A5
Form 705

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

CHANGE OF PUBLIC OFFICER PARTICULARS

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

1. ASSOCIATION NAME AND NUMBER
     	Inc.	A	     	

2.  TYPE AND DATE OF CHANGE
If a new public officer has been appointed, place a 'X' here:		and the date of appointment here:	     	
If the current public officer's details have changed, place a 'X' here:		and the date of change here:	     	

3.  FULL NAME AND RESIDENTIAL ADDRESS OF PUBLIC OFFICER (must be 18 years or older and a resident of the ACT)

4.  OTHER CONTACT DETAILS OF PUBLIC OFFICER (if applicable)
Preferred Postal Address	     	
E-mail Address	     	Telephone (BH)	     	

5.  STATEMENT BY PUBLIC OFFICER 			
As the public officer of this association, I confirm that all of the particulars shown on this form are true and correct, that I have read the ''Important Information' below and 'Privacy Statement' shown overleaf, and that I am eligible to hold the position of public officer under the Act.	
							
	Signature		Name		Date		

IMPORTANT INFORMATION

The public officer is responsible for acting as a point of contact between the association and the community, and is expected to be able to represent the association in dealings with this office under the Associations Incorporation Act 1991 (the Act) and the Associations Incorporation Regulation 1991  (the Regulation).  Section 57 of the Act requires that the public officer be at least 18 years of age and be a resident of the ACT.  In turn, it will be necessary to provide the full ACT residential address of the public officer.  Section 122 of the Act provides for service on an incorporated association of a document or process by leaving it at, or sending it by post to, the address of the public officer.  

The Act prohibits any person from serving as the public officer 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 the public officer.  For more information or to conduct a search, visit the ITSA website at www.itsa.gov.au.  

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.

LOCATION
255 Canberra Avenue
Fyshwick   ACT   2609

OFFICE HOURS
9.00am 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