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Department of State Growth

Emergency Event Impact Registration form

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Introduction

Please select the Emergency Type.

 
 

Enter your ABN


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Enter your ABN


Do you have an Australian Business Number (ABN)?

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Entity Name


 
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Enter ABN Manuallly


Select your Business Name



ABN Status



ABN Status Effective Date


 

Entity Type



Goods and Services (GST) From


 

ACN



Postcode



Address State


 
  Next
Estimated Impact Assessment 
 

Please provide the date that your business was first impacted by this emergency event. *

 
 
...
 
You cannot enter a date in the future
 
 

From the date nominated to now, what do you estimate your loss of turnover to be (excluding GST)?

 
 

* Annual turnover is the total ordinary income that you derive in the income year in the course of running your business.

 
 

What do you estimate the damage to your property and stock to be (if not applicable, leave at $0.00)

 
 
 
 

Please provide a brief description of the damage to your property and stock (if not applicable, write N/A)

 
 
 

Is there any other information you would like to provide?

 
 
 

Are you insured?

 
 
 
 

Please provide details, e.g. yes for damage to property but not for loss of income

 
 
 
 

How many people work in your business (including yourself)?

 
 
 
 
 
 
 
 

How many people are now out of work as a result of the emergency event (including yourself)?

 
 
 
 
 
 
 
Business Details
 

Business Name *

 
 
 

ABN

 
 

Business Address *

 
 

Unit number



Street number



Street name *



Street type



Suburb *



Postcode *



State *


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Business Contact: First Name *

 
 
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Business Contact: Last Name *

 
 
 
 

Business or other email (we will email you with any updates regarding support services) *

 
 
 
 

Confirm email address *

 
 
 
 

Contact Phone Number

 
 
 
 

Choose your Industry

 
 
 
 
 
 

Are you a small business (employ the equivalent of 19 full time employees or less)? *

 
 
 
 
Submission
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Thank you
 


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