Corporations Regulations 2001

SPLIT TRANSFER FORM

MARKING STAMP

PART 1

Full name of company:

Description of Division 3 assets:

Class:

If not fully paid, paid to:

Register:

Quantity:

[Words]

[Figures]

Transfer identification number:

Full name(s) of transferor(s):

The [name of market licensee] hereby certifies that the Security Transfer Form or the Broker’s Transfer Form relating to the Division 3 assets set out above has been or will be lodged at the company’s office.

[Market licensee stamp]

Affixed at

on

(place and date of affixing stamp)

PART 2

Full name(s) and address(es) of transferee(s)

Transferee’s broker hereby certifies:

(a) that the Division 3 assets set out in Part 1 above, having been purchased in the ordinary course of business, are to be registered in the name(s) of the transferee(s) named in this Part; and

(b) that stamp duty, if payable, has been or will be paid;

and hereby requests that such entries be made in the register as are necessary to give effect to this transfer.

[Transferee’s broker’s stamp]

Date of affixing stamp:

PART 3

Transferee’s broker hereby certifies:

(a) that the Division 3 assets set out in Part 1 above, having been purchased in the ordinary course of business, are to be registered in the name(s) of the transferee(s) named in the Consolidated Transfer Form relating to the Division 3 assets; and

(b) that stamp duty, if payable, has been or will be paid;

and hereby requests that such entries be made in the register as are necessary to give effect to this transfer.

[Transferee’s broker’s stamp]

Date of affixing stamp: