PLACEMENT APPLICATION FORM

I/we have read the term sheet and accept the terms of the offer

Bid Amount (AUD)

Name of applicant 1 or company name

individual name, company name, or trustee

Name of applicant 2 or account designation

applicable for joint applicants (specify name of applicant 2) or for SMSFs / Trusts (specify account designation)

Name of applicant 3 or account designation

applicable for joint applicants (specify name of applicant 3) or for SMSFs / Trusts (specify account designation)

Postal address

City/Suburb

State/Territory

Postcode

Country

Contact name (first)

Contact name (last)

Contact number

Holder Identification Number (HIN)

CHESS holders only