8 Digit Numbers (GTIN-8s) Application Form Important Information • Refer to GS1 Australia Fact Sheet on Allocating GTINs before applying. • GS1 Australia Full Membership Subscription and Licence holders are entitled to obtain a restricted set of directly allocated 8 digit Global Trade Item Numbers (GTIN-8s) upon request. • GS1 Australia reserves the right to reject any application for direct numbers to be issued without cause. It should not be assumed that a precedent has been set by the previous allocation of GTIN-8 numbers to a “like” or similar type product under the previous conditions of issue. • Failure to complete this form in full, legibly, including all mandatory fields identified with *, will result in a processing delay • Each application for directly allocated GTIN-8s will incur the following charges: −− An administration fee per request for allocation of $67.50 + GST. −− You will be billed for each GTIN-8 allocated or reinstated $67.50 + GST. This fee is an annual renewable fee. −− You must supply a copy of artwork and samples to make sure the product cannot fit an EAN-13 barcode. • All fees quoted exclude any discounts or surcharges based on payment method, and are exclusive of GST. Section 1: Company Details GS1 Australia Account Number *Company Name / Trading Name Division of / Parent Company (If Applicable) ABN/ACN Other Registered Company Identifier *Company / Head Office Street Address *Suburb/City *State/Country *Postcode/Zipcode Section 2: Contact Details *GS1 Australia Coordinator / Primary Contact: Individual responsible for allocating GS1 Identification Keys within your company Title (Ms/Mrs/Mr) and First Name Last Name Position Address (If different from Company) Suburb / City State / Country Postcode / Zipcode Email Direct Phone 8 Digit Numbers (GTIN-8s) - Application Form Mobile 1 of 3 *Section 3: Product Information Details Please provide product information in the following table (or attach a document with equivalent information) for all products that you wish to obtain directly allocated numbers for. Your Product Brand Name Description Guidelines for the allocation and use of 8 Digit Numbers (GTIN-8s) can be found in the GS1 Australia Information Library under Fact Sheets - Numbering Trade Items. Please see www.gs1au.org/WorkArea/DownloadAsset.aspx?id=2147484580 and then select “Allocating a GTIN-8“ to download the document. It is imperative that these standards are followed when using GTIN-8s. Note: If you wish to cancel a GTIN-8 Number, please advise us by completing a GS1 Identification Keys Cancellation Form. 8 Digit Numbers (GTIN-8s) - Application Form 2 of 3 *Section 4: Payment Methods We provide a number of payment options for your subscription membership. Please choose your preferred payment option below: FF Option A: Direct Debit Payment • Download the Direct Debit form from our website www.gs1au.org and provide with this application form • Direct Debit discounts will not apply to this initial transaction, but will be applicable on all other transactions where the Direct Debit is set up to debit a nominated Bank Account • Direct Debit via a nominated Credit Card will not attract the standard direct debit discount, however Credit Card processing fees will not be applied FF Option B: Credit Card Payment • A credit card processing fee of 2% applies when paying by credit card. These fees will be applied by GS1 Australia when processing payment. • If you wish to make a credit card payment over the phone, please call 1300 227 263 Visa Mastercard American Express Card Holder's Name Card Number Expiry Date Signature Date FF Option C: EFT Payment • Please email your application along with a Remittance Advice to customer.service@gs1au.org or fax to +61 3 9558 9551 • GS1 Australia Bank Details Bank National Australia Bank Account Name GS1 Australia Ltd. BSB No. 083 266 Account No. 69615 7718 FF Option D: Cheque Payment • Please provide your cheque number *Section 5: Signature Approval The GTIN-8 Numbers allocated to your company are exclusively for your use - you must not assign, licence or allow their use by any other company. Your GTIN-8 numbers will be sent to you upon receipt of your completed and approved application form and payment of appropriate fees. I/ We ________________________________________________ declare that I have read, understood and agree to the terms and conditions as set out in my GS1 Australia Full Membership and Subscription Licence Agreement and/or the Terms and Conditions available from www.gs1au.org; and that the information provided by me as the applicant, and in any accompanying documents, is true and correct in every detail, and that when I no longer require these numbers will advise GS1 Australia in order for their issue to be cancelled. Full Name (Director/Company Official) Position Signature Date Download instructions for signing forms Please return the completed form with payment to GS1 Australia. GS1 Australia Head Office, 8 Nexus Court, Mulgrave VIC 3170 Locked Bag 2, Mt Waverley VIC 3149 T 1300 227 263 I E customer.service@gs1au.org www.gs1au.org I F +61 3 9558 9551 I ABN 67 005 529 920 CONNECT WITH US GS1 is a registered trademark of GS1 AISBL. 923_0616 8 Digit Numbers (GTIN-8s) - Application Form 3 of 3