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INVESTORS EXCHANGE LIMITED ACN 116 489 420

APPLICATION FORM [COMPANY*]


PROJECT4CHANGE IMPACT INVESTMENT FUND – OFFER 2
Issuer * Important Note:
Investors Exchange Limited [ACN 116 489 420 | AFS Licence 299024] If you are acting in a Trustee capacity, please
(‘Manager’) complete the SMSF/Trust Application Form
This Application Form is important. Please review the ‘Guide to Completing the Application Form’ attached. If you are in
any doubt how to complete it, please contact a professional adviser. You should read the entire Information
Memorandum carefully before completing the form. If completing by hand, please PRINT all information.

Section 1 – Units applied for


No of Units Price/Unit TOTAL
Your investment must be:
A X AUD $ = B $ • a minimum of $5,000 [i.e. 5,000 Units]
• subsequently in increments of $5,000

C Are you: [select one] Existing Investor New Investor

D EFT DETAILS FOR PAYMENT OF APPLICATION MONEY

Account details Reference Number


EFT Deposits should be made to the following account: Please use the last four digits of your TFN as a deposit reference
BSB: 014596
Account Number: 467734833
Account Name: Investors Exchange Limited Date Deposited

Section 2 – Investor Details


E FULL COMPANY NAME
ABN/ARBN/Other Registration
TFN Name of Relevant Foreign Registration Body [if applicable]
No (if applicable)

F TYPE OF COMPANY
Proprietary Company Controlling Shareholders: %
Please provide details of all shareholders who own more than %
25% of the issued capital in the company and their percentage
holding. Additional shareholder details annexed. %
Public Company Relevant market/exchange:

Foreign Company The company is a majority owned subsidiary of a listed Australian Company:
No Yes Name of Australian Company
Relevant market/exchange

G FULL ADDRESS OF REGISTERED OFFICE


PO Box Number/Street Number/Street Name

Suburb/Town State Postcode Country

H FULL ADDRESS OF PRINCIPAL PLACE OF BUSINESS


PO Box Number/Street Number/Street Name

Suburb/Town State Postcode Country

I CONTACT NAME TELEPHONE

EMAIL

P4C Impact Investment Fund


Section 3 – Account Details
J DIRECT CREDIT FOR DISTRIBUTIONS
Insert name of account which is to be credited

Bank Branch BSB Account Number

Section 4 – Annual Report and Non-disclosure


K The Annual Report will be available on the Investors Exchange Limited Website, www.InvestorsExchange.com.au.

L Non-Disclosure box

Section 5 – Declaration
M
I/We declare that this application is completed according to the declarations/appropriate statements below and:
a agree to be bound by the Constitution of the Australim Investment Fund 2; and
b acknowledge that:
i The offer under this PDS is available to people receiving the PDS within Australia.
ii I/We have read and understood the Product Disclosure Statement (PDS) to which this Application
Form is attached.
iii Investors Exchange Limited reserves the right to accept or reject any application in its absolute
discretion.
iv I/We have had the opportunity to seek professional advice regarding all aspects of this investment.
v I/We have not relied on any statements or representations made by any part (including Investors
Exchange Limited and its officers, employees and agents) prior to applying, other than those written
representations made in the PDS.
vi I/We have personally received a complete and unaltered copy of the PDS, prior to completing the
application.
vii I/We have made an offer to become an investor in the Fund which cannot be revoked.
viii Investors Exchange Limited does not guarantee the repayment of capital or the performance of the
Project4Change Impact Investment Fund- Offer 2.

I/We declare that I/we are not acting in a Trustee capacity.

DIRECTOR 1 DIRECTOR 2

FULL NAME

TITLE

SIGNATURE

DATE

Office Use Only


S1 S2

P4C Impact Investment Fund