Fillable Name Correction Request And Indemnity Template printable pdf download

Name Correction Request And Indemnity Template

Download a blank fillable Name Correction Request And Indemnity Template in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Name Correction Request And Indemnity Template with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

All correspondence and enquiries to

Company or Trust in which Investment is Held

Smart Business Solutions

Full Name(s) of

GPO Box 3993,

Registered

Sydney NSW 2001

Tel: 1300 737 760 (within Aust)

Holding

Tel: + 61 2 9290 9600 (outside Aust)

Fax: + 61 2 9279 0664

.au

Registered

You are required to insert this number

Address

Securityholder Reference Number (SRN) or

Unitholder Identification Number (U)

Post Code

Name Correction Request and Indemnity

Use a black pen. Print in CAPITAL letters inside the boxes. ORIGINAL FORM MUST BE RETURNED

Name Correction

My-Our full and correct name(s) are:

Reason for name change –

Please enter an “X” in the box that applies to the reason for this name change.

Change of name by marriage

Company name change

Change, add or delete an

Other (Please refer to the

account designation

checklist on the reverse)

Reverting to maiden/former

Spelling correction

Addition of a middle name

name

Note: In some cases,

original certified copies of supporting document(s) must be provided. The type of document(s) depends on the type of name change.

Supporting documentation requirements are listed on the reverse of this form.

Sign Here – This section must be signed and witnessed 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 with respect to my/our securities. 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, Boardroom Pty Limited and the directors and officers of, Boardroom 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.

Individual or Securityholder 1

Securityholder 2

Securityholder 3

Sole Director and

Director

Director/Company Secretary

Sole Company Secretary

Witness

Day

Month

Year