Please use a pen and write neatly using BLOCK LETTERS. Tick where appropriate ;
Application Requirements
This application must also be accompanied by the prescribed fee of $620 and those additional items listed
in the attached application checklist. Please note that this is an application fee and is therefore
non-refundable. Incomplete applications may be lapsed after 28 days and the application fee retained.
1. Applicant Details
Name of Body Corporate
ACN
A
BN
(A
ttach a copy of the Certificate of Registration of the Company)
Business Name(s)
A ttach additional sheet if necessary
Place & Date of Incorporation
/
/
Principal Place of Business
If no place of business in Western Australia insert
the principal place of business in Australia.
Primary Postal Address
If different than above
Other Place(s) of Business
Phone and Fax Numbers
Ph
F
Email Address
Registered Office Address
If body corporate was not incorporated in Australia
provide the address of the body corporate’s principal
office in Australia
Does the body corporate intend to carry on the business of a credit provider in partnership with another person?
If the answer is ‘Yes’, provide the following details for each partner or proposed partner:
Full name
Address
Attach additional sheet if necessary
NOTE: It is an offence, with a maximum fine of $5,000, for the holder of a credit provider’s licence to carry on a
business of providing credit in partnership with a person who is not the holder of a credit provider’s licence.
Yes / No
Application for a Credit Provider’s Licence
(Body Corporate)
Department of Consumer &
Employment Protection
Ground Floor “Forrest Centre”
219 St Georges Terrace
PERTH WA 6000
Locked Bag 14
Cloisters Square WA 6850
Licensing Advice Line
8:30am to 5.00pm
Monday to Friday
Tel: 08 9282 0833
Fax: 08 9282 0559
Country Callers
1300 30 40 54
Web Site