"Authority to Deal"
Authority to Deal Chandler Private Equities Pty Ltd P: 08 7120 7028 l F: 08 8383 6001 A: PO Box 763 Blackwood SA 5051 E: firstname.lastname@example.org l W: www.chandlerpe.com.au A Corporate Authorised Representative (CAR 333341) of RM Capital Pty Ltd (AFSL 221938) Account No# Adviser Code 1. Client Details Account Name Designation Address Suburb State Postcode Country The Client authorises RM Capital Limited and its representatives to accept instructions from the Agent to order (as defined in ASX Business Rule 2.1) securities on behalf of the Client through the Account. 2. Agent Details Agent’s Name Street Address Suburb State Postcode Telephone (H) Mobile Telephone (W) Email Photo ID Photo Identification Required - please tick you have included a copy of your photo identification The Client agrees to ratify all instructions given to RM Capital Pty Ltd and its representatives by the Agent and will be liable for any debts, charges and expenses arising through the instructions of the Agent. 3. Clients Authority This Authority may only be revoked by written notice from the Client to RM Capital Pty Ltd and will take effect at the commencement of the business day following the date of receipt of the notice revocation. Client Name (1) Client Signature Date Client Name (2) Client Signature Date Client Name (3) Client Signature Date June 2008 Version 1