Business Assessment

1

Name^*:

2

E-Mail^*:

3

Date of Birth ^*:

4

English Ability

Please Select Native English Speaker Good Average Poor

5

Martial Status

Please Select Never Married Married;De Facto/Common Law Engaged Seperated Divorced Widowed

6

Are you committed to establish and maintain a business or investment activity in Australia?

Yes No

7

In the last twelve months, which of the following statements applies to your Australian Business.

	Employ 3 or more Australian citizens or permanent residents (excluding family members) and have a turnover of AU$200,000 or more.
	Employ 3 or more non-family Australian citizens or permanent residents (excluding family members) and make exports of AU$100,000 or more.
	None of the above

8

What is the combined net total of your business and personal assets?

Please Select AU$2,250,000 or greater At least AU$1,125,000 At least AU$500,000 At least AU$250,000 Less than AU$250,000

9

What is the total net value for your assets in Australia, or available for transfer to Australia with in 2 years?

Please Select over AU$2.5 Million between AU $1.5 and 2.5 million between AU $0.5 and 1.5 million less than AU $0.5 million

10

In any 2 of the last 4 fiscal years, what was the approximate turnover of your business(es)?

Please Select AU$500,000 or greater At least AU$300,000 Less than AU$300,000

11

What was the approximate turnover of the company or organisation you were employed by?

Please Select AU$50 Million or greater At least AU$10 Million Less than AU$10 Million

12

For how many years have you been involved in directly managing your business(es) or investments?

Please Select 3 years or above 2-3 years less than 2 years

13

In any 2 of the last 4 fiscal years, what was the approximate net value of your business assets?

Please Select AU$200,000 or greater Less than AU$200,000

14

Please specify the most senior position you have held in a company for at least two of the last four years.

Please Select Chairman Chief Executive Officer Managing Director General Manager Director Chief Financial Officer Chief Operations Officer Senior Manager Other

15

In any 1 of the last 5 fiscal years, please indicate your ownership interest in your business.

Please Select 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% less than 10%

16

Have you been actively involved in the day-to-day management of your business(es)?

Yes No

17

How many levels of management are there above you (ie. more senior to you) in your current role?

Please Select 0 1 2 3 4

18

In any 1 of the last 5 fiscal years, please indicate the approximate net value of your business assets.

Please Select AU$1.5 Million or greater At least AU$750,000 Less than AU$750,000

19

Please describe your share or ownership of your business.

Please Select Sole proprietor of the business Active partner in a partnership Shareholder in a public listed company
(at least 10% ownership interest) Shareholder in a public listed company
(less than 10% ownership interest) None of the above applies