BP
Form 500

Please fill out these contact details to facilitate communication if necessary. 
Name:
Address:
E-mail: 
Telephone (BH):

PARTICULARS OF BUSINESS NAME

		 PRIVACY COLLECTION STATEMENT and IMPORTANT INFORMATION OVERLEAF 

THIS FORM MAY BE USED TO APPLY FOR A NEW BUSINESS NAME OR TO CHANGE THE PARTICULARS OF AN EXISTING BUSINESS NAME. TICK THE APPROPRIATE BOX AND COMPLETE ALL SECTIONS BELOW.  FEES ARE PAYABLE FOR ALL LODGEMENTS.
	New Registration	
	Change of Particulars 	

1. BUSINESS NAME (if applying to register a new business name, complete in order of preference, otherwise show registered business name at 1(a).)
 (a)		(c)		
 (b)		(d)		

In determining whether a name is available for registration, a search is not made of trade marks registered under the Trade Marks Act 1995 (Commonwealth).  No responsibility is accepted for registration of a name  which might infringe upon proprietary rights acquired by registration of a trade mark. Inquiries should be directed to IP Australia.

2.  DATE OF COMMENCEMENT
    (complete only if new business name – not     more than 2 months after lodgement)

   3.  DATE OF CHANGE
    (complete only if changing particulars)

	
  4.  REGISTERED BUSINESS NUMBER
(leave blank if applying to register a new business name)

F		

5. NATURE OF BUSINESS (describe the goods sold or services provided by the business, and attach supporting documents if required – see overleaf)

6. PRINCIPAL PLACE OF BUSINESS IN THE A.C.T.  
Must be a street address in the A.C.T. (if the business trades from additional places of business in the A.C.T. attach annexure listing additional addresses)	

7. POSTAL ADDRESS (may be outside the A.C.T)

8. NAME AND PARTICULARS OF EACH PROPRIETOR   
(If all proprietors live outside the A.C.T., a resident agent will need to be nominated – see overleaf)
FULL PERSONAL NAME OR CORPORATE NAME & ACN	RESIDENTIAL ADDRESS OR REGISTERED OFFICE OF CORPORATION	DATE OF BIRTH (IF UNDER 18)	

			
			
9. RESIDENT AGENT  (if all proprietors reside outside the ACT, an agent who is resident in the ACT must be appointed. This requirement also applies to corporations registered with the Australian Securities and Investments Commission (ASIC) under Corporations Act 2001.)
FULL PERSONAL NAME OR CORPORATE NAME & ACN	RESIDENTIAL ADDRESS OR REGISTERED OFFICE OF CORPORATION	DATE OF BIRTH (IF UNDER 18)	

Cheques Payable to the Registrar-General                                                                                                          Please Turn Over

CREDIT CARD PARTICULARS

		Bankcard	

Card Number:					
	Mastercard	

	Visa	

	Card Expiry Date	

							/			

Name of Cardholder:		Signature of Cardholder:		Amount: $		

10. NAME AND PARTICULARS OF EACH OUTGOING PROPRIETOR    (Only complete if changing the particulars of proprietor/s)
FULL PERSONAL NAME OR CORPORATE NAME & ACN	RESIDENTIAL ADDRESS OR REGISTERED OFFICE OF CORPORATION	

11. SIGNATURE/S 	(All proprietors (including any outgoing proprietors) and resident agent, where applicable, must sign and print their name/s.  In the case of
	corporations, an authorised signatory may sign).
					
	(signature and name of signatory)		(signature and name of signatory)		
					
	(signature and name of signatory)		(signature and name of signatory)		

WARNING

No expense should be incurred in relation to the use of the proposed name until a certificate of registration has been received by the applicant.

If you register a name consisting of only generic or generally used words you are advised that another name may be registered containing those same words, prefixed of suffixed by a distinguishing word or words e.g. Computer Installations would not preclude the registration of the name A.B. Computer Installations by another party.

There is no provision in the Business Names Act 1963 to change a business name once registered.  Where a change to a business name is required, it will be necessary to lodge a separate application to register the new name.

IMPORTANT INFORMATION

Proprietors -The proprietors are held accountable for the operation of the business trading under the registered business name, and for ensuring that the business operates in compliance with applicable laws, including the Business Names Act 1963 (the Act) and the Business Names Regulation 1963  (the Regulation).  

Trusts and Trustees - Where a person or corporation is acting in this capacity as a trustee, the trustee, not the trust, will be deemed to be the proprietor for the purposes of the Act.

Qualifications - Where the proprietors of a business name are individual persons whose nature of business includes the provision of professional services which may only be carried out by persons holding specific qualifications (barrister, solicitor, veterinarian, architect or a medical professional), the Registrar-General will require a copy of the qualification or proof of endorsement to accompany the application. 

Franchises - Registration of a business name as part of a franchise agreement or under licence will require written consent to the registration to be provided by the holder of the franchise or licence.  Letters of consent must be issued on the letterhead of the franchise/licence holder, and identify both the business name to be registered and the proprietor(s) authorised to trade under that business name.  The business name will still be subject to an examination for availability under the Act. 

Resident Agent - The residential address of individual proprietors must be provided as Section 8 of the Act provides that where all proprietors of the business are individual persons who reside outside the ACT, a resident agent must be appointed.  This requirement also applies where all proprietors of the business are individuals of no fixed address, or where the proprietor is a body corporate or government agency established under the laws of another State or Territory.  

PRIVACY STATEMENT

The Act authorises the Registrar-General to collect the information required by this form for the purpose of establishing and maintaining the public register of business names registered under the Act.  The public register is available for search pursuant to Section 22 and 23 of the Act, and is also made available to government agencies for statistical and administrative purposes, and to non-government persons and organisations. 

LOCATION
B1 Level, Allara House, 
50 Allara Street, 
CANBERRA CITY
	CONTACT NUMBERS
Phone	(02) 62070435 or 
	(02) 62070474  
Fax 	(02) 62070487	
OFFICE HOURS
8.30am to 4.30pm Monday to Friday
(excluding public holidays)
	POSTAL ADDRESS
PO Box 225
CIVIC SQUARE   ACT   2608