Instructing Business: *

Contact Person: *

Address: *

Telephone: *

Facsimile:

Email: *

Fund Name:

Name:

ACN (If Applicable)

Address

Date of Birth (If Applicable)

Place of Birth:

Occupation (If Applicable)

Is this person or entity an employer of any member of the Fund?

State:

Name:

Address:

Date of Birth:

Place of Birth:

Occupation:

TFN:

Binding Death Beneficiary
of Member 1

Name:

Relationship to Member:

Proportion of Benefit (%):

Name:

Address:

Date of Birth:

Place of Birth:

Occupation

TFN

Binding Death Beneficiary
of Member 2

Name:

Relationship to Member:

Proportion of Benefit (%):

Please Answer :

Name:

ACN:

Address:

Director 1

Name:

Address:

Director 2

Name:

Address:

Form of Execution:

1. It is the responsibility of the instructing party at all times to ensure that the information provided is accurate.

2. If new documents have to be prepared as a result of errors in the information given then a further fee will be charged in accordance with the time taken to rectify the error.

3. CR Corporate does not offer any legal advice in the process of drafting the documents requested. If the instructing party requires legal advise then they may make an appointment with one of our commercial lawyers.

4. The documents received will be in a standard form prepared by Solicitors at Coulter Roache Lawyers.

5. All documentation will be prepared on the instructions contained in the order form. CR Corporate has provided no advice to the parties in relation to establishing the particular entity. CR Corporate is not licensed to provide Financial Product ("FP") advice under the Corporations Act 2001 and you should consider taking advice from the holder of an Australian Financial Services Licence before making a decision on an FP.