Merge Multiple Holdings
Company, Trust, Warrant or Product in which investment is held
Full Name(s) of Registered Holding
Account Designation
Please return this form to the
registrar of the issuer
Registered Address
Securityholder Reference Number (SRN)
Please use a BLACK pen. Print CAPITAL
letters inside the combed boxes below.
If you wish to merge two or more of your Issuer Sponsored holdings that share the same registered name and address, please print the
Securityholder Reference Number (SRN) of the holdings that you wish to merge in the “FROM” box. In the “TO” box please list the SRN of
the holding that you wish to retain. Once the form is completed simply return it in the enclosed reply paid envelope.
Please note that only holdings with the same names can be merged. For example, a holding for John Smith and a holding for John and Peter
Smith cannot be consolidated as this would alter the names of one of the holdings.
We can not merge CHESS holdings (the Holder Identification Number (HIN) begins with an “X”) with Issuer Sponsored holdings
(SRNs that begin with an “I”).
FROM:
FROM:
FROM:
TO:
Where multiple holdings have differing instructions in relation to direct credit
instructions, DRP participation, Tax File Number and communications
options, the instructions on the SRN which appears in the above “TO” box
will be the current instructions for your merged holdings. By completing this
form, you authorise and consent to merging the nominated holdings and are
satisfied with the standing instruction of the “TO” holding.
Please complete here in case we need to contact you:
Contact Mobile Number Contact Name
Securityholder 1 (Individual) Joint Securityholder 2 (Individual) Joint Securityholder 3 (Individual)
Sole Director and Sole Company Director/Company Secretary
Secretary/Director
Signing Instructions: This form should be signed by the securityholder. If a joint holding, all securityholders
should sign. If signed by the securityholder’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
accordancewith the company’s constitution andthe Corporations Act 2001 (Cth) (or for New Zealandcompanies,
Date
the Companies Act 1993).
ver:17-02-2014
SIGNATURE(S) OF SECURITYHOLDER(S) THIS MUST BE COMPLETED
MERGE MULTIPLE HOLDINGS
