Outside equity interest
TOTAL EQUITY
STATEMENT OF CHANGES IN EQUITY
Reserves
Balance at start of year
Adjustment on change in accounting policy and correction of errors (net of tax)
Revaluation of land and buildings (net of tax)
Available for sale financial assets (net of tax)
Transfers to retained earnings
Transfers from retained earnings
Other (net of tax)
Balance at end of year
Retained earnings
Balance at start of year
Adjustment on change in accounting policy and correction of errors (net of tax)
Net profit (loss) for the year
Transfers to reserves
Transfers from reserves
Dividends
Rebates and bonuses provided or paid
Balance at end of year
Net income recognised directly in equity
Profit (loss) for the year
Total recognised income and expense for the year
Attributable to:
Equity holders of parent
Minority interest

Co-operative name:

Annual report

INCOME STATEMENT

		Financial year ended 20	Last year 20
	$	$
Revenues
Expenses excluding finance costs
Finance costs
Share of net profits (losses) of associates
Profit (loss) before income tax
Income tax
Profit (loss) from continuing operations
Profit (loss) from discontinued operations
Profit (loss) for the year
Profit (loss) attributable to minority equity interest
Profit (loss) attributable to members of the parent equity

Notes to and forming part of the financial statements are attached

Yes □No □

Subject to any exemption granted by the Registrar, the following documents should be attached at the time of lodgment of this return:

(1) Auditors’ report (section 252 (1) (d))

(2) Directors’ report (section 252 (1) (d))

(3) Directors’ declaration (section 252 (1) (d))

(4) Accounts as submitted to the members (section 252 (1) (b))

(5) List of directors, principal executive officers and secretary (section 252 (1) (a) and Part B of this Form)

(6) Declarations of interest (section 234 (1) and Part C of this Form)

(7) Notice of Appointment or Cessation of Appointment of Directors and Officers (section 251B and Form AF11, supplied with this Form), if appropriate

Annual report

PART B

Co-operative No

Annual report

LIST OF DIRECTORS AND PRINCIPAL EXECUTIVE OFFICERS AND SECRETARY

Annual report

Co-operatives Act 1992 (Section 252 (1) (a))

Name of Co-operative

Ibeing *a director/*the principal executive officer/*the secretary of the abovenamed co-operative, give notice that the undermentioned persons:

*(1) are the directors of the co-operative as at the date of this annual report

*(2) are the directors ofa subsidiary of the co-operative as at the date of this annual report

Surname	Given names (in full)	Date of birth	Residential address	Office held	Date of appointment

*The secretary of the co-operative at the date of this annual report is

*The principal executive officer of the co-operative at the date of this annual report is

*The principal executive officer ofa subsidiary of the co-operative at the date of this annual report is

Has the address of the registered office changed?

*Yes/*No

If yes, the co-operative must lodge separate notification on the approved form.

If yes, specify new addressTelephone

Dated20

Signature

To the Registrar of Co-operatives
154 Russell Street
PO Box 22
BATHURST NSW 2795

* Strike out words not applicable

Annual report

Part C

Co-operative No

Annual report

DECLARATIONS OF INTEREST

Annual report

Co-operatives Act 1992 (Section 234)

Name of Co-operative

The declarations of interest listed below were made to the board of directors of the co-operative under section 234 of the Co-operatives Act 1992 during the financial year ended on20.

Surname of director	Given names (in full)	Date of declaration	Contract or proposed contract referred to in declaration	Nature of interest	Whether contract entered into by co-operative	Nature, character and extent of conflict-eg office or property held

Note: A co-operative must hold its annual general meetings (after the first annual general meeting) within 5 months after the close of the financial year of the co-operative (section 198 (2) (a) of the Co-operatives Act 1992 ).
This report (together with the documents listed at the end of Part A) must be sent to the Registrar of Co-operatives within 28 days after the annual general meeting of the co-operative (section 252 (2) (a) of the Co-operatives Act 1992 ). A late lodgment fee is payable if the report is sent after that time.

Dated20	Signature
	(Secretary, director or principal executive officer)

To the Registrar of Co-operatives
154 Russell Street
PO Box 22
BATHURST NSW 2795

Form 2 - Compulsory acquisition notice

(Clause 32)

Compulsory acquisition notice

Co-operatives Act 1992 (Section 360 (1))

1.

To: (name of dissenting shareholder)
of: (address of dissenting shareholder)

A. The transferee (insert name of person giving notice) on (insert date) made an offer to the holders of *shares in (insert name) Co-operative Limited/*shares included in a class of shares in (insert name) Co-operative Limited for the transfer of those shares to the transferee, not being an offer made under a scheme or contract to which Division 2 of Part 11 of the Co-operatives Act 1992 applies, and

B. The scheme or contract involving the transfer of those shares to the transferee was on or before (insert date) approved by the holders of at least 90% in nominal value of all the shares concerned, other than excluded shares, and

C. You are a dissenting shareholder.

2.

The transferee gives you notice under section 360 (1) of the Co-operatives Act 1992 that the transferee desires to acquire those shares held by you.

3.

You are entitled under section 360 (2) of the Co-operatives Act 1992 to ask the transferee, by written notice given to the transferee within one month after the day on which this notice is given, to give you a statement in writing of the names and addresses of all other dissenting shareholders as shown in the register of members.

*4.

You are entitled not later than the expiration of 28 days after the date on which this notice is given or 14 days after the date on which a statement is supplied to you under section 360 (2) of the Co-operatives Act 1992 , whichever is the later, to elect, by notice to the transferee, which of the alternative terms offered to the approving shareholders under the scheme or contract you prefer. The alternative terms are as follows: (insert details)

5.

Unless, on application made by you within 28 days after the date on which this notice is given or within 14 days after a statement is supplied to you under section 360 (2) of the Co-operatives Act 1992 , the Supreme Court otherwise orders, the transferee will be entitled and bound subject to section 360 (2) to acquire your shares:

(a) on the terms on which, under the scheme or contract, the shares of the approving shareholders are to be transferred to the transferee, or

(b) if alternative terms were offered:
(i) on the terms for which you have elected, or

(ii) if you have not so elected, on whichever of those terms the transferee determines unless the Supreme Court otherwise orders.

Dated20

(Signature of transferee)

* Strike out words not applicable

Form 3 - Notice to remaining shareholder

(Clause 33)

Notice to remaining shareholder

Co-operatives Act 1992 (Section 362 (1) (a))

1.

To: (name of remaining shareholder)
of: (address of remaining shareholder)

A. The transferee (insert name of person giving notice) on (insert date) made offers to the holders of *shares in (insert name of co-operative) Co-operative Limited/*shares included in a class of shares in (insert name of co-operative) Co-operative Limited for the transfer of those shares to the transferee, not being offers made under a scheme or contract to which Division 2 of Part 11 of the Co-operatives Act 1992 applies, and

B. Under the scheme or contract the transferee became on (insert date) beneficially entitled to shares in that co-operative which together with any other shares in that co-operative to which the transferee, or the transferee and any body corporate related to the transferee, is beneficially entitled, comprise or include 90% in nominal value of the shares concerned, and

C. You are the holder of remaining shares *in that co-operative/*included in that class of shares in that co-operative and have not assented to the scheme or contract or been given notice in respect of those shares by the transferee under section 360 (1) of the Co-operatives Act 1992 .

2.

The transferee gives you notice under section 362 (1) (a) of the Co-operatives Act 1992 that under that scheme or contract the transferee on (insert date) became beneficially entitled to shares in (insert name of co-operative) Limited and those shares together with any other shares in that co-operative to which the transferee, or the transferee and any body corporate related to the transferee, is beneficially entitled, comprise or include 90% in nominal value of the shares *in that co-operative/*included in that class of shares in that co-operative.

3.

You are entitled under section 362 (1) (b) of the Co-operatives Act 1992 within 3 months after being given this notice, by notice to the transferee to require the transferee to acquire your shares.

*4.

You are entitled under section 362 (1) (b) of the Co-operatives Act 1992 , within 3 months after being given this notice to elect by notice to the transferee which of the alternative terms offered to the approving shareholders under the scheme or contract you will accept. The alternative terms are as follows: (insert details)

5.

If you require the transferee to acquire the shares held by you, the transferee will be entitled and bound to acquire those shares:

(a) on the terms that under the scheme or contract were offered to the approving shareholders, or

(b) if alternative terms were offered:
(i) on the terms for which you have elected, or

(ii) if you do not so elect, on whichever of the terms the transferee determines, or

(c) on such other terms as are agreed or as the Supreme Court on the application of the transferee or of yourself orders.

Dated20

(Signature of transferee)

* Strike out words not applicable

Form 4 - Notice to appear, answer questions and produce documents

(Clause 40)

Notice to appear, answer questions and produce documents

Co-operatives Act 1992 (Section 375 (1))

To: (name of co-operative or person)

In relation to an inspection of (name of co-operative), you are required:

*(a) to produce to me on (date) at (time) at (full details of place) the documents specified in the Schedule to this notice relating to the co-operative, and

*(b) to attend on (date) at (time) before (name of inspector) at (full details of place) to answer any questions relating to the promotion, formation, membership, control, transactions, dealings, business or property of the co-operative.

Please note section 380 of the Co-operatives Act 1992 (relating to self-incrimination).

Notice to appear, answer questions and produce documents

SCHEDULE

Signed by the inspector

Date

* Strike out words not applicable

Form 5 - Investigator’s notice to involved person

(Clause 41)

Investigator’s notice to involved person

Co-operatives Act 1992 (Section 387 (1))

To: (name of involved person)

In relation to an inquiry into the affairs of (name of co-operative), you are required:

*(a) to produce to me on (date) at (time) at (full details of place) the documents referred to in the Schedule to this notice that are in your custody or control and that relate to the affairs of (name of co-operative),

*(b) to give all reasonable assistance in connection with the inquiry,

*(c) to appear on (date) at (time) before (name of investigator) at (full details of place) for examination on oath or affirmation.

Please note the provisions of section 388 (1) of the Co-operatives Act 1992 (relating to legal representation) and section 388 (2) and (3) of the Co-operatives Act 1992 (relating to self-incrimination).

Investigator’s notice to involved person

SCHEDULE

Signed by the investigator

Date

* Strike out words not applicable

Form 6 - Report as to affairs

(Clauses 51, 53 and 54)

lodging party or agent name
address
	state
telephone
facsimile
DX number	suburb/city

Registry of Co-operatives	Form 6
REPORT AS TO AFFAIRS	(Clauses 51, 53 and 54) Co-operatives Act 1992 (Sch 4, cll 6A (1), 14 (2) (b) and 15 (1))

Co-operative name

A.R.B.N. (if applicable)

Report as to affairs

Annexure Notes

• Wording required on the Annexure should read as follows:
“This is the annexure ofpages marked “A” referred to in the Statement Verifying Report signed by me*/us* and dated//(d/m/y)”
* delete one

• Signature/s are required on the Annexure of each person who signs the Statement Verifying Report

Report as to affairs

Reason for Report

tick one box	□ managing controller	clause 6A (1) of Schedule 4
	□ appointment of controller	clause 14 (2) (b) of Schedule 4
	□ appointment of controller	clause 15 (1) of Schedule 4

Report as to affairs

Assets and Liabilities

Date specified under the relevant section as the date of the report (see directions) / / (d/m/y)

	Valuation (for each entry show whether cost or net book amount)	Estimated Realisable values
	$	$
1. Assets not specifically charged-(a) Interests in land as detailed in Schedule A(b) Sundry debtors as detailed in Schedule B(c) Cash on hand(d) Cash at bank(e) Stock as detailed in annexed inventory(f) Work in progress as detailed in annexed inventory(g) Plant and equipment as detailed in annexed inventory(h) Other assets as detailed in Schedule C Sub Total
2. Assets subject to specific charges, as detailed in Schedule D Less amounts owing as detailed in Schedule D Total Assets Total estimated realizable values
3. Less payable in advance of secured creditor(s) Amounts owing for tax instalment deductions and prescribed payments tax Amounts owing for employee entitlements as detailed in Schedule E
4. Less amounts owing and secured by debenture or floating charge over assets
5. Less preferential claims ranking behind secured creditors, as detailed in Schedule F
6. Balances owing to partly secured creditors as detailed in Schedule G Total claims ($) Security held ($)
7. Creditors (unsecured) as detailed in Schedule H Amount claimed ($)
8. Contingent assets ($) Estimated to produce as detailed in Schedule I
9. Contingent liabilities ($) Estimated to rank as detailed in Schedule J□ Estimated deficiency or□ Estimated surplus□ Subject to costs of administration or□ Subject to costs of liquidationShare capital $ Issued $ Paid up $

Report as to affairs

Schedules

Report as to affairs

SCHEDULE A

Report as to affairs

INTERESTS IN LAND

Address and description of property	Valuation (1)	Estimated realizable value	Valuation for rating purposes	Particulars of tenancy	Where possession of deeds may be obtained	Short particulars of title
	$	$	$

Report as to affairs

SCHEDULE B

Report as to affairs

SUNDRY DEBTORS (INCLUDING LOAN DEBTORS)

Name and address of debtor	Amount owing	Amount realizable	Deficiency	Particulars of Security (if any) held	Explanation of deficiency
	$	$	$

Report as to affairs

SCHEDULE C

Report as to affairs

OTHER ASSETS

Description of deposit or investment	Cost	Amount Realizable
	$	$
Deposits
Investments

Report as to affairs

SCHEDULE D

Report as to affairs

ASSETS SUBJECT TO SPECIFIC CHARGES

Description of asset	Date charge given	Description of charge	Holder of charge	Terms of repayment	Valuation (1)	Estimated realizable value	Amount owing under charge
					$	$	$

Report as to affairs

SCHEDULE E

Report as to affairs

CLAIMS BY EMPLOYEES

Employee’s name and address	Wages	Holiday pay	Long service leave	Estimated liability
	$	$	$	$

Report as to affairs

SCHEDULE F

Report as to affairs

PREFERENTIAL CREDITORS (OTHER THAN THOSE DETAILED IN SCHEDULE E)

Name and address of preferential creditor	Description of amount owing	Amount owing
		$

Report as to affairs

SCHEDULE G

Report as to affairs

PARTLY SECURED CREDITORS

Name and address of creditor	Particulars of security held	Nature of security	Estimated value of security	Amount owing to creditor	Amount estimated to rank as unsecured
			$	$	$

Report as to affairs

SCHEDULE H

Report as to affairs

UNSECURED CREDITORS

Name and address of creditor	Amount claimed by creditor	Amount admitted as owing	Reasons for difference between amount claimed and admitted (if any)

Report as to affairs

SCHEDULE I

Report as to affairs

CONTINGENT ASSETS

Description of asset	Gross asset	Estimated to produce
	$	$

Report as to affairs

SCHEDULE J

Report as to affairs

CONTINGENT LIABILITIES

Name and address of creditor	Nature of liability	Gross liability	Estimated rank for
		$	$

Report as to affairs

Certification

I certify that the particulars contained in the above report as to affairs are true to the best of my knowledge and belief.

Dated thisday of20

(1) Indicate in respect of each entry whether cost or net book amount.

DIRECTIONS

1. This report is to be made as at the following dates:
(a) where prepared by the managing controller under clause 6A (1) of Schedule 4-a day not later than 30 days before the day when it is prepared,

(b) where submitted to a controller under clause 14 (2) (b) of Schedule 4-the control day,

(c) where submitted to the controller under clause 15 (1) (c) of Schedule 4-the date specified by the controller by notice.

2. Where this report is required under clause 15 (1) of Schedule 4, the report is to be verified by a statement in writing, in accordance with the form entitled “Statement Verifying Report”, by a person referred to in that subclause.

3. When a copy of this report is lodged with the Registrar of Co-operatives pursuant to clause 14 (2) (c) of Schedule 4, the report must be certified by the controller of the property of the Co-operative as a true copy of the original report.

Report as to affairs

Additional Requirements

Purpose for lodgment of copy of Statement Verifying Report
(tick appropriate box and complete date)

□ by the managing controller of property under clause 6A (2) of Schedule 4 (to be lodged within 2 months after the control day) if a receiver and manager-date of appointment (d/m/y)//
if a person who is in possession or has control of the property for the purpose of enforcing a charge date when person took control (d/m/y)//

□ by the controller of property under clause 14 (2) (c) of Schedule 4 (to be lodged within one (1) month after the receipt of the report date of receipt of report) (d/m/y)//

Send to	Annexures
Registry of Co-operatives & Associations PO Box 22 154 Russell Street BATHURST NSW 2795 or DX 3123 BATHURST	To make any annexure you must1. use A4 size paper of white or light pastel colour2. provide a margin of at least 10mm on all sides3. number the pages consecutively4. print or type in dark blue or black ink, so that the document is clearly legible when photocopied	5. identify the annexure with a mark such as A, B, C etc.6. endorse the annexure with the words The annexure (mark) of (number) pages referred to in Form (form number and title)7. sign and date the formThis annexure must be signed by same person(s) who signed the form.

Form 7 - Notification that a person has been appointed controller/entered into possession etc.

(Clause 52)

lodging party or agent name
address
	state
telephone
facsimile
DX number	suburb/city

Registry of Co-operatives	Form 7
Notification that a person has been appointed controller/entered into possession etc.	(Clause 52 (1)) Co-operatives Act 1992 (Sch 4, clauses 12 (1) (a), (2) (a) and (3) (a))

	co-operative in respect of which the controller was appointed/entered into possession etc.
Co-operative name
A.R.B.N. (if applicable)
This notice is being given by	□ the person who obtained an order for the appointment of, or who appointed, the receiver under clause 12 (1) of Schedule 4□ the appointee of the controller under clause 12 (2) (a) of Schedule 4□ the controller under clause 12 (3) (a) of Schedule 4
	Details of the appointment/entry into possession etc.
(tick one box)	□ receiver of the property described in the schedule to this form□ receiver & manager of the property described in the schedule to this form□ controller (other than a receiver or managing controller) of the property described in the schedule to this form□ managing controller (other than a receiver and manager) of the property described in the schedule to this form
□ appointment by court order
court	□ Federal Court of Australia (give State or Territory registry)
	□ Family Court of Australia (give State or Territory registry)
	□ Supreme Court of (give State or Territory)
	□ Other (specify)
date of obtaining order	//proceeding matter numberyear
□ appointment by or under instrument
	date of appointment/entry into possession etc. (d/m/y)//
	date of instrument (d/m/y)//
description of instrument

(tick one of the following boxes)
	□ Register of co-operative charges	registered charge number
instrument is registered in	□ Australian register of company charges	registered charge number
	□ register of company charges of State or Territory (give State or Territory)	registered charge number
instrument not registered	□

	Details of the person(s) appointed
name (surname & given names)
at the office of
office, floor, building name
street number & name
suburb/city	statepostcode
country (if not Australia)
type of appointment	□ appointed singly□ appointed jointly□ appointed jointly and severally
name (surname & given names)
at the office of
office, floor, building name
street number & name
suburb/city	statepostcode
country (if not Australia)
type of appointment	□ appointed singly□ appointed jointly□ appointed jointly and severally

Notification that a person has been appointed controller/entered into possession etc.

Signature

This form must be signed by

(a) where the form is lodged for the purposes of clause 12 (1) (a) or (2) (a) of Schedule 4, by the person who obtains an order for the appointment of, or who appoints, the controller, or

(b) where the form is lodged for the purposes of clause 12 (3) (a) of Schedule 4, by the controller.

print name	name of corporation (if applicable)
capacity	□ director□ secretary□ principal executive officer
sign here	date//

Notification that a person has been appointed controller/entered into possession etc.

Schedule of property

Notification that a person has been appointed controller/entered into possession etc.

(if insufficient space) Further details are enclosed in the annexure marked (

Send to	Annexures
Registry of Co-operatives & Associations PO Box 22 154 Russell Street BATHURST NSW 2795 or DX 3123 BATHURST	To make any annexure you must1. use A4 size paper of white or light pastel colour2. provide a margin of at least 10mm on all sides3. number the pages consecutively4. print or type in dark blue or black ink, so that the document is clearly legible when photocopied	5. identify the annexure with a mark such as A, B, C etc.6. endorse the annexure with the words The annexure (mark) of (number) pages referred to in Form (form number and title)7. sign and date the formThis annexure must be signed by same person(s) who signed the form.

Form 8 - Notification of appointment or cessation as an external administrator

(Clause 52)

lodging party or agent name
address
	state
telephone
facsimile
DX number	suburb/city

Registry of Co-operatives	Form 8
Notification of appointment or cessation as an external administrator	(Clause 52 (2) and (3)) Co-operatives Act 1992 (Sch 4, clause 12 (4) and (6) (a))

Co-operative name

A.R.B.N. (if applicable)

Notification of appointment or cessation as an external administrator

Details of person(s) appointed

name (surname & given names)
at the office of
office, floor, building name
street number and name
suburb/city	statepostcode
country (if not Australia)
type of appointment	□ appointed singly□ appointed jointly□ appointed jointly and severally
name (surname & given names)
at the office of
office, floor, building name
street number and name
suburb/city	statepostcode
country (if not Australia)
type of appointment	□ appointed singly□ appointed jointly□ appointed jointly and severally
Appointment
type of administrator
(tick one box)	□ administrator of a compromise or arrangement□ receiver of the property described in the schedule of property to this form□ receiver & manager of the property described in the schedule of property to this form□ managing controller (other than a receiver & manager) of the property described in the schedule of property to this form□ controller (other than a receiver or managing controller) of the property described in the schedule of property to this form□ administrator of a co-operative under administration□ administrator of a deed of company arrangement□ liquidator in a winding up by Court□ liquidator in a voluntary winding up by members□ liquidator in a voluntary winding up by creditors□ provisional liquidator
method of appointment
□ appointment by court order	□ Federal Court of Australia (give State or Territory registry)
	□ Family Court of Australia (give State or Territory registry)
	□ Supreme Court of (give State or Territory registry)
	□ Other (specify)
date of obtaining order (d/m/y)	//proceeding matter numberyear
□ appointment by or under instrument
date of appointment (d/m/y)	//date of instrument (d/m/y)//
description of instrument

(tick one of the following boxes)
instrument is registered in	□ Register of co-operative charges	registered charge number
	□ Australian register of company charges	registered charge number
	□ register of company charges of State or Territory (give State or Territory)	registered charge number
instrument not registered	□ name of appointer

□ by company by writing under its common seal

□ by liquidator or provisional liquidator

	Cessation, resignation or removal
	(If a controller, show details of method of appointment above)
□ cessation of administrator of compromise or arrangement	date (d/m/y)//
□ cessation of receiver	date (d/m/y)//
□ cessation of receiver & manager	date (d/m/y)//
□ cessation of managing controller (other than receiver & manager)	date (d/m/y)//
□ cessation of controller (other than receiver or managing controller)	date (d/m/y)//
□ cessation, resignation or removal of administrator of a co-operative under administration	date (d/m/y)//
□ cessation, resignation or removal of administrator of deed of company arrangement	date (d/m/y)//
□ resignation or removal of liquidator	date (d/m/y)//
□ resignation or removal of provisional liquidator	date (d/m/y)//

Notification of appointment or cessation as an external administrator

Signature

This form must be signed by the external administrator

print name
sign here	date//

Notification of appointment or cessation as an external administrator

Schedule of property

Notification of appointment or cessation as an external administrator

(if insufficient space) Further details are enclosed in the annexure marked (

Notification of appointment or cessation as an external administrator

Additional information requirements

If this notice is lodged to notify the cessation, resignation, removal of an external administrator or where an administrator has been appointed to replace a currently appointed person or persons, please show below the details of the person or persons who have resigned etc. If joint administrators, show only the names of the person or persons who have resigned etc.

name
name
name

If one of the following administrators, please tick appropriate box and complete date of appointment of the person(s) who have ceased etc.

□ receiver	appointment date (d/m/y)//
□ receiver and manager	appointment date (d/m/y)//
□ managing controller (other than a receiver & manager)	appointment date (d/m/y)//
□ controller (other than a receiver or managing controller)	appointment date (d/m/y)//

Please note that failure to supply this information may result in the rejection of this document.

Send to	Annexures
Registry of Co-operatives & Associations PO Box 22 154 Russell Street BATHURST NSW 2795 or DX 3123 BATHURST	To make any annexure you must1. use A4 size paper of white or light pastel colour2. provide a margin of at least 10mm on all sides3. number the pages consecutively4. print or type in dark blue or black ink, so that the document is clearly legible when photocopied	5. identify the annexure with a mark such as A, B, C etc.6. endorse the annexure with the words The annexure (mark) of (number) pages referred to in Form (form number and title)7. sign and date the formThis annexure must be signed by same person(s) who signed the form.

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