CHESS Brochure Order

Company: Business Unit: Email: Subject: ASX Settlement Pty Limited Clearing & Settlement Operations OperationsAdministration@asx.com.au CHESS Brochure Order

NAME OF BROKER / NBP* CONTACT PERSON* DELIVERY ADDRESS*

_____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _______________________________________________________

. PHONE*
*REQUIRED FIELDS

_______________________________________________________ ( )_________________________________________________

No. of Bundles (100 in a Bundle)

GST* Inclusive Cost per Bundle

Total Cost (Including GST)

For Internal Use Only: Date Despatched

$34.10

Please email your completed form to OperationsAdministration@asx.com.au Please include CHESS Brochure Order Form in email subject title * The 10% GST charge is not applicable to non-Australian resident and the goods supplied are used or enjoyed outside Australia.

PRIVACY COLLECTION STATEMENT: Your personal information is collected by ASX Settlement Pty Limited only for the purpose for which you provided it. ASX Settlement Pty Limited does not use or disclose personal information for other purposes without your consent or unless permitted to do so under the Privacy Act 1988 (Cth). Failure to provide this information may prevent ASX Settlement Pty Limited from providing your organisation with the requested CHESS brochures. Please see ASX Settlement Pty Limited contact details if you wish to access your personal information.

ASX Settlement Pty Limited A.B.N. 49 008 504 532 20 Bridge Street, Sydney NSW 2000 P.O. Box H227 Australia Square, Sydney NSW 1215 Telephone 1800 814 051 Facsimile + 612 9227 0265