REGISTRATION APPLICATION
AFFORDABLE AND COMMUNITY HOUSING PROVIDER IN THE AUSTRALIAN CAPITAL TERRITORY
Housing Assistance Act 2007, s 39 AF2009-233

Organisation Details
Provider Name:		
Trading Name:		
Australian Business Name (ABN):		
Australian Tax Office status:  
(Public Benevolent Institution, Income Tax Exempt Charity, Deductable Gift Recipient)		
Address of Registered Office:
		
Postal Address:
		
Type of Incorporation:(e.g. Incorporated Association / Company)		
Number of residential housing properties managed (including properties to which the organisation has title):		
Please attach Constitution/ Rules	
		
Nominated Contact Person:		
Position:		
Address:		
Telephone number:		
Mobile number:		
Fax number:		
Email address:		
 
Registration Tier		
Tier of Registration Sought:	Tier 1: Affordable Housing Provider             
                      
                          OR                              (Please tick only one) 

Tier 2: Community Housing Provider            

DECLARATION 

<Provider name> is seeking to register as a/n Affordable Housing Provider or Community Housing Provider (please strikeout whichever does not apply). The Board of Management of <Provider name> affirms that it is their held belief that <Provider name> is eligible to register under this Tier.

The Board of Management / Management Committee of <Provider name> is willing to engage with the  
Office of Registrar and participate in the assessment process.

SIGNED		______________________________ 		________________
			Chair or Delegate of Board/Management Committee	Date 
	
			______________________________
Name of Signatory						

Please Affix Common Seal 					    

HOW TO SUBMIT AN APPLICATION

The Board of Management / Management Committee is required to sign and declare this application under common seal by the authorised signatories for the organisation.

An application along with supporting evidence must be made using this form and be lodged by mail and addressed to: Office of Registrar – Not for Profit Housing Providers, Locked Bag 8000, Canberra ACT 2601, or scanned and lodged electronically to Housing.RegistrarNFP@act.gov.au.

    Office of Registrar use only:

________________________ 
Signature receiving officer

________________________
Name of signatory
______________________
Date