CNL
C O M P A N Y NAME:

Instruction to Corporate Network Ltd TO INCORPORATE A NEW COMPANY

P A R T 5 of 5

ENTER DETAILS OF THE OFFICE APPOINTMENTS & SHARES TO BE ISSUED
NAME: G I V E N NAMES SURNAME F O R M E R NAME(S)
A D D R E S S : UNIT/SUITE/FL

(ONE/PAGE)

A C N (if a Company):

BUILDING: SUBURB/CITY: POSTCODE: COUNTRY: CITY: COUNTRY:

S T R E E T NO. & NAME STATE

D A T E & PLACE OF BIRTH: D A T E : (dd-mm-yyyy)

STATE:
R E G I S T R A T I O N FOUNDER:

R O L E of 1ST DIRECTOR & SHAREHOLDER - Relevant only to Founder Formations R E S I G N AS FOUNDER DIRECTOR on the appointment of other Directors R E D E E M FOUNDER SHARE on Incorporation when further Shares are issued

O F F I C E APPOINTMENTS:

DIRECTOR SECRETARY

A L T E R N A T E DIRECTOR for: CHAIR
AMOUNT PAID/SHR

M A N A G I N G DIRECTOR
AMOUNT DUE/SHR N o . PAID I N KIND

P U B L I C OFFICER

S H A R E S TO BE ISSUED
CLASS NUMBER

ISSUE PRICE/SHR

I S S U E PRICE RETURN ON WINDUP A S CAPITAL/SHR A S ASSETS/SHR

P A Y M E N T IN KIND ( d e s c ) : J O I N T HOLDER(S) ( i f any):

(1): (2): (3):

A C N (if a company): A C N (if a company): A C N (if a company): T E N A N T S IN COMMON J O I N T TENANTS ( e a c h joint holder’s interest CAN be sold separately)

J O I N T L Y HELD AS OR

( e a c h joint holder’s interest CANNOT be sold separately)

N O T E : ( If no nomination is made, CNL’s Default = TENANTS IN COMMON ) S H A R E S HELD IN TRUST FOR:

THE DECLARATIONS SET OUT BELOW NEED TO BE GIVEN BEFORE THE COMPANY IS REGISTERED NOTE 1 :

T h e person named at the top of this page should make the following Declarations r e OFFICE APPOINTMENTS and SHARE APPLICATIONS. T h e Instructing Firm should hold the signed original. I CONSENT to being appointed to the offices (if any) indicated above, and confirm t h a t there is no legal impediment to my appointment to those offices. I / W e HEREBY APPLY for the shares (if any) indicated above, and request that t h o s e shares be issued subject to the condition that the company registers m e / u s in the Register of Members as the holder of those shares, upon which I / W e agree to be bound by the terms of the Constitution of the company.
DATE :

NOTE 2 :

OFFICES :

SHARES :

SIGNED :

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F O L L O W I N G PAGES

D E T A I L S OF MORE OFFICERS AND/OR SHAREHOLDERS ARE ATTACHED
(VERSION : 1-5-2010)

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