Intermediary Name Type Disclosing Entity Name Type Reponsible Entity Name Type Intermediary Organisation Name Disclosing entity name Responsible Entity Organisation Name Disclosing entity name - Provide the full company name Intermediary Family Name Signatory Family Name Intermediary Given Name Signatory Given Name Intermediary Other Given Name Signatory Other Given Name Capacity Capacity - Provide the capacity of signatory eg Director or Secretary Signatory identifier Date Date - Date that the document is signed (Date of transmission). Statement accepted Declaration Type Code f7051 Prelodge Request [Abstract]