NDIS Entity Engagement Form

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NDIS ENTITY ENGAGEMENT LETTER

Are you a registered NDIS service provider?

Current number of NDIS participants

Name of the Firm

Name of Director/ Secretory

Type of Entity: (Company) TrustPartnershipOthers

Legal Name

Tax File number

Company ABN or ACN

Do you have a Trading Name YesNo

Trading Name:

Registered Address

State

Postcode

Phone number

Email

Name of Trustee

List of Director(s)/ Beneficiary/ Partner(s)

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Former Accountant

Do you have a Former Accountant YesNo

Former Accountant's name:

Phone Number

Email