Sra 23 - Transfer Form For Non-Market Transactions
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1
2TRANSFER FORM FOR NON-MARKET TRANSACTIONS
Use a black pen. Print in CAPITAL letters
Note: Any alterations must be initialled by the seller/s and the buyer/s.
Any increase to the quantity of securities being transferred is not acceptable even if initialled
Correction fluid or tape must not be used.
1 Stamp Duty
Uncertificated CHESS Holdings - This form must be forwarded to the CHESS Sponsoring Broker or Non-Broker Participant.
if applicable
Uncertificated Issuer Sponsored Holdings - This form must be forwarded to the Issuer’s Registry or your broker as appropriate.
Full name of Company or
State of Incorporation
3
2
Corporation
Description of Securities
Class
If not fully paid, paid to
Register
5
4
(Shares, options etc.)
Quantity
Words
Figures
6
Full name/s of
Given Name/s
Surname
For Company Use
....................................................………….....
Transferor/s
7
(Seller/s)
.........................................…………................
8
Securityholder Reference
SRN : __________________________________
Number
(must be quoted)
Date of Purchase
/
/
9
Consideration
10
A$
Title
Given Name/s
Surname
Full name/s of
Mr
}
......................................................................................................……………..
11
Transferee/s
Mrs
}
(Buyer/s)
Ms
}
………………………………………………………………………………………
12
Full postal address of
………………………………………………………………………………………………………
Transferee/s
(Buyer/s)
………………………………………………………………………………………………………
State/Country
...........................................................................
Postcode
....................
13
Transferee/s (Buyer/s)
SRN : ____________________________________
Securityholder Reference
Number (if known)
I / We the registered holder/s and undersigned seller/s for the above consideration do hereby transfer to the above name/s hereinafter called the
Buyer/s the securities as specified above standing in my/our name/s in the books of the above named Company, subject to the several conditions on
which I/We held the same at the time of signing hereof and I/We the Buyer/s do hereby agree to accept the said securities subject to the same
conditions. I/We have not received any notice of revocation of the Power of Attorney by death of the grantor or otherwise, under which this transfer is
signed (if applicable).
To sign as power of attorney you must have already lodged it with the registry or your broker as appropriate or enclose a
certified copy with this transfer.
14
Individual or Securityholder 1
Securityholder 2
Securityholder 3
Transferor/s
(Seller/s) sign
Director or Sole Director and
Director/Company Secretary
Sole Director (
No Company Secretary)
here
Sole Company Secretary
Day
Month
Year
15
/
/
Individual or Securityholder 1
Securityholder 2
Securityholder 3
16
Transferee/s
(Buyer/s) sign
Director or Sole Director and
Director/Company Secretary
Sole Director (
No Company Secretary)
here
Sole Company Secretary
Day
Month
Year
SRA 23
17
/
/
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