Form C2.1 - Application To Dfes For Change In Dba Details
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1
2FIRE ALARM MONITORING SERVICES
[9.4] FORM C2.1
APPLICATION TO DFES FOR CHANGE IN DBA DETAILS
THIS FORM HEREBY ADVISES DFES THAT A CHANGE IS BEING MADE TO THE DBA PREMISES LISTED BELOW.
TO PREVENT DELAYS TO PROCESSING PLEASE ENSURE THE MANDATORY SECTIONS ON THIS FORM ARE FILLED
OUT AND THAT THE FORM IS SIGNED AND DATED.
1.CURRENT DETAILS OF PREMISES (MANDATORY SECTION)
DBA NUMBER (IF KNOWN):
NAME OF BUILDING:
STREET/LOT NUMBER:
STREET NAME:
SUBURB:
POST CODE:
2. FORMER DETAILS OF PREMISES
(IF DIFFERENT TO CURRENT DETAILS & NOTIFYING OF SITE NAME
CHANGE)
FORMER BUILDING NAME:
STREET/LOT NUMBER:
STREET NAME:
SUBURB:
POST CODE:
FOR STREET NUMBER/ NAME
CHANGE PLEASE PROVIDE
REASON FOR CHANGE:
3.1 FOR CHANGES IN OWNERSHIP
(IF APPLICABLE)
OLD COMPANY NAME:
NEW COMPANY NAME:
NEW OWNER NAME:
NEW OWNER EMAIL:
ABN / ACN FOR NEW
OWNERSHIPS:
DATE OF OWNERSHIP
TRANSFER:
INVOICE REFERENCE / PO#:
PLEASE NOTE:
ANNUAL MONITORING FEES WILL BE CALCULATED AND TRANSFERRED PRO RATA TO THE NEW
OWNER EFFECTIVE FROM THE DATE THIS FORM IS RECEIVED COMPLETED CORRECTLY.
3.2 FOR CHANGES IN BILLING DETAILS
(IF APPLICABLE)
NEW BILLING ADDRESS:
SUBURB:
POST CODE:
BILLING CONTACT NAME:
BILLING CONTACT PHONE:
MOBILE:
BILLLING EMAIL:
ABN/ ACN FOR NEW
OWNERSHIPS:
INVOICE REFERENCE/ PO#:
DATE OF CHANGE OF BILLER:
PLEASE NOTE:
ANNUAL MONITORING FEES WILL BE CALCULATED AND TRANSFERRED PRO RATA TO THE NEW
OWNER EFFECTIVE FROM THE DATE THIS FORM IS RECEIVED COMPLETED CORRECTLY.
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FOR ASSISTANCE WITH COMPLETING THIS FORM PLEASE CONTACT: FIRE ALARM MONITORING SERVICES: 1300 793 722
COMPLETED C2.1 FORMS CAN BE EMAILED TO: .AU OR FAXED TO: (08) 9499 7885
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