1

The full name of the applicant

2

The business name (if any) used by the applicant, and the date and place of registration of such business name

3

The applicant's ABN

4

If the applicant:

(a) is a Commonwealth authority--the name of the applicant's principal officer; or

(b) is an eligible corporation--the name of the corporation's principal executive officer

5

The full street address and postal address of the applicant's principal office, and of any other registered office

6

The name, email address and telephone number of an officer nominated by the applicant for communication relating to the application

7

The URL of any website operated by the applicant in relation to the applicant's business or undertaking

8

If the applicant is a Commonwealth authority--the name of the Act by which it is established

9

If the applicant is an eligible corporation--the date and place of its incorporation

10

The names of the directors or members of the governing body (if any) of the applicant

11

An organisational chart setting out:

(a) the structure of the applicant; and

(b) the subsidiaries (if any) of the applicant

12

Details of any parent guarantees or indemnities

13

Details of the applicant's employees to whom the proposed licence will apply

14

The total number of the applicant's employees, disaggregated by location and structure

15

The total salary and wage expenditure of the applicant for the last financial year, disaggregated by location and structure

16

The scope of the proposed licence