New South Wales Repealed Regulations New South Wales Repealed RegulationsThis legislation has been repealed.
(Clause 19)
Part A
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 19 | Last year 19 | Financial year ended 19 | Last year 19 | |||||
| ANZSIC | % | ANZSIC | % | LGA | % | LGA | % | |
| Financial year ended 19 | Last year 19 | |||
| 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 the Co-operation (Accounts and Audit) Regulation 1988 or clause 15 of the Co-operatives Regulation 1997 ? | Yes/No | ||
| If yes, please specify details |
Note: * May be signed by secretary, director or principal executive officer
Co-operative name:
Financial year ended:
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 | ||||||
| Sub-total | ||||||
| Forfeiture | ||||||
| Re-purchase non-active | ||||||
| Re-purchase active | ||||||
| Transfers | ||||||
| Sub-total | ||||||
| Balance at end of year |
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 | ||||||
| Sub-total | ||||||
| Repayment | ||||||
| Transfers | ||||||
| Sub-total | ||||||
| Balance at end of year |
Co-operative name:
BALANCE SHEET
| Financial year ended 19 | Last year 19 | ||
| $ | $ | ||
| CURRENT ASSETS | |||
| Cash | |||
| Receivables | |||
| Investments | |||
| Inventories | |||
| Other | |||
| Total current assets | |||
| NON-CURRENT ASSETS | |||
| Receivables | |||
| Investments | |||
| Inventories | |||
| Property, plant & equipment | |||
| Intangibles | |||
| Other | |||
| Total non-current assets | |||
| TOTAL ASSETS | |||
| CURRENT LIABILITIES | |||
| Creditors and borrowings | |||
| Provisions | |||
| Other | |||
| Total current liabilities | |||
| NON-CURRENT LIABILITIES | |||
| Creditors and borrowings | |||
| Provisions | |||
| Other | |||
| Total non-current liabilities | |||
| TOTAL LIABILITIES | |||
| NET ASSETS | |||
| SHAREHOLDERS EQUITY | |||
| Share capital | |||
| Reserves | |||
| Retained profits or accumulated losses | |||
| Shareholders’ equity attributable to members of the chief entity within the meaning of the | |||
| Outside equity shareholders’ interest in controlled entities | |||
| TOTAL SHAREHOLDERS’ EQUITY |
Co-operative name:
PROFIT & LOSS ACCOUNT
| Financial year ended 19 | Last year 19 | ||
| $ | $ | ||
| Operating profit and loss | |||
| Income tax attributable to operating profit or loss | |||
| Operating profit or loss after income tax | |||
| Profit or loss on extraordinary items | |||
| Income tax attributable to profit or loss on extraordinary items | |||
| Profit or loss on extraordinary items after income tax | |||
| Operating profit or loss and extraordinary items after income tax | |||
| Outside equity interests in operating profit or loss and extraordinary items after income tax | |||
| Operating profit or loss and extraordinary items after income tax attributable to members of the chief entity within the meaning of the Corporations Law | |||
| Retained profits or accumulated losses at the beginning of the financial year | |||
| Aggregate of amounts transferred from reserves | |||
| Total available for appropriation | |||
| Dividends provided for or paid | |||
| Rebates and bonuses provided for or paid | |||
| Aggregates of amounts transferred to reserves | |||
| Other appropriations | |||
| Retained profits or accumulated losses at the end of the financial year |
| 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’ or directors’ report (section 252 (1) (d))
(2) Directors’ statement (section 301 of the Corporations Law as adopted by clause 15)
(3) Accounts as submitted to the members (section 252 (1) (b))
(4) List of directors and principal executive officers (section 252 (1) (a) and Part B of this Form)
(5) Declarations of interest (section 234 (1) and Part C of this Form)
PART B
Co-operative No
LIST OF DIRECTORS AND PRINCIPAL EXECUTIVE OFFICERS
Co-operatives Act 1992 (Section 252 (1) (a))
Name of Co-operative
Ibeing *a director/*the principal executive officer/*a 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 the date of this annual report
| Surname | Given names (in full) | Date of birth | Residential address | Office held | Date of appointment |
*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, specify new address(Telephone)
| Dated19 | (Signature) |
To the Registrar of Co-operatives
PO Box 3035
BANKSTOWN 2200
Note: * Strike out words not applicable
Part C
Co-operative No
DECLARATIONS OF INTEREST
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 on19.
| 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 ) unless further time is allowed under section 198 (2) (b).
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.
(Clause 32)
Co-operatives Act 1992 (Section 360 (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.
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.
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.
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)
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.
Dated19
(Signature of transferee)
Note: * Strike out words not applicable
(Clause 33)
Co-operatives Act 1992 (Section 362 (1) (a))
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 .
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.
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.
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)
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.
Dated19
(Signature of transferee)
Note: * Strike out words not applicable
(Clause 40)
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 Act (relating to self-incrimination).
SCHEDULE
Signed by the inspector
Date
Note: * Strike out words not applicable
(Clause 41)
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 Act (relating to legal representation) and section 388 (2) and (3) of the Act (relating to self-incrimination).
SCHEDULE
Signed by the investigator
Date
Note: * Strike out words not applicable
| 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)
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)”Note: * delete one
• Signature/s are required on the Annexure of each person who signs the Statement Verifying Report
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 |
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 1 | ||
| 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 $ |
Schedules
SCHEDULE A
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 |
| $ | $ | $ | ||||
SCHEDULE B
SUNDRY DEBTORS (INCLUDING LOAN DEBTORS)
| Name and address of debtor | Amount owing | Amount realizable | Deficiency | Particulars of Security (if any) held | Explanation of deficiency |
| $ | $ | $ | |||
SCHEDULE C
OTHER ASSETS
| Description of deposit or investment | Cost | Amount Realizable |
| $ | $ | |
| Deposits | ||
| Investments |
SCHEDULE D
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 |
| $ | $ | $ | |||||
SCHEDULE E
CLAIMS BY EMPLOYEES
| Employee’s name and address | Wages | Holiday pay | Long service leave | Estimated liability |
| $ | $ | $ | $ | |
SCHEDULE F
PREFERENTIAL CREDITORS (OTHER THAN THOSE DETAILED IN SCHEDULE E)
| Name and address of preferential creditor | Description of amount owing | Amount owing |
| $ | ||
SCHEDULE G
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 |
| $ | $ | $ | |||
SCHEDULE H
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) |
SCHEDULE I
CONTINGENT ASSETS
| Description of asset | Gross asset | Estimated to produce |
| $ | $ | |
SCHEDULE J
CONTINGENT LIABILITIES
| Name and address of creditor | Nature of liability | Gross liability | Estimated rank for |
| $ | $ | ||
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 of19
Note: (1) Indicate in respect of each entry whether cost or net book amount.
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.
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 Bankstown Civic Tower Level 8 66-72 Rickard Road BANKSTOWN 2200 or P.O.Box 3035 BANKSTOWN 2200 | 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. |
| 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 |
Signature
This form must be signed by
(a) where the form is lodged for the purposes of clause 12(1)(a) or clause 12(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// |
Schedule of property
| (if insufficient space) Further details are enclosed in the annexure marked () of () pages |
| Send to | Annexures | |
| Registry of Co-operatives Bankstown Civic Tower Level 8 66-72 Rickard Road BANKSTOWN 2200 or P.O.Box 3035 BANKSTOWN 2200 | 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. |
| 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)
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)// |
Signature
This form must be signed by the external administrator
| print name | ||
| sign here | date// | |
Schedule of property
| (if insufficient space) Further details are enclosed in the annexure marked () of () pages |
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 Bankstown Civic Tower Level 8 66-72 Rickard Road BANKSTOWN 2200 or P.O.Box 3035 BANKSTOWN 2200 | 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. |