Name Correction Request And Indemnity
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1
2Company or Trust in which Securityholding is held
All c c orrespondence t t o:
Computershare Investor Services Pty Limited
GPO Box 2975 Melbourne
Registered
Victoria 3001 Australia
Enquiries (within Australia) 1300 850 505
Name(s)
(outside Australia) 61 3 9415 4000
Facsimile 61 3 9473 2500
.au
Registered
Address
Securityholder Reference Number (SRN)
Use a black pen.
A B C
1 2 3
Print in CAPITAL letters.
Name Correction Request and Indemnity
A
Name Correction Request and Indemnity
My/Our full and correct name(s) or Company Name is/are:
There has been no change in beneficial ownership and I/we request my/our full and correct name(s) be recorded on the register.
In consideration of the security issuer amending the register I/we hereby covenant to indemnify and forever keep indemnified the security issuer,
the directors and trustees of the security issuer, Computershare Investor Services Pty Limited and the directors and officers of Computershare
Investor Services Pty Limited from and against all losses in respect thereof and all claims, actions, proceedings, demands, costs and expenses
whatsoever which may be made or brought against them by reason of compliance with this request.
Contact Name
Telephone Number - Business Hours / After Hours
B
Sign Here – This section must be signed for your instructions to be executed.
I/We authorise you to act in accordance with my/our instructions set out above. I/We acknowledge that these instructions supersede and have
priority over all previous instructions in respect to my/our securities.
Individual or Securityholder 1
Securityholder 2
Securityholder 3
Director
Director/Company Secretary
Sole Director (No Company Secretary) *
Day
Month
Year
* By signing here I, ......................................................................................................................
(Name in full)
/
/
warrant that, pursuant to the Corporations Act, the company does not have a Company
Secretary and that as the Sole Director I am authorised by the company to complete this form.
Note: when signed under Power of Attorney, the attorney states that they have not received a notice of revocation. Computershare Investor
Services Pty Limited needs to sight a certified copy of the Power of Attorney.
F N C
A
22/06/04
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