Northern Territory Indigenous Business Network






Applicant Information Step 1 - 5

Business Information

When submitting this application, you will need to attach relevant following documentation, whichever is applicable, to support your application, including:
1) Evidence of Business Registrations/Company extract
2) Proof of Aboriginality or Torres Strait Islander
3) Certificate of Incorporation (if applicable)
4) Information relating to percentage of partnership
5) Any other legal document that show the business status

RegionStep 2 - 5


I authorise the verification of the information provided on this form is true and correct. I have retained a copy of this application.

Upload Signature*:

Use of Information

Yes   No

Business extract:
Confirmation of aboriginality:
Upload Additional Doc:

Talent Release Authority Step 3 - 5

  1. I agree to appear in visual and/or audio recordings which can be used in advertisements and other documents published by the Northern Territory Indigenous Business Network (NTIBN).
  2. I give permission for my name and visual and/or audio recordings of me to be used in any associated advertisements and promotional documents.
  3. I assign any rights I may have in the visual and/or audio recordings and associated advertisements and promotional documents to the NTIBN.
  4. I am free to enter into this Agreement and to appear in the proposed associated advertisements and promotional documents
  5. This Agreement is made under the laws of the Northern Territory and any dispute can be taken for resolution by the courts in the Northern Territory.

Wherever possible, the NTIBN will remain sensitive to and understanding of cultural, family and personal sensitivities.

Yes   No
Your Signature*:

The Northern Territory Indigenous Business Network (NTIBN) is collecting the information in this form to obtain permission to use visual and audio recordings in NTIBN advertising, promotional materials and publications. Visual and/or audio recordings, or other personal information described in this form may be supplied to contractors or service providers engaged by the NTIBN develop or produce advertising, promotional materials or publications, but will not be provided to any other person or organization for purposes other than Northern Territory Government advertising and promotions. You are entitled at any time to access and amend the information provided by you on this form.

Membership Fees Step 4 - 5

Sole Trader
Aboriginal Corporation
Company (Pty Ltd)
Not for Profit
      $242.00       $242.00

*To be eligible for full membership the business must be at least 51% Indigenous owned and based in the Northern Territory. Each application for full or associate membership must provide documentary evidence to support the application.
NTIBN Applicants who do not meet the eligibility criteria for full membership and who wish to be affiliated with NTIBN may apply to NTIBN to become an Associate member. Once received your completed application will be assessed by the NTIBN at the next Committee meeting. You will be advised of the outcome and, if endorsed, an invoice will be issued to the business for payment of membership fee.

Payment Information Step 5 - 5


Northern Territory Indigenous Business Network, 76 Esplanade, Darwin City NT 0800

Phone No.

08 89996268