Individual / Joint Application Form

Which Investment are you applying for?*

Full Company Name*

Quotation of TFN OR ABN

Quotation of your Tax File Number (TFN) or Australian Business Number (ABN) is not compulsory and will not affect your application. However, if you do not provide this information we will be required to deduct tax from your distributions at the highest marginal rate. If exempt, please supply supporting documentation.

Tax File Number or Exemption Code*

Country of Residence for Tax Purposes (if not Australia)

Registration Number ACN, ABN, ARBN (if registered with ASIC) or other Registration Number*

Registration Body (ASIC or name of Foreign Registration Body)

Name of Regulator (if licenced by an Australian Commonwealth, State or Territory statutory regulator (ie an Australian Credit Licensee)

License Details

If an Australian Company registration status with ASIC

Proprietary CompanyPublic Company

If a Foreign Company registration status with the relevant foreign registration body

Proprietary CompanyPublic CompanyOther

If "other" please specify if a public listed company or a majority-owned subsidiary of a public listed company.

Name of Market/Exchange

Listed Holding Company Name (if subsidiary)

If the company is an ASIC registered proprietary company and not listed on an exchange or a private company registered by a foreign registration body please list the name of each director of the company.

Name

First NameLast Name

Name

First NameLast Name

If more than two (2) Directors, please complete on a separate page and attach to this Application Form.

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BENEFICIARY DETAILS

If the company is an ASIC registered proprietary company, not listed on an exchange and not regulated or a private company registered by a foreign registration body please provide details for each Beneficial Owner having more than 25% of the company’s issued share capital through direct or indirect shareholdings or those individuals who directly or indirectly control the company. If no such person can be identified please provide details of the most senior managing officials of the company.
In this context regulated means subject to supervision beyond that provided by ASIC as a company registration body. Examples include Australian Financial Services Licensees, Australian Credit Licensees and Registrable Superannuation Licensees.

Beneficiary 1

First NameLast Name

Residential Address (PO Box is NOT acceptable)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Beneficiary 2

First NameLast Name

Residential Address (PO Box is NOT acceptable)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If more than two (2) Shareholders, please complete on a separate page and attach to this Application Form.

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POLITICALLY EXPOSED PERSON

"politically exposed person" means an individual who holds a prominent public position or function in a government body or international organisation in Australia or overseas.

Are you a politically Exposed Person?*

YesNo

If "Yes" please provide details

INVESTMENT AMOUNT (AUD) - (Must meet minimum investment subscription amount)*

BANKING DETAILS FOR DISTRIBUTIONS / REDEMPTIONS (IF APPLICABLE)

Bank:

Account Name:

BSB:

Account Number:

DISTRIBUTION REINVESTMENT PLAN

Please consider the disclosure document regarding whether or not your investment will receive a cash distribution or if your distribution will be reinvested.

You can change your election at any time by contacting:

registry@primarysecurities.com.au

Please tick the box for your preference.*

I confirm I wish to have my distributions reinvested.I confirm I wish to receive a cash distribution.

CONTACT AND COMMUNICATION

Contact Name

Postal address (unless already provided above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

ADVISER DETAILS (Optional)

I / We agree that information relating to my investment be supplied to my / our adviser. If this Section is not completed, information will not be provided to the adviser.

Advisory Name

Dealer Group

AFSL Number

Postal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Adviser Email

example@example.com

ADVISER PROFESSIONAL FEE FOR SERVICE DETAILS (Optional)

(Please consider the disclosure document if this is applicable to your application)

If you have negotiated a professional fee for service with your financial adviser, you need to complete this section.

PROFESSIONAL FEE FOR SERVICE AUTHORITY

I request until further notice from me, that the Responsible Entity/Trustee deduct a professional fee for service from my Application Amount and/or an ongoing professional fee for service from my distribution payments as set out below. I acknowledge that these fees will be paid to my financial adviser as specified in the Adviser Details section above which forms part of this Application Form and that the balance of my Application Amount will be invested in the Fund and/or the balance of my distribution payments will be paid to me.

I AGREE TO THE PROFESSIONAL FEE FOR SERVICE AUTHORITY ABOVE (Please leave blank if not applicable)

Upfront professional fee for service. Either a percentage of your Application Amount or a fixed amount.

Ongoing professional fee for service. Either a percentage or fixed amount from your distributions up to a maximum of 1% per annum (excluding GST) of your net Application Amount after deduction of any upfront professional fee for service.

Enter % amount of $ amount above

ANNUAL REPORTS

We will send you an email when the annual report is available on our website.

If you would like us to send you a copy of the annual report for the Fund, please indicate below how you would like to receive it:

EmailMail

Email

FOREIGN ACCOUNT TAX COMPLIANCE ACT (FATCA) AND COMMON REPORTING STANDARD (CRS) SELF CERTIFICATION

Tax authorities require Primary Securities Ltd to collect and report certain information about an investor's tax residency status.

If you are unable to answer any of the following questions, please seek appropriate advice relating to the tax information required (as set out in the Automatic Exchange of Information Guidance published by the Australian Taxation Office www.ato.gov.au).

SECTION ONE

Australian Retirement Fund - registered Security Holder

Is the applicant an Australian Retirement Fund (including an Australian Self Managed Superannuation) where the registered security holder is NOT a Financial Institution?

YesNo

If Yes, go to DECLARATION AND SIGNATURE

SECTION TWO - ENTITIES

Are you a US Citizen or resident of the US for tax purposes?

YesNo

Jurisdiction of Tax Residency US Applicants Only - is the entity a Specified US Person for US tax purposes?

Yes - Please provide the applicant’s US taxpayer identification number (TIN) belowNo

Please enter your US TIN

Please indicate the applicant’s jurisdiction of tax residence (other than the US identified above). If a tax resident in more than one jurisdiction please include details for all jurisdictions. If the applicant is a tax resident in Australia write Australia in the table below but do not provide the Australian Tax File number.

Jurisdiction of Tax Residence

Tax Identification Number (TIN) or Equivalent

Reason code if no TIN provided

Reason A: the jurisdiction of the tax residence does not issue TIN's to its residents

Reason B: the individual is otherwise unable to obtain a TIN or equivalent number, (please explain why in the section below)

Reason C: No TIN is required (only select this reason if the domestic law of the relevant jurisdiction does not require the TIN to be disclosed)

Withheld TIN - REASON CODE B Please explain why the individual is unable to obtain a TIN.

Go to section 3 if the applicant is a Financial Institution or Section 4 if the applicant is not a Financial Institution.

SECTION THREE - FINANCIAL INSTITUTIONS

3A. - FATCA STATUS - Is the applicant a Financial Institution for the purposes of FATCA?

Yes - Please provide details belowNo - Continue to Section 3.B

If "Yes" please provide the company’s Global Intermediary Identification Number, or otherwise provide its FATCA status(exempt beneficial owner, deemed compliant FFI, non participating FFI, or excepted Financial Institution)

If a Sponsored Financial Institution please provide the Sponsoring Entity’s name and Global Intermediary Identification Number

Sponsoring Entity’s name

Global Intermediary Identification Number (GIIN)

If a Trustee Documented Trust please provide the Trustee’s name and Global Intermediary Identification Number

Trustee’s name

Global Intermediary Identification Number (GIIN)

3B. CRS STATUS - Specify the type of Financial Institution below (reporting financial institution/non reporting financial institution).

3C. CRS STATUS - Are you an investment entity resident in a non participating jurisdiction for CRS purposes and managed by another financial institution.

Yes - Go to Section FourNo - Go to Declaration and Signature

SECTION FOUR - CONTROLLING PERSONS

If the applicant is: a. for FATCA purposes a Passive NFFE; or b. for CRS purposes a Passive NFE or an investment entity managed by a financial institution with a tax residence in a non CRS jurisdiction.

Please provide details for Controlling Persons below. Please provide the information requested below on any of the applicant’s controlling persons if the controlling person is a tax resident of any country outside of Australia. A controlling person is:

• any natural person that exercises control over a corporation, including directors or beneficial owners who ultimately own 25% or more of the share capital.

• In respect of a trust, any natural person including the trustee, protector, beneficiary settlor or any other natural person exercising ultimate effective control over the trust.

Individuals and Joint Individual Applicants please continue to Section 5.

Name

First NameLast Name

Date of Birth

MonthDayYear

Town of Birth

Country of Birth

Residential Address

Jurisdiction of tax residence (country)

Tax identification number of equivalent

Reason code if no TIN provided (see below)

Reason Codes - Wittheld TIN - If "Reason Code B" Please provide explanation below

Reason A: the jurisdiction of the tax residence does not issue TIN's to its residents

Reason B: the individual is otherwise unable to obtain a TIN or equivalent number, (please explain why in the section below)

Reason C: No TIN is required (only select this reason if the domestic law of the relevant jurisdiction does not require the TIN to be disclosed)

Accepted Documents (Proof of Company)

A certificate of registration or incorporation issued by ASIC or the relevant foreign registration body showing name of company, name of registration body, company identification number and type of company or a recent ASIC search (Australian registered companies) or if regulated a record of regulated status via search of regulator’s register ie RSE licence from APRA or AFSL from ASIC Where details of beneficial owners are required please also provide verification documents as per “Individuals”.

Certificate of Registration (ASIC or equivalent)Recent ASIC searchProof of regulated status (register search)

Proof of Company - File Upload (Certified Copy)

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Please ensure all documents are certified copies. (see list at Proof of ID page)

INDIVIDUAL PROOF OF ID (AML/CRS)
Please upload certified proof of identification documents for all Beneficial Owners named in this form to fulfil the requirements of the Anti Money Laundering and Counter- Terrorism Financing Legislation (see below for links).

For a list of require identification documents Click Here

Proof of ID (Individual Beneficiaries) - File Upload (Certified Copies)

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DECLARATION AND SIGNATURE

I declare and agree that:

1. The details given in this application are true and correct;

2. I am over 18 years of age;

3. My information will be collected and used in accordance with Primary Securities Ltd's privacy policy;

4. The information provided in the FATCA / CRS section may be disclosed to the Australian Taxation Office or any other government bodies, including bodies located overseas, to enable it to be reported and used in compliance with any FATCA or CRS regulations;

5. I will notify Primary Securities Ltd with any changes to the information provided by me and provide any futher information reasonably required by Primary Securities Ltd to comply with any obligation under the FATCA / CRS regulations within 30 days of such change in circumstances.

6. I have read and understood the current Information Memorandum or Product Disclosure Statement to which this application relates and agree to be bound by the Constitution governing the Trust;

7. I am not aware of and have no reason to suspect that the moneys used to fund our investment have been or will be derived from or realted to any money laundering, terrorism financing or similar illegal activities and that I will continue to comply with Australian anti money laundering and counter terrorism financing laws.

8. We acknowledge that the Trust is subject to investment risks, which could include delays in repayment, and loss of income and capital invested and that no member of Primary Securities Ltd, or any of its agents guarantees the performance of the Trust or any particular rate of return;

9. If signed under power of attorney, the attorney encloses a certified copy of the power of attorney and declares that he/she has not received notice of revocation of that power.

10.By typing my signature and sending it via the Internet, I acknowledge that I have read the Information Memorandum or Product Disclosure Statement and understand all information provided during the application process; that I intend Primary Securities Ltd to rely upon it; that I intend to be bound thereby; and that I understand and agree that my electronic signature is the equivalent of a manual written signature.

Signature

Tick capacity

DirectorSecretarySole Director

Date

Signature

Date

Choose capacity

DirectorSecretarySole Director

Once your application has been received and reviewed you will receive an email confirming receipt of your application and advising you of the bank account details for the funds to be deposited.

Company Application Form