XYZ PTY LTD
A.C.N. 111 222 333

To The Director(s),

I, Adam Smith

Of 123 Smith Street, SMITHVILLE   NSW   2015

Hereby apply for ONE HUNDRED Ordinary share(s) payable at $1.00 (ONE DOLLAR) each.

I agree to accept the said allotment and to be bound by the Replaceable Rules/Constitution/Memorandum & Articles of Association of the Company and  hereby authorise my name to be placed on the Register of Members.

Dated:Signature:

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