Document text
Statement of Circumstances — Request to Waive an ASIC Late Fee
Company name: [COMPANY NAME]
ACN: [ACN]
Annual review date: [ANNUAL REVIEW DATE]
Contact person and role: [NAME, DIRECTOR / SECRETARY]
Contact address: [ADDRESS]
Phone: [PHONE]
Email: [EMAIL]
To: Australian Securities and Investments Commission
Lodged with ASIC's online fee waiver application
[DATE]
Request to waive late fee — invoice [INVOICE NUMBER], amount $[AMOUNT]
1. The fee
The company's annual review fee of $[AMOUNT] was due on [DUE DATE]. It was paid on [DATE PAID] (receipt [RECEIPT NUMBER]). ASIC charged a late fee of $[AMOUNT] on invoice [INVOICE NUMBER] dated [INVOICE DATE]. The late fee has not been paid.
2. What happened (circumstances beyond the control of the company and its representatives)
( ) Delay caused by ASIC: [WHAT HAPPENED, WITH DATES AND ANY REFERENCE NUMBERS].
( ) Delay caused by a court: [ORDER NOT ISSUED IN TIME — COURT, FILE NUMBER, DATES].
( ) Cyber or ransomware attack: [DATE OF ATTACK, SYSTEMS AFFECTED, WHEN ACCESS RETURNED].
( ) Emergency or natural disaster: [EVENT, DATE, HOW RECORDS WERE LOST OR UNAVAILABLE].
3. Timeline
Date Event
[DATE] [ANNUAL STATEMENT ISSUED]
[DATE] [EVENT THAT CAUSED THE DELAY]
[DATE] [WHEN THE COMPANY COULD ACT AGAIN]
[DATE] [FEE PAID / DETAILS UPDATED]
4. Why the company could not avoid it
[EXPLAIN IN YOUR OWN WORDS: what you did to meet the deadline, why it was not possible, and that no representative failed to act.]
5. Evidence attached
[ASIC CORRESPONDENCE OR REFERENCE NUMBERS]
[INCIDENT REPORT, POLICE OR CYBER REPORT, INSURER LETTER, EMERGENCY NOTICE]
[PROOF OF PAYMENT OF THE ORIGINAL FEE]
The company asks ASIC to waive the late fee of $[AMOUNT]. Please send the decision in writing to the contact address above.
____________________
[NAME], [ROLE], for and on behalf of [COMPANY NAME]
For me
[ ] Original annual review fee paid on: [DATE]
[ ] Late fee NOT paid while the waiver is pending
[ ] Applied online on: [DATE]; confirmation number: [NUMBER]
[ ] No answer after 28 days ([DATE]): contact ASIC