Lobbyist Details

Business Entity Name: * #
Trading Name: * #
Do you have an ABN?: Yes No

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Phone Number: *

[+] Add Phone Number

Fax Number:

[+] Add Fax Number

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Postal Address: *
Suburb: *
State: ACT NSW NT Qld SA Tas Vic WA * Postcode: *

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Same as above:
Street Address:
(if different to above)
Suburb:
State: ACT NSW NT Qld SA Tas Vic WA Postcode:

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Web Address:

Responsible Officer

The Responsible Officer is the contact person for any matters relating to a lobbyist's listing on the Register of Lobbyists.

Full Name: *
Position: *
Phone Number: *
Email: *
Confirm Email: *

Communications from the Department of the Prime Minister and cabinet will primarily be carried out by email. In the event of a change to the Responsible Officer you will need to update their details, including their email address, to ensure that you continue to receive emails relating to the Register of Lobbyists. In nominating a person as the Responsible Officer you should ensure that the person is at a level that he or she can deal with any communications from the Department as appropriate.

Owner Details

For businesses which are not publicly listed companies, please provide the names of all the owners, partners or major shareholders in your business, including other businesses or individuals. Please note that, where relevant, this information should match the details in your business listing with the Australian Securities and Investments Commission.

Full Name: * #

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Details of all persons or employees who conduct lobbying activities

Provide the details of all staff members who are involved in lobbying activities. Refer to clauses 5.1(a)(ii)-(iv), 7.1 and 7.2 of the Lobbying Code of Conduct for further information.

Statutory declarations for all newly added lobbyists should be forwarded to the Register as soon as possible. Legible electronic and faxed copies of statutory declarations will be accepted.

Full Name: * #
Position: * #
Former government representative?: Please select No Yes Cessation Date: January February March April May June July August September October November December / 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 * #

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Client Details

List any clients who have engaged you on a retainer to provide services or any other clients for whom you have provided lobbying services (paid or unpaid) in the past three months. You will not be able to submit an application to register which has no client listing.

Name: * #

[+] Add More Clients