A9
Form 709

Lodged By:
Name:
Address:
E-mail: 
Telephone (BH):

CHANGE OF COMMITTEE PARTICULARS

		 PRIVACY COLLECTION STATEMENT (PRIVACY ACT 1988 (C’WLTH)) OVERLEAF 

NOTE: IF THE PUBLIC OFFICER IS ON THE COMMITTEE OF THE ASSOCIATION, CHANGES TO THE PARTICULARS OF THAT OFFICER ALSO REQUIRE THE LODGEMENT OF A "CHANGE OF PUBLIC OFFICER PARTICULARS" FORM.  

1. ASSOCIATION NAME AND NUMBER
     	
     	Inc.	A	     	
 
This form must be completed with the full particulars of the committee, including the status of each committee member ('New', 'Continuing', 'Change of Address', 'Resigned', 'Dismissed' or 'Deceased' as applicable). Vacant positions must also be identified, with the date of vacancy shown.  If an officer holds more than one position, complete separate rows unless the status and date of change for each position is the same.	

2. PARTICULARS OF COMMITTEE (if insufficient space, use additional table 2 overleaf or attach list with remaining information) 
Position	Full Name and Residential Address	Status	Date of Change	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	

3.  STATEMENT BY COMMITTEE MEMBER (must be completed by one of the committee members listed at Item 2)
As a current committee member of this association, I confirm that the information shown on this form is true and correct and that I have read the 'Privacy Statement' below and 'Important Information' shown overleaf.	
							
	Signature		Name		Date		

2. PARTICULARS OF COMMITTEE (CONT.)  
Position	Full Name and Residential Address	Status	Date of Change	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	

PRIVACY STATEMENT

Section 9 of the Associations Incorporations Act 1991 provides for the Registrar-General to collect the information for the purpose of establishing and maintaining the register of incorporated associations.  The register is available for search pursuant to Section 11 of the Act, to any person upon payment of a fee.  The register is also made available to a range of government agencies for law enforcement, administrative and statistical purposes.

IMPORTANT INFORMATION

The committee members are held accountable for ensuring that the association operates in compliance with applicable laws, including the Associations Incorporation Act 1991 (the Act) and the Associations Incorporation Regulation 1991  (the Regulation).  The residential address of the committee members should be provided as Section 122 of the Act provides for service on an incorporated association of a document or process by serving it personally on a member of the committee of the association. 

The Act prohibits any person from serving as a committee member if he/she is insolvent or bankrupt, without leave from the ACT Supreme Court under S.63 of the Act.  A search should be conducted of the records held by the Insolvency and Trustee Service Australia (ITSA) before accepting the nomination of a person as a committee member.  For more information or to conduct a search, visit the ITSA website at www.itsa.gov.au. Further information on the obligations of incorporated associations can be found in the Associations Kit available from the Registrar-General's Office, and on-line at www.rgo.act.gov.au. 

LOCATION
255 Canberra Avenue
Fyshwick   ACT   2609

OFFICE HOURS
8.30am to 4.30pm Monday to Friday
(excluding public holidays)

CONTACT NUMBERS
Phone	(02) 62070435 or 
	(02) 62070474  
Fax 	(02) 62070487

POSTAL ADDRESS
PO Box 225
CIVIC SQUARE   ACT   2608