| Name of NTER entity: |
| ............................................... |
| ................................................ |
| Australian Business Number: |
| ............................................... |
| Postal address for service of notices (include e-mail address where applicable): |
| ............................................... |
| ............................................... |
| Address of place of central management: |
| ............................................... |
| ............................................... |
| Name and contact details of public officer or principal accounting officer: |
| ............................................... |
| ............................................... |
| ANZSIC Code and description of principal business activity: |
| ............................................... |
| ............................................... |
| Tax equivalent year end: _ _ (day) of _ _ _ _ _ _ _ _ _ _ (month) |
|
Entity's NTER commencement date:
...................... |
