Corporations Regulations 2001

RENUNCIATION AND CONSOLIDATION TRANSFER FORM

MARKING STAMP

PART 1

Full name of company:

Description of Division 3 rights:

Register:

Quantity:

[Words]

[Figures]

Transfer identification number:

Transfer Consolidation Number:

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 of the Form(s) whose Transfer Consolidation Number(s) is (or are) 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 the renunciation(s) and transfer(s).

[Transferee’s broker’s stamp]

Date of affixing stamp: