Insolvency Appointment Notification Portal

Appointment Details
Date of Appointment:
Type of Appointment:
Name of Company:
A.C.N or A.B.N:
Business Activity or Occupation:
 
Main Business Address:
Address Line 1:
Address Line 2:
City:
State:
Postcode:
 
Practitioner Details
Insolvency Firm:
Appointee(s):
Primary Contact:
Primary Contact office location:
Email:
Phone Number:
 
Please complete the below Name and Email Address field if you require a copy of the notification receipt to be sent to the appointee or a colleague:
Additional Recipient:
Additional Recipient Email:
 
Trading:                
Employing:                 
 
General and Underwriting Information
Estimated Annual Turnover:                          
Estimated Asset Values:                
Number of Employees:                    
   
Trading Locations:


 
WH&S inspection required:            
Environmental inspection required:            
 
Pre Appointment Insurance Details
General Insurance Program
Insurer and/or Broker:
General Insurance Program
Workers Compensation:
 
Letter of Appointment
Please ensure the Letter of Appointment and Deed of Appointment files are not in use or open prior to attaching otherwise the appointment will not be able to be submitted.
Attachments must be in PDF format.
Upload Letter of Appointment:
Max File Size upto 4 MB
Upload Deed of Appointment (optional):
Max File Size upto 4 MB
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