Short-term Wholesale Funding

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					Australian Government Guarantee Scheme for Large Deposits and Wholesale Funding

                                           GUARANTEED SHORT-TERM WHOLESALE FUNDING - FEE REPORTING FORM
Please use this form to notify the Scheme Administrator of short-term wholesale funding covered under the Australian Government Guarantee Scheme and fees payable.
Please provide this information in both excel format and a signed copy in PDF format.
This information is to be sent to within 7 business days of the end of the month.

Amounts reported and fees need to be calculated in accordance with Schedule 5 of the Scheme Rules.

Queries relating to the completion of this form can be directed to the Scheme Administrator on 1800 013 806.

                         Reporting Eligible ADI                                            <Name>                                                                         Date               <date>

                                       Legal Entity                                        <Name>                                                          For the month of                  <month>

                                 ADI credit rating          Moody's <Rating>                     Standard&Poor's         <Rating>                                         Fitch   <Rating>

                                           Fee Rate                         <Fee Rate>

                For Eligible Foreign ADIs only          Confirmation that the requirements of section B.12 of Schedule 2 have been met                                            Yes

                                                                                 Average daily value (in AUD millions) 1                                          Fee
                                                                                                                                                           (in AUD millions)
                 Currency of issue                             Bank bills                     CDs                     Other                    Total
AUD                                                             <amount>                  <amount>                  <amount>                     0
USD                                                             <amount>                  <amount>                  <amount>                     0
EUR                                                             <amount>                  <amount>                  <amount>                     0
JPY                                                             <amount>                  <amount>                  <amount>                     0
GBP                                                             <amount>                  <amount>                  <amount>                     0
NZD                                                             <amount>                  <amount>                  <amount>                     0
HKD                                                             <amount>                  <amount>                  <amount>                     0
Other                                                           <amount>                  <amount>                  <amount>                     0
Total (in AUD)                                                       0                         0                         0                       0             <amount>

    In calculating the value of liabilities on which the Eligibility Certificate Fee is payable, the gross proceeds of the fund raising are to be used.

                                                                         (Signature of eligible signatory as outlined in Schedule 5 of the Scheme Rules)

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