Use this section to notify the name and address of each person who consents to become a member. If shares are jointly owned, provide names and addresses of all joint-owners as an attachment, clearly indicating the share class and with whom the shares are jointly owned.

Note: Beneficially held usually means that the owner of the shares is entitled to the direct benefit from the shares. For example, benefits could include the entitlements to payments in relation to dividends. Shares held by a person as trustee, nominee or on account of another person are non-beneficially held.

I/we apply for registration of a company on the basis of the information in this form and any attachments. I/we have the necessary written consents and agreements referred to in the application concerning the member and officeholders and I/we shall give the consents and agreements to the company after the company becomes registered. The information provided in the application and in any attachments is true and correct at the time of signing.