SECTION 7 - Amazon Simple Storage Service (S3)



TO: New Zealand Exchange Limited (NZX)

ATTENTION: Legal and Regulatory Department

PO Box 2959

Wellington

I ……………………………………………...….. of …………………………………………………………..

(Name of Applicant) (Address of Applicant)

do solemnly declare that:

(a) I am a fit and proper person without any history of dishonest or fraudulent activities;

(b) I have not been declared a bankrupt by the High Court of New Zealand or any other overseas regulatory body;

(c) I agree that upon being designated an NZX Associate Advisor/NZX Advisor the NZX Participant Rules shall form a binding contract between NZX and me;

(d) I agree to provide any additional information as requested by NZX for the purpose of reviewing my application for designation as an NZX Associate Advisor/NZX Advisor;

(e) I agree to pay to NZX such fees, levies or other charges (including, but not limited to, fines for breaches of the NZX Rules) as are set from time to time by NZX;

(f) I have undertaken the accreditation and training as required from time to time by NZX Participant Rule 5.6 (NZX Associate Advisor) or NZX Participant Rule 5.7 (NZX Advisor);

(g) I have not had any charges bought against me as a result of a breach of the NZX Participant Rules, and/or the NZX Business Rules, Regulations and Code of Practice in existence prior to the NZX Participant Rules coming into force;

(h) I have not had any disciplinary action bought against me by any government and/or regulatory authority;

(i) I agree to undertake any additional accreditation and/or training as required from time to time by NZX;

(j) I agree to abide by all the NZX Participant Rules, Guidance Notes, and any direction given from time to time by NZX as applicable to my position as an NZX Associate Advisor/NZX Advisor; and

(k) Have provided, as attached to this application, written confirmation from ……………………………………………..……... in support of my application for

(Name of Client Advising Participant)

designation as an NZX Associate Advisor/NZX Advisor

AND I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957.

……………………………………………….

Signature of declarent

Declared at this day of 20

Before me:

…………………………………………

A Solicitor of the High Court of New Zealand

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APPENDIX 14

NZX ASSOCIATE ADVISOR/NZX ADVISOR – STATUTORY DECLARATION

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