Form 2—Application for ballot under PartForm 2—Application for ballot under Part 3 of Chapter 3

## Form 2—Application for ballot under Part 3 of Chapter 3 (paragraph 82(a)) Fair Work (Registered Organisations) Act 2009, subsection 94(4) APPLICATION FOR BALLOT UNDER PART 3 OF CHAPTER 3 TO: THE FAIR WORK COMMISSION I/We, (full name(s) of applicant(s)), the applicant(s) listed in the schedule to this application,\*: (a) apply for a ballot to be held to decide whether (name of constituent part of amalgamated organisation) should withdraw from (name of amalgamated organisation); and (b) nominate (name), of (address) as the representative constituent member for the purposes of the ballot. \*Omit if inapplicable. PARTICULARS 1. Details of the eligibility of the applicant(s) to make the application in accordance with subsection 94(3) of the Act. 2. The date of the amalgamation as a result of which the constituent part became part of the amalgamated organisation. 3. A statement that neither of the events in subsection 94(2) of the Act has occurred. 4. Each question proposed to be put to the ballot. 5. Any other information that the applicant wishes the FWC to have regard to. Note: Section 95 of the Act requires this application to be accompanied by a fair and accurate written outline of the proposal to withdraw from the amalgamation. Dated 20 . ................................................ Signature of applicant(s)