|
Date (dd/mm/yy)
|
|
|
Name
of firm or customer code*
|
|
|
Author*
|
|
|
Your
client name or matter number
|
|
|
OPTIONAL
INFORMATION REQUIRED TO THIS REGISTRATION
|
|
|
I
require a post registration confirmation search of the debtor |
|
|
I
require a verification statement to be sent to the debtor pursuant
to section 148 of the PPSA (address taken from debtor information
on this form) |
|
|
I
require a pre registration search of the debtor |
| To perfect a Financing Statement and
maintain priority in a accordance with Part 10 PPS Act 1999 on the
Personal Securities Register, please record the relevant information
heron: |
|
SECURED
PARTY (ie creditor) DETAILS
|
|
Name
of Secured Party/Parties*
(if more than one list in order)
|
|
We strongly advise you utilise the
address of the secured party as this is the address where debtor
change demands and communications from the PPSR will be sent. You
can however utilise your address details, for you to forward the
information to the secured party. Should you wish to utilise our
address details, for us to forward the communications from PPSR
direct to you (not the secured party) type "landinfo" in the spaces
provided.
N.B.Should you or the secured party
choose to maintain in anyway the register independently in the future,
we accept no liability or responsibility for any ramification of
this charge being either on or off the Personal Property Securities
Register. |
|
Email Address/es*
of secured party or see red copy above
(if more than one list in order as above)
|
|
|
Fax No/s*
of secured party or see red copy above
(if more than one list in order as above)
|
|
|
Address/es*
of secured party or see red copy above
(if more than one list in order as above)
|
|
| If the secured party is an organisation
the PPSR require an individual acting on behalf of the secured party
for the PPSR to forward correspondence and change demands notices
direct. |
|
*
Individual acting on behalf when secured
party is an organisation (this will over ride the contact details
set out above if the secured party is an organisation
|
|
First Name
|
|
|
Last name
|
|
|
Email Address of person acting on behalf
if different from above
|
|
|
Fax no. of person acting on behalf if different
from above
|
|
|
Contact Address of person acting on behalf if different from
above
|
|
|
DEBTOR
DETAILS
|
| Names to be taken from official documentation
(ie certificate of incorporation) |
|
Organisation
Name*
|
|
|
Organisation
Type*
|
|
|
Incorporation
No
|
|
|
Contact
Address of Organisation*
|
|
Contact
at Organisation FIRST
NAME*
LAST
NAME*
|
|
|
MOTOR
VEHICLE
|
|
(You
must list at least one identifying number)
|
|
VIN
|
|
|
Chassis No
|
|
|
Registration No
|
|
|
Make*
|
|
|
Model*
|
|
|
Year*
|
|
|
Special instructions or information
|
|
|
Send
confirmation of registration by
|
|
|
|
|
| If first time using our services please provide the following
contact details: |
|
Email
|
|
|
Phone
|
|
|
Fax
|
|
|
DX
or postal
|
|
|
Physical address
|
|
|
|
|
 |
|
