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1
Application details
2
Trading information
3
Principal Business contact information
4
Complaint Handling contact information
5
Accounts contact information
6
Privacy information
Application details
Company name
*
*
Must match company name registered with ASIC under ACN
ACN
*
Trust/Sole trader name
*
ABN
*
Trading names/Brands
*
*
By which customers may know this entity
Type of organisation
*
e.g. sole trader, partnership, public company etc
ACMA licence
*
Does the Applicant hold a carrier licence issued by the Australian Communications and Media Authority?
ACMA licence
Yes
ACMA licence
No
Provide the date of issue
*
Registered address
*
*
Unit number (Registered)
*
Street Number (Registered)
*
Street number and name
*
Global address key (Registered)
*
Suburb or town
*
State
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Postcode
*
Ultimate holding company if applicable
*
A group or holding company that owns the company applying
Has the applicant previously traded under another name?
Has the applicant previously traded under another name?
Yes
Has the applicant previously traded under another name?
No
Previous trading name
*
Date trading ended under this name
*
Postal address is the same as the registered address
*
Postal address is the same as the registered address
Yes
Postal address is the same as the registered address
No
Postal address
*
*
Address unit number (Postal)
*
Adress street number (Postal)
*
Street number and name
*
Suburb
*
State
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Postcode
*
Company postal address validation global key
*
Website
*
*
Public email
*
*
*
Customer service number
*
*
