Consent to Become a Director

Confirm your agreement to take on director responsibilities within the organisation.

Consent to Become a Director Form

PuipiKak Malu Indigenous Corporation Appointment of Director Form

First name

Last name

Address

Postal Address

Date of Birth

Month

Day

Year

Place of Birth

Phone

I acknowledge I am automatically disqualified from managing corporations if I:

have been convicted of an offence under the Corporations (Aboriginal and Torres Strait Islander) Act 2006 (CATSI Act) that is punishable by imprisonment for more than 12 months
have been convicted of an offence involving dishonesty that is punishable by imprisonment for at least three months
have been convicted of an offence against the law of a foreign country that is punishable by imprisonment for more than 12 months
am an undischarged bankrupt
have signed a personal insolvency agreement and have not kept to the agreement
have been disqualified under the Corporations Act 2001 from managing corporations,
and I will notify the corporation if any of the above events occur after my appointment.

By ticking this box, I acknowledge that it serves as my signature for the Consent to Become a Director Form.