ABN/WPN :________________________

Company/Organisation :________________________

I, {name of authorised signatory}, as {title of signatory's position held} of the above company/organisation, hereby authorise {name of new authorised individual}, in his/her capacity as {name of position held}, to sign {name(s) of PAYG document(s) - eg payment summaries, annual reports}.

Specimen signature of individual : ______________________ Date : _____________________

Signature of authorised signatory : ______________________ Date : _____________________