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Change of Company Details Order Form ABN: 47 002 604 088

Shareholding - Allotment/Cancellation/Buy-back/Transfer

E-mail to: pliance@.au Phone: 1300 139 001 Fax to: 1300 139 013

|Please complete all mandatory fields (*). Reckon Docs can not be held responsible for illegible forms. By completing this form, you agree to Reckon Docs |

|Trading Terms & Conditions on reckon-.au, and the customer confirms that all officeholders and shareholders have consented to their appointments |

|under section 117(5) of the Corporations Act 2001 and confirms Reckon Docs Pty Ltd to act as the lodging agent on their behalf. |

|Contact Details* Date of Order:       |

|Practice Name:       |

|Contact Name:       E-mail:       |

|Shipping Address: Level/St.:       |

|Shipping Address Suburb:       State: Postcode:       |

|Telephone:       Fax:       |

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|Special Instructions:       |

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|Payment Details* (if no method selected, the order will be placed on a 30-day account) |

|Reckon Docs holds a Direct Debit Authority Direct Deposit (fax or e-mail receipt) On Account |

|Credit Card Details: (discount for payment with order) Visa MasterCard AMEX Diners |

|Name on Card:       CCV/AMEX ID:       |

|Card Number:       Expiry Date:       (mm/yyyy) |

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|Print Options* (If no option is selected, a Print & Delivery will be provided) | |

|Print & Delivery DIY Print (e-mail) | |

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|Company Details* |

|Company Name:       |

|Company ACN:       |

|Registered Office Address: Level/St.:       |

|Registered Office Address: Suburb:       State: Postcode:       |

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|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |

|Date of Change:       if Transfer, this shareholder is the Transferor Transferee |

|Surname/ACN:       Given Names/Company:       |

|Address: Level/St.:       |

|Address: Suburb:       State: Postcode:       |

|Class of Shares: No. of Shares:       Amt p/ Share: $      |

|(all Shares are held beneficially) OR as Trustee for:       (e.g. trust/ super fund) |

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|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |

|Date of Change:       if Transfer, this shareholder is the Transferor Transferee |

|Surname/ACN:       Given Names/Company:       |

|Address: Level/St.:       |

|Address: Suburb:       State: Postcode:       |

|Class of Shares: No. of Shares:       Amt p/ Share: $      |

|(all Shares are held beneficially) OR as Trustee for:       (e.g. trust/ super fund) |

| |

|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |

|Date of Change:       if Transfer, this shareholder is the Transferor Transferee |

|Surname/ACN:       Given Names/Company:       |

|Address: Level/St.:       |

|Address: Suburb:       State: Postcode:       |

|Class of Shares: No. of Shares:       Amt p/ Share: $      |

|(all Shares are held beneficially) OR as Trustee for:       (e.g. trust/ super fund) |

| |

|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |

|Date of Change:       if Transfer, this shareholder is the Transferor Transferee |

|Surname/ACN:       Given Names/Company:       |

|Address: Level/St.:       |

|Address: Suburb:       State: Postcode:       |

|Class of Shares: No. of Shares:       Amt p/ Share: $      |

|(all Shares are held beneficially) OR as Trustee for:       (e.g. trust/ super fund) |

| |

|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |

|Date of Change:       if Transfer, this shareholder is the Transferor Transferee |

|Surname/ACN:       Given Names/Company:       |

|Address: Level/St.:       |

|Address: Suburb:       State: Postcode:       |

|Class of Shares: No. of Shares:       Amt p/ Share: $      |

|(all Shares are held beneficially) OR as Trustee for:       (e.g. trust/ super fund) |

| |

|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |

|Date of Change:       if Transfer, this shareholder is the Transferor Transferee |

|Surname/ACN:       Given Names/Company:       |

|Address: Level/St.:       |

|Address: Suburb:       State: Postcode:       |

|Class of Shares: No. of Shares:       Amt p/ Share: $      |

|(all Shares are held beneficially) OR as Trustee for:       (e.g. trust/ super fund) |

| |

|Shareholder/Member Details* Type of Change Allotment Buy-Back Transfer Cancellation |

|Date of Change:       if Transfer, this shareholder is the Transferor Transferee |

|Surname/ACN:       Given Names/Company:       |

|Address: Level/St.:       |

|Address: Suburb:       State: Postcode:       |

|Class of Shares: No. of Shares:       Amt p/ Share: $      |

|(all Shares are held beneficially) OR as Trustee for:       (e.g. trust/ super fund) |

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|What to do next: Submit form with the following items: |Please forward copies to: |

|copy of a current company extract; OR |e: pliance@.au; OR |

|copy of the company’s annual review statement |f: 1300 139 013. |

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