Signature of witness. Address of Witness
Signature of witness. Date .......................................................... ▶ Statement by the person taking consent – when it is read I have accurately read out the explanatory letter and State School Consent Form to the potential consenter, and to the best of my ability made sure that the person understands that the following will be done:
Signature of witness. Signature .......................................................................
Signature of witness. Name of witness (print) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature of authorised person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Signature of witness. Name of witness (print) ......................................................................................Name of officer (print) ......................................................................................
Signature of witness. Note: 1) Failure to complete the declaration will lead to the rejection of a claim for a preference.
Signature of witness. OCCUPATION ..............................................
Signature of witness. Name of witness (block letters) .......................................................................... By executing this agreement the attorney states that the attorney has received no notice of revocation of the power of attorney <<Choice 7: Company Execution Clause – 2 directors / 1 director and 1 secretary>> EXECUTED by <company name (Uppercase)> <<Mandatory Sub-Choice: Insert ABN or ACN>> <<Sub-Choice 7a: ABN>> ABN <ABN number> <<Sub-Choice 7b: ACN>> ACN <ACN number> <<End Sub-Choice>> <<Sub- Choice: Insert if the company is acting as trustee>> as trustee for <name of trust> <<End Sub-Choice>>: .......................................................................... Signature of director .......................................................................... Name of director (block letters) ......................................................................................... Signature of director/secretary .......................................................................... Name of director/secretary (block letters) <<Choice 8: Company Execution Clause – sole director/sole secretary>> EXECUTED by <company name (Uppercase)> <<Mandatory Sub-Choice: Insert ABN or ACN>> <<Sub-Choice 8a: ABN>> ABN <ABN number> <<Sub-Choice 8b: ACN>> ACN <ACN number> <<End Sub-Choice>> <<Sub- Choice: Insert if the company is acting as trustee>> as trustee for <name of trust> <<End Sub-Choice>>: .......................................................................... Signature of director .......................................................................... Name of director who states that they are the sole director and sole company secretary of <company name (Uppercase)> <<Choice 9: Company Execution Clause - attorney power which is registered in Qld, Tas, SA, WA or NT>> SIGNED by <attorney name (Uppercase)> as attorney for <company name (Uppercase)> <<Mandatory Sub-Choice: Insert ABN or ACN>> <<Choice 9a: ABN>> ABN <ABN number> <<Choice 9b: ACN>> ACN <ACN number> <<End Sub-Choice>> <<Sub- Choice: Insert if the company is acting as trustee>> as trustee for <name of trust> <<End Sub-Choice>> under power of attorney no. <registered number> in the presence of: ..........................................................................
Signature of witness. Name of witness (block letters) .......................................................................... By executing this agreement the attorney states that the attorney has received no notice of revocation of the power of attorney <<Choice 10: Company Execution Clause - attorney power which is registered in NSW> SIGNED by <attorney name (Uppercase)> as attorney for <company name (Uppercase)> <<Mandatory Sub-Choice: Insert ABN or ACN>> <<Sub-Choice 10a: ABN>> ABN <ABN number> <<Sub-Choice 10b: ACN>> ACN <ACN number> <<End Sub-Choice>> <<Sub-Choice: Insert if the company is acting as trustee>> as trustee for <name of trust> <<End Sub-Choice>> under power of attorney book <book number> no. <number> in the presence of: ..........................................................................
Signature of witness. Signature of authorised representative .................................................................
