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Company or Stock in which investment is held SECTION 1 ANNUAL

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Company or Stock in which investment is held SECTION 1 ANNUAL Powered By Docstoc
					                                Company or Stock in which investment is held:


              C/- Security Transfer Registrars Pty Ltd, 770 Canning Highway, Applecross, Western Australia 6153
                         All correspondence to: PO Box 535, Applecross, Western Australia 6953.
                                     Telephone: (08) 9315 2333 Facsimile: (08) 9315 2233
                    Email: registrar@securitytransfer.com.au Web Address: www.securitytransfer.com.au


          ________________________________________________________
          Full Name of Registered Holding

          Address:___________________________________________
                                                                                          ASX CODE:
          __________________________________________________
          __________________________________________________                          Security Reference Number (SRN):
                                                                                      Or Holder Identification Number (HIN)
          __________________________________________________




PLEASE USE BLOCK LETTERS AND BLACK PEN

SECTION 1:                              ANNUAL & QUARTERLY REPORTS

Please select whether you would like to receive the following:
                                      BY               BY
    NO             YES                MAIL             EMAIL
                                                                        Annual Report


                                                                        Any other documents / reports if available

                                              SHAREHOLDER DETAILS
                  Home Telephone Number                                                Facsimile Number


             Work Telephone Number                                                 Mobile Telephone Number


                                                            Email




SECTION 2: TAX FILE NUMBER NOTIFICATION

These are only applicable to Australian investors or Australian residents living overseas.
Non residents living in Australia must indicate the name of their resident country for withholding tax purposes.

Please indicate the type of investment you hold
        Individual Investment:                                               Super Fund
        Joint Investment                                                     Company Investment
        Partnership:                                                         Government:
        Trust:                                                               Exempt: Aged Pensioner, Invalid pensioner, Other
        Non Resident: Please provide name of the country of which you are a resident ……………………………..

N.B Collection of Tax File Number information is authorised and its use and disclosure are strictly regulated by the TAX
LAWS and the PRIVACY ACT. It is not an offence if you do not choose to give your Tax File Number or exemption, but
                                 tax may be taken out of your dividends or interest.
        1st Holder’s TFN                                                                           2nd Holder’s TFN




If exempt, reason for
exemption…………………………………………………………………………………………………………
________________________________________________________________________________________________________

SECTION 3: DIRECT CREDIT OF CASH DIVIDEND PAYMENTS
                         BANK ACCOUNT REQUEST – DO NOT USE YOUR CARD NUMBER
Account – Name in which account is held (eg: John Smith). Please note that payment CANNOT be paid to third party
accounts.




BSB Number                                                                                  Bank Account Number
          -


This must be an Australian bank. If you do not complete this section any cash dividend paid to you will be paid to you
by cheque. Please note that payments cannot be made into third party accounts.
If you change your bank account details you will need to notify Security Transfer Registrars.
______________________________________________________________________________________________

SECTION 4 :                                      DIVIDEND REINVESTMENT PLAN
                                                     NOTICE OF ELECTION

If the company does not have a Dividend Reinvestment Plan or it is currently suspended, then your dividend
will be paid by cheque or direct credit. If you wish to participate in the Company’s Dividend Reinvestment
Plan, tick option 1A or 1B otherwise your dividend will be paid by cheque or direct credit.

I/We wish to participate in the Company’s Dividend Reinvestment Plan.
LEVEL OF PARTICIPATION (select either 1A or 1B).

1A. Full Participation in respect of all fully paid ordinary
    shares in the Company (“Shares”) registered in my/our
    name(s).

1B. Partial Participation in respect of the number of
     shares registered in my/our name(s).


      Please specify either percent or number of Shares.                          %                    OR                  SHARES


2.    Cash Dividend

I/We agree to be bound by the Rules of the Company’s Dividend                                      Reinvestment Plan as they exist from
time to time.

_____________________________________________________________________________________________________
SECTION 5 :SIGN HERE – This section MUST be signed for your instructions to be executed.
       Individual or Securityholder 1                              Securityholder 2                                 Securityholder 3


                   Director                                       Director/Secretary                        Sole Director or Sole Secretary


                     Joint Holdings: Where the holding is in more than one name, all security holders must sign.
                   Companies : Director, Company Secretary, Sole Director and Sole Company Secretary can sign.
                            Note: Two signatures are required unless you are the Sole Director/Secretary.



This information is to be collected by Security Transfer Registrars Pty Ltd (“Security Transfer”) in its capacity as a share registry for issuers of
securities. Your personal information may be provided on a confidential basis to our clients, companies listed on the Australian Stock Exchange,
and other third party providers (including, but not limited to, mailing houses). This information collected for the purpose of assisting Security
Transfer in the proper administration and maintenance of the register of members. By providing this information, you consent to Security Transfer
disclosing this information to such organisations for the purposes outlined. Should you have any queries regarding our privacy policy, please
contact our office.

				
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