Corporations Regulations 2001

BROKER’S RENUNCIATION AND TRANSFER FORM

MARKING STAMP

PART 1

Full name of company:

Description of Division 3 rights:

Register:

Quantity:

[Words]

[Figures]

Transfer identification number:

Full name(s) and address(es) of transferor(s):

Transferor’s broker hereby certifies:

(a) that the Security Renunciation and Transfer Form relating to the Division 3 rights set out above has been or will be lodged at the company’s office; and

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

[Transferor’s broker’s 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 rights set out in Part 1 above having been purchased in the ordinary course of business, the Division 3 assets to which the Division 3 rights relate are to be issued to the transferee(s) named in this Part; and

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

and hereby requests that the Division 3 assets be issued by the company to the transferee(s) and such entries be made in the register as are necessary to give effect to this renunciation and transfer.

[Transferee’s broker’s stamp]

Date of affixing stamp:

PART 3

Transferee’s broker hereby certifies:

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

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

and hereby requests that the Division 3 assets be issued by the company to the transferee(s) and such entries be made in the register as are necessary to give effect to this renunciation and transfer.

[Transferee’s broker’s stamp]

Date of affixing stamp: