BEFORE YOU BEGIN

I am filling in this application as: *

The investor or one of the investorsAn advisor, representative or person assisting the investor/s

Who can invest in the Company

The Company is only open to investors who qualify as Wholesale clients as defined in the Corporations Act.

An investor will generally be regarded as a Wholesale Client if:

the investment into the Company is at least $500,000, or
a qualiﬁed accountant certiﬁes that the person has net assets of at least $2.5 million, or
a qualiﬁed accountant certiﬁes that the person had a gross income for each of the last two ﬁnancial years of at least $250,000, or
the client is a professional investor, or
the client is a Sophisticated Investor.

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Please specify *

CONTACT DETAILS

Your Email Address *

Contact Phone Number *

First Name *

Last Name *

APPLICATION CHECKLIST

Individual, Joint, or Sole Trader Investors

Full name, date of birth, and residential address (no PO Box).
Valid email address and mobile number.
Proof of age (18 years or older).
TFN or reason for exemption (for Australian tax residents).
Source of funds and wealth.
Bank statement showing account name, BSB, and account number.

Joint applications must use a joint bank account in the names of all investors.

Wholesale Investor Certificate (required if total investment is below AUD 500,000). For additional information, please visit ASIC’s website.
Certified identification (see Identity Verification section).
Power of Attorney documentation and specimen signatures (if applicable).
Information collected in accordance with AML/CTF legislation, including details of any beneficial owners.

Partnership Entity Investors

Partnership name and trading name (if applicable).
Full names of all partners.
Registered office and principal place of business (no PO Box).
Copy or extract of the Partnership Agreement.
Regulator details (if applicable).
Source of funds and wealth.
Bank account details.
Wholesale Investor Certificate (required if total investment is below AUD 500,000). For additional information, please visit ASIC’s website.
Certified identification for all partners.
AML/CTF information for all partners and beneficial owners (anyone owning or controlling >25%).

Company Entity Investors

For Australian Companies:

ASIC company extract showing company name, ACN/ABN, registered and business addresses, directors, and shareholders.

For Foreign Companies:

Certificate of Incorporation or Articles of Association showing name, registration number, and type (public/private).

Corporate bank account details.
Source of funds and wealth.
Wholesale Investor Certificate (required if total investment is below AUD 500,000). For additional information, please visit ASIC’s website.
Personal Information Required for Each Director and Beneficial Owner:

Full name (as per identification document)
Residential address (no PO Box)
Date of birth
Country of birth and nationality
Position or role (e.g. Director, Shareholder, Beneficial Owner)
Contact email and mobile number
Certified identification (see Identity Verification section)

AML/CTF information as required.

Trust or Superfund/SMSF Investors

Copy of the Trust Deed (including any variations) confirming:

Trust/Fund name and type
Country of establishment
Names or classes of beneficiaries

Trustee details (individual or corporate).
TFN/ABN and registered address.
Trust/SMSF bank account details.
Source of funds and wealth.
Wholesale Investor Certificate (required if total investment is below AUD 500,000). For additional information, please visit ASIC’s website.
If the Trustee is a Company:
Provide the following for each Director and Beneficial Owner of the corporate trustee:

Full name (as per identification document)
Residential address (no PO Box)
Date of birth
Country of birth and nationality
Role within the entity (e.g. Director, Beneficiary, Appointer)
Certified identification (see Identity Verification section)

AML/CTF information for all trustees, directors, and beneficiaries.

Power of Attorney (if applicable)

If applying under a Power of Attorney, provide:

Certified copy of the Power of Attorney document; and
Specimen signature of the attorney(s).

Beneficial Owners (All Investor Types)

Provide details of each individual who (directly or indirectly):

Owns or controls more than 25% of the entity; or
Has the authority to appoint or remove trustees, partners, or directors.

Identity Verification (All Applicants)

Provide either:

One document from Group 1, or
Two documents from Group 2 (one from each list).

Group 1 – Primary Photo ID
Certified copy of one of the following:

Australian or foreign driver’s licence (front and back)
Australian or foreign passport (expired within 2 years acceptable)
Government-issued ID card (Australian or foreign, showing DOB, signature, and photo)

Group 2 – Secondary ID
Certified copy of one of:

Birth certificate or citizenship certificate (Australian or foreign)
Centrelink pension or health card (front and back)
AND one of:
Utility, rates, or government notice (showing name and residential address, dated within 12 months).

ELIGIBILITY CERTIFICATE

For investments less than $500,000.00, Section 708 of the Corporations Act specifies that a qualified accountant will be required to certify that the investing entity can be classified as a Wholesale Investor. Please download the following document and forward it to your accountant for completion. Once complete, please upload the signed copy below.

Download the Eligibility Certificate and Professional Investor Declaration Template

Please note that the Accountant’s Certificate will need to be reconfirmed every two years. If an Accountant’s Certificate (in the investor's name) has previously been provided to the Company, Investment Manager, or Share Registry Administrator, it is valid for two years from the date it is signed. If you wish to make an investment within six months of the Accountant’s Certificate expiring, you will be required to provide a new one.

* Qualified accountant means any member of:

CPA Australia (CPAA) who is entitled to use the post-nominals ‘CPA’ or ‘FCPA’;
Institute of Chartered Accountants Australia and New Zealand (CA ANZ) who is entitled to use the post-nominals ‘CA’, ‘ACA’ or ‘FCA’;
Institute of Public Accountants (IPA) who is entitled to use the post-nominals ‘AIPA’, ‘MIPA’ or ‘FIPA’; or
Accountants belonging to any of the following foreign bodies who have at least three years of experience in accounting or auditing and are providing this certificate to a person who is a resident in the same country:

American Institute of Public Certified Accountants.
Association of Certified Chartered Accountants (United Kingdom).
Canadian Institute of Chartered Accountants.
Institute of Chartered Accountants of New Zealand.
The Institute of Chartered Accountants in England and Wales.
The Institute of Chartered Accountants in Ireland.
The Institute of Chartered Accountants of Scotland.

ACCEPT THE TERMS AND CONDITIONS

By ticking each of the boxes below, you acknowledge and agree that:

You have read a copy of the offer document in relation to this Company, e.g. the Information Memorandum or Supplementary Information Memorandum. The offer document is an important document and is required by law. We strongly encourage you to read the offer document to help you decide if the investment meets your needs. *

You give consent to use your personal information for Anti-Money Laundering / Know Your Customer(AML/KYC) verification purposes. *

This application form may be accepted, executed or agreed to through the use of an electronic signature in accordance with the Electronic Transactions (Victoria) Act 2000 and the Electronic Transactions Act 1999 (Cth) and will be binding as if it were physically executed. *

I.D. Verification

To comply with Australia’s Anti-Money Laundering and Counter-Terrorism Financing (AML/CTF) legislation, we must collect certain information from prospective investors and their Beneficial Owners supported by either original certified copies of relevant identification documents or reliable and independent electronic data.

By selecting ‘I/We consent’ below and agree to MSC Abacus performing an online identity verification check using the supplied information. The supplied information will be used to confirm your identity with the Australian Government. Your ID document details will be submitted to the Australian Government's Document Verification Service (DVS). The DVS is a national online system that allows organisations to compare an individual’s identifying information with a government record. More information about the DVS is available on their website.

By providing your consent, you agree that:

You are authorised to provide the ID document of the applicant and
You understand that the ID document details will be checked against records held by the Issuer or Official Record Holder (including the supplied information and any documents to be verified with the document issuer or official record holder through the DVS).

I/We consent *

APPLICATION FORM

Deployable Energy Fund Limited

This application relates to an investment in Deployble Energy Fund Limited (ACN 701 609 387 | ABN 31 701 609 387), which is the issuer. Financial services in connection with the Company are provided by the Manager, Deployable Energy Funds Management Pty Ltd (ACN 701 592 350 | ABN 38 701 592 350), a Corporate Authorised Representative (CAR No. 1322961) of Deployable Energy AFSL Pty Ltd (ACN 122 284 888), holder of Australian Financial Services Licence No. 478547. The Information Memorandum (IM) contains important information about investing in the Company and can be downloaded from the Company’s website at www.defl.com.au. You should read the IM in full before applying.

Important: Applications must only be in the name of a natural person or persons, companies or other entities acceptable to the Company. If applying under a Trust structure, all account designations must be in the form (Trustee) ATF (Trust).

APPLICATION AMOUNT

I/We wish to apply for *

SECTION 1: INVESTOR DETAILS

Please complete this section in conjunction with the AML/CTF Checklist. If the AML/CTF information requirements are not satisfied, then your application will not be accepted.

A. INDIVIDUAL INVESTOR PERSONAL DETAILS

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Tax File Number or reason for exemption

Residential address (Not PO Box) *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Country of residence for Tax purposes (if not Australia)If you are not an Australian resident for tax purposes, please indicate your country of residence for tax purposes.

Phone (Work)

Phone (Home)

Mobile *

Individual Investor - Document Upload

Driver's Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Driver’s Licence (Australian State or Territory), or foreign country equivalent containing a photograph and signature of the holder (accompanied, where relevant, by English language translation by an accredited translator).

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Current passport issued by the Australian Commonwealth (or current within the preceding two years provided not cancelled) or Current passport or similar document issued for the purpose of international travel that contains a photograph and signature of the person and is issued by a foreign government, UN or UN Agency (accompanied where relevant by English language translation by an accredited translator).

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

A. JOINT HOLDING DETAILS

INVESTOR 1 - PERSONAL DETAILS

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Tax File Number or reason for exemption

Residential address (Not PO Box) *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Country of residence for Tax purposes (if not Australia)If you are not an Australian resident for tax purposes, please indicate your country of residence for tax purposes.

Phone (Work)

Phone (Home)

Mobile *

Joint Investor 1 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

INVESTOR 2 - PERSONAL DETAILS

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Tax File Number or reason for exemption

Residential address (Not PO Box) *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Country of residence for Tax purposes (if not Australia)If you are not an Australian resident for tax purposes, please indicate your country of residence for tax purposes.

Phone (Work)

Phone (Home)

Mobile *

Joint Investor 2 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

A. SOLE TRADER PERSONAL DETAILS

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Tax File Number or reason for exemption

Australian Business Number (ABN)

Business Name (for Sole Trader)

Residential address (Not PO Box) *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Country of residence for tax purposes (if not Australia)If you are not an Australian resident for tax purposes, please indicate your country of residence for tax purposes.

Phone (Work)

Phone (Home)

Mobile *

Sole Trader - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

B. COMPANY / CORPORATE TRUSTEE DETAILS

ABN

Lookup

Please use the lookup function or enter details manually.

ACN *Please use the lookup function or enter details manually.

ABN StatusPlease use the lookup function or enter details manually.

ABN Status Effective FromPlease use the lookup function or enter details manually.

Full Name of Entity *Please use the lookup function or enter details manually.

Entity TypePlease use the lookup function or enter details manually.

Entity Registered PostcodePlease use the lookup function or enter details manually.

Registered StatePlease use the lookup function or enter details manually.

Company - Certificate of Registration

Browse

Australian Company - A current full company search of ASIC databases showing the following: the full name of the company, the ABN/ACN, the registered office address of the company, and the principal place of business of the company. Foreign Company: Company’s Certificate of Registration / Incorporation (issued by ASIC or by a regulatory or Government Authority stating the company type (public or private) and Registration Number; or Articles of Association stating the Company’s name and type (public or private).

Tax File Number or reason for exemption

Business Name (if applicable)

Registered office address (not PO Box) *

Street address *Street address line 2

City *

State *

Postcode *

Country *

The Principal Place of Business address is the same as the Registered office address.Provide the Principal Place of Business address.

Principal Place of Business (not PO Box) *

Street address *Street address line 2

City *

State *

Postcode *

Country *

* For registered foreign companies, this may be the name (care of) and address of the Company’s local agent (if any).

Is this a *

Public Companya majority owned subsidiary of a public company ora private company

If this entity is a public company, please provide details of the exchange on which it is listed: *

If this entity is a majority owned subsidiary of a public company, please provide the following details:

Name of the parent company: *

Details of the exchange on which the parent company is listed: *

If this entity is a private company you must also provide details of the directors and beneficial owners.

DIRECTORS PERSONAL DETAILS

Number of Directors *

Director 1 - Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Director 1 - Residential address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Director 1 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Director 2 - Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Director 2 - Residential address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Director 2 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Director 3 - Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Director 3 - Residential address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Director 3 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Director 4 - Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Director 4 - Residential address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

If there are more than four directors, please provide details to MSC Abacus via email at registry@msc.group and quote application details.

Mobile

Director 4 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

BENEFICIAL OWNERS PERSONAL DETAILS

Please provide details of all individuals who are beneficial owners through one or more shareholdings of more than 25% of the issued capital of the company.

Beneficial owner(s) is/are the same as Director(s).If Beneficial owners are different, provide details below.

Number of Beneficial Owners *

Beneficial Owner 1 - Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Beneficial Owner 1 - Residential address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Beneficial Owner 1 - Document Upload

Driver's Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Beneficial Owner 2 - Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Beneficial Owner 2 - Residential address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Beneficial Owner 2 - Document Upload

Driver's Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Beneficial Owner 3 - Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Beneficial Owner 3 - Residential address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Beneficial Owner 3 - Document Upload

Driver's Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Beneficial Owner 4 - Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Beneficial Owner 4 - Residential address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

If there are more than four beneficiaries, please provide details to MSC Abacus via email at registry@msc.group and quote application details.

Mobile

Beneficial Owner 4 - Document Upload

Driver's Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

C. PARTNERSHIPS DETAILS

Full Name of Partnership *

Business Name (if applicable)

Tax file number or reason for exemption

Country of Establishment *

Registered Office address (not PO Box) *

Street address *

City *

State *

Postcode *

Country *

Partnership Agreement

Browse

Please upload a certified copy or relevant extracts of the partnership agreement, the full name of the partnership and any business name(s) used by the partnership.

PARTNER 1 - PERSONAL DETAILS

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Residential address (not PO Box) *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Tax file number or reason for exemption

Country of residence for tax purposes (if not Australia)

Phone (Work)

Phone (Home)

Mobile *

Partner 1 - Document Upload

Driver's Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

PARTNER 2 - PERSONAL DETAILS

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth

Country of Birth *

Residential address (not PO Box) *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Tax file number or reason for exemption

Country of residence for tax purposes (if not Australia)

Phone (Work)

Phone (Home)

Mobile *

Partner 2 - Document Upload

Driver's Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

REGULATION INFORMATION

Is the Partnership regulated by a Professional Body? *

Yes. Provide the following detailsNo

Association name

Association website

Partner’s membership number / reference

D. TRUST / SUPERANNUATION FUNDS DETAILS

Please select the structure of your Trust/Superfund *

Individual Trustee/(s)Corporate Trustee

No. of Individual Trustee/(s) *

No. of Directors *

Full name of Company or Corporate Trustee

Registered office address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Full Name of Trust *

Full Name of Superannuation Fund *

Tax file Number or Reason for Exemption

Country where Trust / Superannuation was established

Certified copy of Trust Deed - Unregulated Trusts and Self-Managed Superannuation Funds

Browse

Please upload a certified copy of the trust deed (including any variations to the trust deed) confirming the full name of the trust, the type of trust, the country where the trust was established, and the name of each beneficiary or class of beneficiary.

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

DIRECTORS DETAILS (CORPORATE TRUSTEE)

Director 1 - Details (Corporate Trustee)

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Director 1 (Corporate Trustee) - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Director 2 - Details (Corporate Trustee)

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Director 2 (Corporate Trustee) - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Director 3 - Details (Corporate Trustee)

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Director 3 (Corporate Trustee) - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Director 4 - Details (Corporate Trustee)

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Director 4 (Corporate Trustee) - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

TRUSTEE DETAILS

Trustee 1 Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Trustee 1 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Trustee 2 Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Trustee 2 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Trustee 3 Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Trustee 3 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

Trustee 4 Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Trustee 4 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Eligibility Certificate and Professional Investor Declaration (if required)

Browse

If your investment is below $500,000.00, the applicant must provide a Wholesale Investor Certificate issued by a qualified accountant. For additional information, please visit ASIC’s website.

REGULATED TRUST

If the Investment is via a Regulated Trust or SMSF, select and complete one of the following 3 options and then go to section E - Politically Exposed Persons.

Self-Managed Superannuation Fund

ABN

Registered Managed Investment Scheme

ARSN

Other Regulated Trust Name of Regulator

Please provide Name of Regulator and Registration/Licensing details

UNREGULATED TRUST

If the Investment is via an Unregulated Trust, select the Type of Unregulated Trust and provide Beneficiary details, Settlors details and Beneficial Owner details.

Please specify

BENEFICIARY DETAILS

Do the terms of the trust identify the beneficiaries by reference to membership of a class?

Yes. Provide details of membership classes (unitholders, family members of named person, charitable organisations).No. Please complete the following:

Beneficiary(s) is/are the same as Director(s) and/or Individual Trustees.If the Beneficiary(s) is/are different, provide details below.

Number of Beneficiaries

Beneficiary 1 - Personal Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address (not PO Box) *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Beneficiary 1 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Beneficiary 2 - Personal Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address (not PO Box) *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Beneficiary 2 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Beneficiary 3 - Personal Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address (not PO Box) *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Beneficiary 3 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Beneficiary 4 - Personal Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address (not PO Box) *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Beneficiary 4 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

If there are more than four beneficiaries, please provide details to MSC Abacus via email at registry@msc.group and quote application details.

SETTLOR DETAILS FOR UNREGULATED TRUST

This is only required if the amount used to establish the trust was greater than $10,000 unless the Settlor is deceased.

The full name of the SettlorPlease provide the full name of the Settlor

Settlor - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Front)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

BENEFICIAL OWNER(S) / CONTROLLER OF THE TRUST

Please provide details of each individual who (directly or indirectly):

Owns more than 25% of the trust; orControls the trust.

If neither of these applies, then any individual who holds the power to appoint or remove the trustee of the trust (‘Appointer’).

Beneficial owner(s) is/are the same as Trustee(s).If Beneficial owners are different, provide details below.

Number of Beneficial Owners

Beneficial Owner 1 - Personal Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Residential address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Beneficial Owner 1 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Beneficial Owner 2 - Personal Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Residential address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Beneficial Owner 2 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Beneficial Owner 3 - Personal Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Residential address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Beneficial Owner 3 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Beneficial Owner 4 - Personal Details

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Residential address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

If there are more than four beneficial owners, please provide details to MSC Abacus via email at registry@msc.group and quote application details.

Mobile

Beneficial Owner 4 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

E. POLITICALLY EXPOSED PERSON (‘PEP’)

A PEP is an individual who holds a prominent public position or role in a government body or international organisation, either in Australia or overseas. Immediate family members and/or close associates of these individuals are also considered PEPs.

Types of PEPs

The AML/CTF Act identifies three types of PEPs.

Domestic PEP – someone who holds a prominent public position or role in an Australian government body.
Foreign PEP – someone who holds a prominent public position or role with a government body in a country other than Australia. This would include foreign PEPs working or residing in Australia.
International organisation PEP – someone who holds a prominent public position or role in an international organisation, such as the United Nations (UN), the World Trade Organisation (WTO) or the North Atlantic Treaty Organisation (NATO).

Is the Applicant a Politically Exposed Person? *

NoYes

Please provide the name of anyone that is named in this Application Form as a PEP or is an immediate family member or close associate of a PEP. *

SECTION 2: APPLICANT’S TAX RESIDENCY AND CLASSIFICATION - FATCA AND CRS

Important

All investors must complete this section to declare their FATCA and CRS status. The Company or the administrator is unable to provide you with tax or professional advice in respect of FATCA or CRS, and we strongly encourage you to seek the advice of an experienced tax or professional adviser in relation to completing this form.

What are FATCA & CRS?

The U.S. Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) are two ways in which a large number of governments are seeking the same thing – to improve global tax compliance. Both require financial institutions to capture relevant information on foreign taxpayers, as follows:

FATCA promotes cross-border tax compliance by U.S. taxpayers by implementing an international standard for the automatic exchange of information related to those taxpayers. Australia has entered into an inter-governmental agreement (IGA) with the U.S. to implement FATCA in Australia, to be administered through the ATO. The AUS-USA FATCA IGA requires the ATO to obtain detailed account information for U.S. citizens and/or taxpayers on an annual basis. The effect of this is that to satisfy their FATCA obligations, relevant Australian financial institutions must identify any U.S. taxpayers and report those taxpayers’ financial account data to the ATO.
CRS is a global reporting standard developed by the OECD for the automatic exchange of information (AEoI). Its goal is to allow tax authorities to obtain a clearer understanding of financial assets held abroad by their residents for tax purposes. Over 88 countries (refer to OECD link in section IV for participating jurisdictions) have agreed to share information on residents’ assets and incomes in accordance with defined reporting standards. Once again, this means that financial institutions around the globe must provide tax authorities with taxpayer financial account data, and the financial institutions must therefore collect this information from their customers and pass it on.

If you are unable to complete Section 2, please seek appropriate advice relating to the tax information required. For further details relating to the implementation of FATCA and CRS, please refer to the Australian Taxation Office (ATO) website.

Further information about FATCA & CRS can be found at:

A. TAX RESIDENCE - INDIVIDUAL

A. TAX RESIDENCE – SOLE TRADER

Please provide details for all jurisdictions in which the Applicant is resident for tax purposes.

Are you a Tax Resident (outside Australia) *

YesNo

If so, how many? *

Country of Tax Residence 1 *

Taxpayer Identification Number (TIN) 1 *

Country of Tax Residence 2 (if applicable) *

Taxpayer Identification Number (TIN) 2 (if applicable) *

Country of Tax Residence 3 (if applicable) *

Taxpayer Identification Number (TIN) 3 (if applicable) *

I certify the tax residence countries provided represent all countries in which I am considered a tax resident.
If Applicant has more than three countries of tax residence please attach a statement to this form containing Applicant, the Country and TIN for each such additional country.

Are you a U.S. citizen or U.S. resident for tax purposes?

A US person includes a US citizen or resident alien of the US even if residing outside the US *

Yes. If ‘Yes’, the Applicant’s US country of residence and US Tax Identification Number must be provided above.No.

A. TAX RESIDENCE – JOINT HOLDING

INVESTOR 1

Please provide details for all jurisdictions in which the Applicant is resident for tax purposes.

Are you a Tax Resident (outside Australia) *

YesNo

If so, how many? *

Country of Tax Residence 1 *

Taxpayer Identification Number (TIN) 1 *

Country of Tax Residence 2 (if applicable) *

Taxpayer Identification Number (TIN) 2* (if applicable) *

Country of Tax Residence 3 (if applicable) *

Taxpayer Identification Number (TIN) 3* (if applicable) *

Are you a U.S. citizen or U.S. resident for tax purposes?

A US person includes a US citizen or resident alien of the US even if residing outside the US *

Yes. If ‘Yes’, the Applicant’s US country of residence and US Tax Identification Number must be provided above.No.

INVESTOR 2

Please provide details for all jurisdictions in which the Applicant is resident for tax purposes.

Are you a Tax Resident (outside Australia) *

YesNo

If so, how many? *

Country of Tax Residence 1 *

Taxpayer Identification Number (TIN) 1* *

Country of Tax Residence 2 (if applicable) *

Taxpayer Identification Number (TIN) 2* (if applicable) *

Country of Tax Residence 3 (if applicable) *

Taxpayer Identification Number (TIN) 3* (if applicable) *

Are you a U.S. citizen or U.S. resident for tax purposes?

A US person includes a US citizen or resident alien of the US even if residing outside the US *

Yes. If ‘Yes’, the Applicant’s US country of residence and US Tax Identification Number must be provided above.No. Go to Section 3.

* TIN is the number assigned by each country, for the purpose of administering tax laws (equivalent of a Tax File Number in Australia).

B. COMPANIES, TRUSTS, PARTNERSHIPS AND OTHER ENTITIES

I. TAX RESIDENCE – COMPANIES, TRUSTS AND OTHER ENTITIES

Please provide details for all jurisdictions in which the Applicant is a resident for tax purposes.

Are you a Tax Resident (outside Australia) *

YesNo

If so, how many? *

Country of Tax Residence 1 *

Taxpayer Identification Number (TIN) 1 *

Country of Tax Residence 2 (if applicable) *

Taxpayer Identification Number (TIN) 2 (if applicable) *

Country of Tax Residence 3 (if applicable) *

Taxpayer Identification Number (TIN) 3 (if applicable) *

I certify the tax residence countries provided represent all countries in which I am considered a tax resident.

If Applicant has more than three countries of tax residence, please provide details below.

II. FATCA STATUS – COMPANIES, PARTNERSHIPS, TRUSTS AND OTHER ENTITIES

Is the Applicant a specified US person? *

Yes, Provide a US TIN and complete US Person Certification below.If no, complete the Non-US Person Certification section below.

US Person Certification

US Taxpayer Identification Number (‘TIN’): *TIN is the number assigned by each country for the purpose of administering tax laws (equivalent to a Tax File Number in Australia).

Non-US Person Certification

Please provide your FATCA status below.

Select a deemed-compliant category: *

Trustee-Documented Trust (Provide GIIN below)Sponsored Investment Vehicle (Provide GIIN and Sponsor’s name below)Registered-Deemed Compliant FFI (Provide GIIN below)Other Deemed-Compliant Category

APPLICANT’S GLOBAL INTERMEDIARY IDENTIFICATION NUMBER (‘GIIN’)Applicant’s GIIN (if any)

III. CRS STATUS – COMPANIES, TRUSTS AND OTHER ENTITIES

IS THE APPLICANT A FINANCIAL INSTITUTION?

Financial Institution

Is the Applicant an Investment Entity located in a non-CRS Participating Jurisdiction managed by another Financial Institution? *

Yes, if yes, please complete the section – Controlling Persons.No, if no, please complete the section below.

Non-Financial Entity (‘NFE’)

If the Applicant is an NFE, select a classification that matches your CRS status: *

Government Entities, International organisations and the Central BankA corporation the stock of which is regularly traded on an established securities market (or entity related to such a corporation):Non-Reporting Financial Institution (includes Broad Participation Retirement Fund, Narrow Participation Retirement Fund, Exempt Collective Investment Vehicle, Trustee Documented Trust and Self-managed Superannuation Fund)Other Active NFFEPassive NFE (Please provide Controlling Persons details)Other – (please provide CRS Status)

Name of Securities Market *

Name of Related Entity *

Please provide your CRS Status below. *

CONTROLLING PERSON

This section is considered an integral part of the self-certification to which it is associated. If there is a change in Controlling Persons / Beneficial Ownership, please submit an updated form within 30 days.

Controlling person(s) is/are the same as director(s).If the Controlling Person is different to the Director/(s), please provide details below.

Number of Controlling Persons

Controlling Person 1

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Are you a Tax Resident (outside Australia) *

YesNo

If so, how many? *

Country of Tax Residence 1 *

Taxpayer Identification Number (TIN) 1 *

Country of Tax Residence 2 (if applicable) *

Taxpayer Identification Number (TIN) 2 (if applicable) *

Country of Tax Residence 3 (if applicable) *

Taxpayer Identification Number (TIN) 3 (if applicable) *

Controlling Person 1 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Controlling Person 2

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Are you a Tax Resident (outside Australia) *

YesNo

If so, how many? *

Country of Tax Residence 1 *

Taxpayer Identification Number (TIN) 1 *

Country of Tax Residence 2 *

Taxpayer Identification Number (TIN) 2 (if applicable) *

Country of Tax Residence 3 *

Taxpayer Identification Number (TIN) 3 (if applicable) *

Controlling Person 2 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Controlling Person 3

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Are you a Tax Resident (outside Australia) *

YesNo

If so, how many? *

Country of Tax Residence 1 *

Taxpayer Identification Number (TIN) 1 *

Country of Tax Residence 2 *

Taxpayer Identification Number (TIN) 2 (if applicable) *

Country of Tax Residence 3 *

Taxpayer Identification Number (TIN) 3 (if applicable) *

Controlling Person 3 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

Controlling Person 4

Title *

First Name *

Middle Name

Last Name *

Date of Birth *

City of Birth *

Country of Birth *

Address *

Street address *Street address line 2

City *

State *

Postcode *

Country *

Mobile

Are you a Tax Resident (outside Australia) *

YesNo

If so, how many? *

Country of Tax Residence 1

Taxpayer Identification Number (TIN) 1

Country of Tax Residence 2

Taxpayer Identification Number (TIN) 2 (if applicable)

Country of Tax Residence 3

Taxpayer Identification Number (TIN) 3 (if applicable)

If there are more than 4 Controlling Persons or Beneficial Owners or Countries of Tax Residence, please provide the details below.

Controlling Person 4 - Document Upload

Driver’s Licence Number

Card Number

Issuer

Australian or Overseas Driver's Licence (Front)

Browse

Australian or Overseas Driver's Licence (Back)

Browse

Passport Number

Passport Issuer Country

Australian or Overseas Passport

Browse

Power of Attorney (if applicable)

Browse

Applications submitted under a power of attorney must be accompanied by an original certified copy of the power of attorney document and a specimen signature of the relevant attorney(s).

SECTION 3: DISTRIBUTION PAYMENT DETAILS

I/we elect to receive distributions by: *

Pay to the bank account.

Please make deposits and redemptions to the following account:

Bank Name: *

Account Name: *

BSB Number: *

Account Number: *

For us to process your application, please select either option 1 or option 2 *

Option 1 - Important: Please provide a copy or an extract of your bank statement reflecting your Name, BSB and Account number so that we can verify the details against the application form.Option 2 - I / We opt for a call-back verification

Important: Please provide a copy or an extract of your bank statement reflecting your Name , BSB and Account number so we can verify the details provided.

Browse

Please provide a suitable time and contact phone number, and we will give you a call to verify the details.

SECTION 4: METHOD OF PAYMENT

$USD DIRECT DEPOSIT

Application Amount

Important

Following the satisfactory completion of AML/KYC due diligence and verification of your eligibility to participate, we will provide you the relevant bank account details to fund your investment.

SECTION 5: REPORTING

Primary EmailPlease indicate your preferred email address to receive communications about your Investment.

Full NamePrimary Contact

Contact Phone NumberPrimary Contact

Secondary EmailSecondary Contact Email

Full NameSecondary Contact

Contact Phone NumberSecondary Contact

Accountant Details

Accountant/Financial Contact Name

Accountant/Financial Contact Email

If you would like copies of the correspondence emailed to your Financial Adviser, and if you authorise your Financial Adviser to access your investment information (in respect of all your investments) on the Investor Portal, please have your Financial Adviser complete the section on the next page.

SECTION 6: ADVISER USE ONLY

Dealer Group:

Dealer Group AFSL:

Adviser Firm:

Adviser Firm AFSL:

Adviser Name:

Authorized Representative Number:

Adviser Email Address:

Adviser Contact Phone Number:

Adviser Signature

Draw signature|Type signatureClear

DECLARATION AND SIGNING

By completing, signing and lodging this Application Form, you acknowledge and agree that:

You have read in full and understood the IM to which this Application Form relates, including understanding the risks set out in the IM.
You will promptly notify the Company and the Investment Manager of any change to the information you have previously provided to the Company or the Investment Manager, including any changes which result in a person or entity controlling, owning or otherwise holding an interest in the Company.
You consent to the Company and the Investment Manager disclosing any information it has in compliance with its obligations under the US Foreign Account Tax Compliance Act (‘FATCA’) and the OECD Common Reporting Standards for Automatic Exchange of Financial Account Information (‘CRS’) and any related Australian law and guidance implementing the same. This may include disclosing information to the Australian Taxation Office, who may in turn report that information to the relevant tax authorities as required.
The details you have inserted into the Application Form are complete and accurate and where applicable reflects your tax status for purposes of FATCA/CRS.
You acknowledge that the collection of your personal information may be required by the Financial Transaction Reports Act 1988, the Corporations Act 2001, the Income Tax Assessment Act 1936, the Income Tax Assessment Act 1997, the Taxation Administration Act 1953, the FATCA and CRS (includes any related Australian law and guidance) and the Anti-Money Laundering and Counter- Terrorism Financing Act 2006.
You will provide the Company and the Investment Manager with all additional information and assistance that the Company and the Investment Manager may request in order for the Company and the Investment Manager to comply with the AML/CTF Law, FATCA and CRS.
You will be bound by the Company's constitution and the terms on which the Shares are being issued (as explained in the IM).
If you are sole signatory signing on behalf of a company, you confirm that you are signing as sole director and sole secretary of the company or as duly authorised representative or agent of the company.
If you are investing as a trustee, on behalf of a superannuation fund or a trust, you confirm that you are acting in accordance with your designated powers and authority under the trust deed. In the case of a superannuation fund, you also confirm that it is a complying fund under the Superannuation Industry (Supervision) Act.

If you sign this Application Form under a power of attorney, then a certified copy of the power of attorney is submitted with this Application Form, which as at the date of this application, has not been revoked.
You are over the age of 18.
You have made an offer for Shares in the Company and that offer cannot be revoked.
You acknowledge that an updated IM will not be reissued after the establishment of the Company's constitution, unless there is a material change to the IM.
We may accept or reject this application in whole or in part.
You may not be allocated any Shares, and the Company has absolute discretion to allocate Shares as it sees fit.
You have had the opportunity to seek independent professional advice regarding the legal, taxation and financial implications of investing in the Shares and in the Company generally.
You have not relied on any statements or representations made by anybody (including the Company, Investment Manager, Licensee or their officers, employees or agents) prior to applying, other than those representations made in this IM.
Monies invested in the Company do not represent an investment in or a deposit of or other liability of the Company, Licensee or Investment Manager and an investment is subject to investment risk, including possible delays in the repayment and loss of income and capital investment.
You have provided all documentation requested for AML/CTF investor identification purposes.
If your investment is via a trust that is not a registered managed investment scheme or a government superannuation fund and you have not provided details of the name of each beneficiary or class of beneficiary, you certify that the trust is an unregistered managed investment scheme that only has wholesale clients as beneficiaries and does not make small scale offerings under section 1012E of the Corporations Act.
If an adviser’s details are provided in the Application Form, the Company, Investment Manager and Share Registry Administrator are authorised to provide information directly to that adviser and their AFSL.
I/We confirm that I/we have read and understood the privacy section contained in the IM.

DECLARATION AND SIGNING (continued)

By signing this Application Form, you acknowledge that you have received and read the current Information Memorandum (IM), either accompanied with this Application Form or available for download from the Company’s website at www.defl.com.au. Shares will only be issued upon receipt of a valid Application Form completed in accordance with the IM.

Applicant #1

Name *Applicant 1 or Individual or Sole Director and Sole Company Secretary

Date *

Individual

Sole Trader

Sole Director and Company SecretaryDirectorTrustee

Signature *

Draw signature|Type signatureClear

Applicant 1 or Individual or Sole Director and Sole Company Secretary

Applicant #2

NameJoint Applicant 2 or Partner 2 or Director/Company Secretary

Date

Joint Applicant

Company Secretary (for company investments only)DirectorTrustee

Signature

Draw signature|Type signatureClear

Joint Applicant 2 or Partner 2 or Director/Company Secretary

SIGNING INSTRUCTIONS

This form should be signed by the investor. If a joint holding, all investors should sign unless indicated otherwise on your latest operating instructions. If signed by the investor’s attorney, the power of attorney must have been previously noted by the registry or a certified copy attached to this form. If executed by a company, the form must be executed in accordance with the company’s constitution and the Corporations Act 2001 (Cth) (or for New Zealand companies, the Companies Act 1993).

Save and Complete Later