PAPUA NEW GUINEA

BUSINESS NAMES ACT (CHAPTER 145)

Act, Sec. 13(3),(4),(5),(6),(8)

Form 6 Business Name No …………………

STATEMENT OF CHANGE OF PERSONS IN RELATION TO WHOM

BUSINESS NAME IS REGISTERED

Business Name (insert business name as registered): …………………………………………………………………………….……

Address of principal or only place of business: …………………………………………………………………………………………...
…………………………………………………………………………………………………………………………………………………..

Given name & surnames Former given names or Usual place of residence Date of cessation,
of each individual & surname of each & postal address of each commencement or
corporate name of each individual individual and place of appointment
corporation (If any individual is registered office in the
(If any individual is under 21 years, he is to country of each
under the age of 21 be described as an corporation
years, he is to be infant and the date of
described as an infant his birth is to be set out)
and the date of his birth
is to be set out)
Persons who have ceased **************************** ******************************
to carry on business under **************************** ******************************
the business name **************************** ******************************
**************************** ******************************
Persons who have
commenced to carry on
business under the
business name

Persons previously ****************************** ***********************

registered in relation to
business name who are
continuing to carry on
business under this name
Person (if any) ceasing to ****************************
be resident agent ****************************
****************************
****************************
****************************
****************************
Person (if any ) appointed ****************************
to be resident agent ****************************
****************************
****************************
****************************
****************************
****************************** ***********************
****************************** ***********************
****************************** ***********************
****************************** ***********************
******************************
******************************
******************************
******************************
******************************
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(PLEASE COMPLETE BOTH SIDES OF THIS FORM)

 Dated the …….day of ………………., 20……

Signed by (insert name) ………………………………………………………………………………………………

Signature (see note 1 below) …………………………………………………………………………………………

Signed by (insert name) ………………………………………………………………………………………………

Signature (see note 1 below) …………………………………………………………………………………………

Signed by (insert name) ………………………………………………………………………………………………

Signature (see note 1 below) …………………………………………………………………………………………

Signed by (insert name) ………………………………………………………………………………………………

Signature (see note 1 below) …………………………………………………………………………………………

(if more space is required for signatures add a separate sheet)

1. This Statement is to be signed by each person carrying on business under the business name immediately before and
immediately after the change or some person or persons authorised in writing to sign the statement on his or their behalf. In
the case of a deceased person, the statement must be signed by his personal representative. In the case of a corporation,
the statement is to be signed by a director or manager or the secretary of the corporation or, in the case of a corporation
registered under Division X11.3 of the Companies Act, it may be signed by the agent of the corporation appointed for the
purpose of that Division.

Lodged by: ………………………………………………. Lodged in the office of the Registrar of

Address: …………………………………………… Companies
....................................................................…............ on:............................................................
Telephone: ...............................................................
Registrar of Companies: