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Transaction reference:

1-44ERXE7

Australian Securities &


Investments Commission

Apply for a business name


Record of online transaction

1 Lodgement details
Given name Oliver

Other given
Hugo
names

Family name Peterson


Telephone number
Email
admin@maclifesaver.com.au
address
Date submitted 03/12/2013
DD/MM/YYYY

2 Proposed business name


What business name would the proposed business name holder like to register?

Fix Your Crack


Transfer of business name

Consent to
transfer number

3 Registration period and fees


X

1 year
3 years

4 Proposed business name holder type


X

Individual (sole trader).


Company (with an ACN) or registered body (with an ARBN).
An organisation that is an incorporated body (without an ACN or ARBN), a trust, a
superannuation fund or an unincorporated body.
Partnership or joint venture with an ABN.
Joint venture with an ABN for each of the joint venture partners.
Entity that carries on business exclusively on Christmas Island or the Cocos (Keeling) Islands and
does not have an ABN.

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5 Details of a proposed business name holder that is an individual


Australian Business
14647099508
Number (ABN)

or

Given name OLIVER

ABN
application
reference
number
Other given
HUGO
names

Family name PETERSON


Birth details
Date 17/10/1974
DD/MM/YYYY
City /
Mulumbimby
Suburb

State /
Country NSW Australia

Residential address
Building/Property
name
Floor/Level
Street number 11
Suburb/City Mullumbimby

Unit/Office
Street
Whian St
name
State/
Territory

NSW

Postcode

2482

Country Australia

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12 Details of addresses
Address for service of
documents
Building/Property
name
Floor/Level

Unit/Office
Street
Whian St
name

Street number 11

Suburb/City Mullumbimby

Principal place of business

State/
NSW
Territory

Postcode 2482

Building/Property
name
Floor/Level

Unit/Office
Street
Bay Vista Lane
name

Street number 42

Suburb/City Ewingsdale

State/
NSW
Territory

Postcode 2481

If the proposed business name holder is an individual, is this address the same as the
individual's residential address?
Yes

Email address

No

Email address admin@maclifesaver.com.au

SMS

SMS

13 Attachments

Declarations
Declare

Declaration:
X

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This transaction is submitted for lodgement under, and is compliant with, the terms and conditions of the ASIC
Electronic Lodgement Protocol.
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To the best of my knowledge, the information supplied in this transaction is complete and accurate (it is an offence
to provide false or misleading information to ASIC).

I am the applicant (proposed business name holder); or

Authority:

I am lodging this application on behalf of the applicant (the proposed business name holder) and am authorised to;
-

Submit this application for lodgement on behalf of the applicant under the terms and conditions of
the ASIC Electronic Lodgement Protocol.
Make each of the above declarations on behalf of the applicant after making all due and proper
enquiries.

We may contact the applicant or lodging party if we have any questions regarding this application for registration of a business name.

Name of person signing and


Oliver Hugo Peterson
making declaration
Date signed

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03/12/2013

(DD/MM/YYYY)

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