NEW BUSINESS REGISTRATION FORM

Enter your details in the fields below. The form will be sent directly to Liedon.
All fields need to be completed, if you have no information for a field, indicate N/A.

BUSINESS DETAILS

BUSINESS NAME (IN ORDER OF PREFERENCE)

1

2

3

4

5

6

TYPE OF BUSINESS:
COMPANY TRUST

WHAT SERVICES WILL YOU PROVIDE?

NUMBER OF MEMBERS / DIRECTORS / TRUSTEES

CONTACT PERSON - FULL NAME

CONTACT PERSON - ID NUMBER

PHYSICAL ADDRESS (STREET, SUBURB, CODE)

PO BOX ADDRESS (PO BOX NUMBER, SUBURB, CODE)

BUSINESS EMAIL ADDRESS

TELEPHONE NUMBER

FAX NUMBER

CELLPHONE NUMBER

DIRECTOR/MEMBER/TRUSTEE NO 1

FULL NAME

ID NUMBER

HOME ADDRESS

OCCUPATION

% MEMBER'S INTEREST / SHAREHOLDING

DIRECTOR/MEMBER/TRUSTEE NO 2

FULL NAME

ID NUMBER

HOME ADDRESS

OCCUPATION

% MEMBER'S INTEREST / SHAREHOLDING

DIRECTOR/MEMBER/TRUSTEE NO 3

FULL NAME

ID NUMBER

HOME ADDRESS

OCCUPATION

% MEMBER'S INTEREST / SHAREHOLDING

DIRECTOR/MEMBER/TRUSTEE NO 4

FULL NAME

ID NUMBER

HOME ADDRESS

OCCUPATION

% MEMBER'S INTEREST / SHAREHOLDING

HOW DID YOU HEAR ABOUT LIEDON?

Bring a copy of each member/director/trustee’s ID document with you
to your appointment in order to register your business.