Shortfall Application Form

ACN 150 597 541
PIN CHEQUE(S) HERE
Shortfall Application Form
Fill out this Application form if you want to apply for a Share in Kin Mining N.L.
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Please read the Prospectus lodged with ASIC on 31 July 2015
Follow the instructions to complete this Application form (see reverse).
Print clearly in capital letters using black or blue pen.
Number of Shortfall Shares you are applying for:
Total amount payable
x $0.10 per Share =
A
Write the name(s) you wish to register the Securities in (see reverse for instructions)
Applicant 1
Name of Applicant 2 or < Account Designation >
Name of Applicant 3 or < Account Designation >
B
Write your postal address here
Number / Street
Suburb/Town
C
D
State
CHESS participant – Holder Identification Number (HIN)
ISSUER participant – Existing Security Reference Number (SRN)
X
I
Postcode
Enter your Tax File Number(s), ABN, ACN or exemption category
Applicant 1
Applicant 2
Applicant 3
E
Cheque payment details
Please enter details of the cheque(s) that accompany this application.
Name of drawer of cheque
F
Contact telephone number (daytime/work/mobile)
Cheque No.
BSB No.
G
Account No.
Cheque Amount A$
Email address
By submitting this Application form, I/We represent and warrant that I/we have read and understood the Prospectus to which this Application Form relates and
declare that this Application is completed and lodged according to the Prospectus and the instructions on the reverse of this Application Form and declare that all
details and statements made by me/us are complete and accurate. I/We agree to be bound by the constitution of Kin Mining N.L. and agree to the terms and
conditions of the Offer under this Prospectus (including the representations, warranties and agreements contained in the Prospectus), and in particular, that I/we
have not relied on any other information provided by the Company other as set out in this Prospectus when making my/our decision to invest. I/We represent,
warrant and undertake to the Company that our subscription for the above Securities will not cause the Company or me/us to violate the laws of Australia or any
other jurisdiction which may be applicable to this subscription for securities in the Company.
Application forms and cheques must be received by the Share Registry by 5.00 pm WST 2 September 2015.
Guide to the SHORTFALL Application Form
YOU SHOULD READ THE PROSPECTUS CAREFULLY BEFORE COMPLETING THE APPLICATION FORM
Please complete all relevant sections of the appropriate Application Form using BLOCK LETTERS.
These instructions are cross-referenced to each section of the Application Form.
INSTRUCTIONS
A.
B.
C.
D.
E.
F.
G.
Write your full name. Initials are not acceptable for first names.
Enter your postal address for all correspondence. All communications to you from Kin Mining N.L. will be mailed to the person(s) and
address as shown. For joint Applicants, only one address can be entered.
If you are sponsored in CHESS by a stockbroker or other CHESS participant, you may enter your CHESS HIN if you would like the allocation
to be directed to your HIN.
NB: your registration details provided must match your CHESS account exactly.
If you are ISSUER sponsored, you may enter your existing Security Reference Number (SRN) .
Enter your Australian tax file number ("TFN") or ABN or exemption category, if you are an Australian resident. Where applicable, please
enter the TFN /ABN of each joint Applicant. Collection of TFN's is authorised by taxation laws. Quotation of your TFN is not compulsory
and will not affect your Application Form.
Complete cheque details as requested. Make your cheque payable to “Kin Mining N.L” in Australian currency, cross it and mark it "Not
Negotiable". Cheques must be made in Australian currency, and cheques must be drawn on an Australian Bank.
Enter your contact details so we may contact you regarding your Application Form or Application Monies.
Enter your email address so we may contact you regarding your Application Form or Application Monies or other correspondence.
CORRECT FORMS OF REGISTRABLE TITLE
ONLY legal entities can hold the Securities. The Application must be in the name of a natural person(s), companies or other legal entities
acceptable to the Company. At least one full name and surname is required for each natural person. Examples of the correct form of registrable
title are set out below.
Type of Investor
Correct Form of Registrable Title
Incorrect Form of Registrable Title
Trusts
Mr John David Smith
<J D Smith Family A/C>
Mr Michael Peter Smith
<Est Lte John Smith A/C>
Mr John David Smith & Mr Ian Lee Smith
John Smith Family Trust
Mr John David Smith
<Smith Investment A/C>
John Smith Pty Limited
<J Smith Super Fund A/C>
Smith Investment Club
Deceased Estates
Partnerships
Clubs/Unincorporated Bodies
Superannuation Funds
John Smith (deceased)
John Smith & Son
John Smith Superannuation Fund
LODGMENT
Mail or deliver your completed Application Form with cheque(s) attached to the following:
In person
Advanced Share Registry Services
110 Stirling Highway
NEDLANDS WA 6009
Or post to
Advanced Share Registry Services
PO Box 1156
NEDLANDS WA 6909
It is not necessary to sign or otherwise execute the Application Form.
If you have any questions as to how to complete the Application Form, please contact the Share Registry on (08) 9389 8033.