Community pharmacy blicenceb additional company details - ACT Health 2026

1. Click ‘Get Form’ to open it in the editor.
2. In Section 1, enter the Company Name and Australian Company Number (ACN). Ensure you attach the current ASIC extract outlining directors and shareholders.
3. Fill in the Registered Company Address, including property name, street number, street name, city/suburb/town, state/territory, and postcode.
4. Confirm attachment of the ASIC extract by selecting 'YES' in the required information section.
5. Complete the Company Declaration by signing and dating the form. Include your position title.
6. In Section 2, provide details for each director. Enter their names and pharmacist registration numbers as applicable.
7. Proceed to Section 3 to list shareholder details. Include names and either pharmacist registration numbers or their relation to a pharmacist.
8. If applicable, complete Section 4 with trustee beneficiary details following the same format as previous sections.

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