Form 12	Notice of appointment of provisional liquidator
Court Procedures Rules 2006
(see sch 6 r 6.2 (Notice of appointment of provisional liquidator))
In the Supreme Court of the Australian Capital Territory

No SC		of (year) 
In the matter of (name of company to which proceeding relates)
ACN: (ACN of company to which proceeding relates)

On (date), in proceeding No SC (insert number) of (year), heard by the Supreme Court, I was appointed as the provisional liquidator of the company.

Date:
Name and address of provisional liquidator: (name and address).