Common use of CORPORATE DETAILS Clause in Contracts

CORPORATE DETAILS. l) Full Legal Name of Entity Trading Name (if different to above) Entity Name to appear on Card and Reporting (maximum 24 characters) Registered Office Address (as registered with Companies Office) City Postcode Principal Place of Business (if different from above) City Postcode Mailing Address (if different from Principal Place of Business) City Telephone Number Fax Number What type of Company? What is your legal entity type? Postcode – – Private Public New Zealand Company Partnership* Registered Foreign Company Government Body Co-operative* Association / Club / Society* Unregistered Foreign Company Other * Note: For non-Company entities, please provide certified establishing documents (eg. Constitution, Partnership agreement etc). Certifier should print their name, sign, date and include their qualification and registered number on the document. Company registration No. Other entity registration/Identification number Jurisdiction of Incorporation For Association/Club/Society please state legal status and purpose Industry or Nature of Business Annual Revenue/Turnover Date Company Formed D D / M M / Y Y Number of Employees AEX9691 10/15 All fields are MANDATORY and must be completed in black pen and BLOCK LETTERS. S/C: PD1Ø7ØØ2Ø1

CORPORATE DETAILS. l) Full Legal Name of Entity Trading Name (if different to above) Entity Name to appear on Card and Reporting (maximum 24 characters) Registered Office Address (as registered with Companies Office) City Postcode Principal Place of Business (if different from above) City Postcode Mailing Address (if different from Principal Place of Business) City Telephone Number Fax Number What type of Company? What is your legal entity type? Postcode – – Private Public New Zealand Company Partnership* Registered Foreign Company Government Body Co-operative* Association / Club / Society* Unregistered Foreign Company Other * Note: For non-Company entities, please provide certified establishing documents (eg. Constitution, Partnership agreement etc). Certifier should print their name, sign, date and include their qualification and registered number on the document. Company registration No. Other entity registration/Identification number Jurisdiction of Incorporation For Association/Club/Society please state legal status and purpose Industry or Nature of Business Annual Revenue/Turnover Date Company Formed D D / M M / Y Y Number of Employees AEX9691 10/15 AEX9672 04/18 All fields are MANDATORY and must be completed in black pen and BLOCK LETTERS. S/C: PD1Ø7ØØ2Ø1

CORPORATE DETAILS. l) Full Legal Name of Entity Trading Name (if different to above) Entity Name to appear on Card and Reporting (maximum 24 characters) Registered Office Address (as registered with Companies Office) City Postcode Principal Place of Business (if different from above) City Postcode Mailing Address (if different from Principal Place of Business) City Telephone Number Fax Number What type of Company? What is your legal entity type? Postcode – – Private Public New Zealand Company Partnership* Registered Foreign Company Government Body Co-operative* Association / Club / Society* Unregistered Foreign Company Other * Note: For non-Company entities, please provide certified establishing documents (eg. Constitution, Partnership agreement etc). Certifier should print their name, sign, date and include their qualification and registered number on the document. Company registration No. Other entity registration/Identification number Jurisdiction of Incorporation For Association/Club/Society please state legal status and purpose Industry or Nature of Business Annual Revenue/Turnover Date Company Formed D D / M M / Y Y Number of Employees AEX9691 10/15 AEX9672 03/15 All fields are MANDATORY and must be completed in black pen and BLOCK LETTERS. S/C: PD1Ø7ØØ2Ø1

CORPORATE DETAILS. l) Full Legal Name of Entity Trading Name (if different to above) Entity Name to appear on Card and Reporting (maximum 24 characters) Registered Office Address (as registered with Companies Office) City Postcode Principal Place of Business (if different from above) City Postcode Mailing Address (if different from Principal Place of Business) City Telephone Number Fax Number What type of Company? What is your legal entity type? Postcode – – Private Public New Zealand Company Partnership* Registered Foreign Company Government Body Co-operative* Association / Club / Society* Unregistered Foreign Company Other * Note: For non-Company entities, please provide certified establishing documents (eg. Constitution, Partnership agreement etc). Certifier should print their name, sign, date and include their qualification and registered number on the document. Company registration No. Other entity registration/Identification number Jurisdiction of Incorporation For Association/Club/Society please state legal status and purpose Industry or Nature of Business Annual Revenue/Turnover Date Company Formed D D / M M / Y Y Number of Employees AEX9691 10/15 03/15 All fields are MANDATORY and must be completed in black pen and BLOCK LETTERS. S/C: PD1Ø7ØØ2Ø1

CORPORATE DETAILS. l) Full Legal Name of Entity Trading Name (if different to above) Entity Name to appear on Card and Reporting (maximum 24 characters) Registered Office Address (as registered with Companies Office) City Postcode Principal Place of Business (if different from above) City Postcode Mailing Address (if different from Principal Place of Business) City Telephone Number Fax Number What type of Company? What is your legal entity type? Postcode – – Private Public New Zealand Company Partnership* Registered Foreign Company Government Body Co-operative* Association / Club / Society* Unregistered Foreign Company Other * Note: For non-Company entities, please provide certified establishing documents (eg. Constitution, Partnership agreement etc). Certifier should print their name, sign, date and include their qualification and registered number on the document. Company registration No. Other entity registration/Identification number Jurisdiction of Incorporation For Association/Club/Society please state legal status and purpose Industry or Nature of Business Annual Revenue/Turnover Date Company Formed D D / M M / Y Y Number of Employees AEX9691 10/15 AEX9672 08/16 All fields are MANDATORY and must be completed in black pen and BLOCK LETTERS. S/C: PD1Ø7ØØ2Ø1

CORPORATE DETAILS. l) Full Legal Name of Entity Trading Name (if different to above) Entity Name to appear on Card and Reporting (maximum 24 characters) Registered Office Address (as registered with Companies Office) City Postcode Principal Place of Business (if different from above) City Postcode Mailing Address (if different from Principal Place of Business) City Telephone Number Fax Number What type of Company? What is your legal entity type? Postcode – – Private Public New Zealand Company Partnership* Registered Foreign Company Government Body Co-operative* Association / Club / Society* Unregistered Foreign Company Other * Note: For non-Company entities, please provide certified establishing documents (eg. Constitution, Partnership agreement etc). Certifier should print their name, sign, date and include their qualification and registered number on the document. Company registration No. Other entity registration/Identification number Jurisdiction of Incorporation For Association/Club/Society please state legal status and purpose Industry or Nature of Business Annual Revenue/Turnover Date Company Formed D D / M M / Y Y Number of Employees AEX9691 10/15 AEX9672 10/14 All fields are MANDATORY and must be completed in black pen and BLOCK LETTERS. S/C: PD1Ø7ØØ2Ø1