Electronic Agreement

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Contact Details

Salutation:

First name:

Middle name:

Last name:

Company

Position

Country:

Address:

Suburb:

State/Territory:

Postcode:

Email address:

Telephone:

Mobile:

Please provide either a Telephone or Mobile number.

By registering my information, I declare that, to the best of my knowledge, the details provided above are true and correct and believe that I have, or represent someone who has or may have a claim with respect to the class action described above. I acknowledge that any information disclosed to me as part of this online sign up process may contain confidential information relating to the above class action (Confidential Information). I agree to hold any such Confidential Information in strict confidence and only use Confidential Information solely for the purposes of determining whether to join the class action and/or apply for an interest in any litigation funding scheme established for the class action.

Claimant Details

The Claimant is the person or entity who has a NZ judgment debt in their favour against BMX in the proceedings Body Corporate 346799 (and others) v KNZ International Co Limited (and others) CIV 2012-404-6290. Please select the type of claimant that is making the claim:

An Individual

The Victopia Apartment was owned in the name of a single individual.

A Joint Owner

The Victopia Apartment was owned in the name of more than one individual.

A Company

The Victopia Apartment was owned in the name of a company.

A Trustee

The Victopia Apartment was held on trust (such as a superannuation fund or trust account) and the trustee is an individual, joint owner, company or other.

A Deceased Estate

The Victopia Apartment owner is now deceased and the estate is making a claim.

First Name:

Last Name:

DOB: (dd/mm/yyyy)

Email Address:

First Name:

Last Name:

DOB: (dd/mm/yyyy)

Email Address:

First Name:

Last Name:

DOB: (dd/mm/yyyy)

Email Address:

First Name:

Last Name:

DOB: (dd/mm/yyyy)

Email Address:

Full name of claimant:

Claimant Address:

The claimant address is the same as the contact address (entered on the previous screen)

The claimant address is different from the contact address (entered on the previous screen)

Please note that P.O. boxes are not allowed in this section.

Country:

Address:

Suburb:

State/Territory:

Postcode:

Claimant declaration:

You are the Claimant, or are acting on behalf of and with authority of the Claimant.

Investment Details

In this section, we ask you to provide details of the claimant's trading history in the securities which form part of your claim.

It is important these details are accurate. We suggest you refer to trade confirmation forms and contract notes when completing this section.

Stock Exchange:
(if you have traded in multiple exchanges you are required to complete an additional registration)

Opening Balance:
Please provide the number of securities held as at close of trade on 27-Jan-2021. If you did not hold any securities as at 27-Jan-2021, please write "0"

Trade details:
In the sections below, list all transactions (buys and sells) in the trade collection period for the claim.

The Trade Collection Period for this claim is 28-Jan-2021 to 28-Jan-2021 (inclusive)

Trade Date	Type	Buy/Sell	Stock Code	Quantity	Total Net Amount in AUD (including brokerage)	Price

Investment details declaration:

I confirm the information provided is true and correct to the best of my knowledge.

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Claim Details

Please answer the following questions accurately in relation to your claim:

Omni Bridgeway Product Disclosure Statement Acceptance

The Lloyds Group Litigation Funding Scheme is governed by the terms of the Constitution which include the Claim Funding Terms (Schedule 3 to the Constitution). You can access a full copy of the constitution here.

We ask that you review the PDS and the Claim Funding Terms carefully before applying for an interest in the scheme. If you have any questions about the PDS or the Claim Funding Terms, please contact us at:

The PDS contains all of the relevant information concerning costs and expenses.

Upon clicking submit, you will receive an acknowledgement from OBIML of your application. If you do not receive this email please contact us. This email is not confirmation of your membership of the Scheme. You will not receive confirmation of your interest and membership of the scheme until the expiry of the cooling off period (see below). Accordingly, please allow 4-6 weeks for receipt of this email.

We note that the application is subject to a [21] day cooling off right in which time you may cancel your application by following the notice requirements in the PDS.

Declaration:

By selecting the 'tick boxes' and typing my name below, I/we declare and agree that I/we:

have read and understood in full the PDS and the Scheme’s constitution (including the Claim Funding Terms in Schedule 3 of the Scheme’s constitution (collectively, the ‘Scheme Documents’), copies of which are available at https://portal.omnibridgeway.com/lloyds;

agree that the terms and conditions of the Scheme Documents form part of this declaration;

by signing this declaration, agree to make the Assignment referred to in the Scheme’s constitution;

agree that all of the information provided in my/our application is true and correct and I/we undertake to inform you of any changes to the information supplied as and when they occur;

acknowledge that this application may be submitted electronically and that such electronic version shall be legally binding;

agree that OBIML may contact me/us where required by using the email address provided on this Application Form; and

acknowledge that OBIML may require us to provide any additional documentation or other information to enable compliance with any laws relating to anti-money laundering and counter terrorism financing (‘AML/CTF’) or any other law, including the Foreign Account Tax Compliance Act ('FATCA') and OECD Common Reporting Standard (‘CRS’).

Please type your name:

Position/Capacity:

Omni Bridgeway Product Disclosure Statement Acceptance

The PDS contains all of the relevant information concerning costs and expenses.

We note that the application is subject to a [21] day cooling off right in which time you may cancel your application by following the notice requirements in the PDS.

Declaration:

By selecting the 'tick boxes' and typing my name below, I/we declare and agree that I/we:

agree that the terms and conditions of the Scheme Documents form part of this declaration;

by signing this declaration, agree to make the Assignment referred to in the Scheme’s constitution;

agree that all of the information provided in my/our application is true and correct and I/we undertake to inform you of any changes to the information supplied as and when they occur;

acknowledge that this application may be submitted electronically and that such electronic version shall be legally binding;

agree that OBIML may contact me/us where required by using the email address provided on this Application Form; and

Please type your name:

Position/Capacity:

Registration Acceptance

By electronically accepting the below conditions you will agree to register your potential claim for inclusion in the Lloyds Underwriters Class Action and for the purpose of any possible settlement.

A copy of the completed registration form will be emailed to you on completion of this registration process.

It is important that following your registration you send 3rd party supporting documentation, such as contract notes, for each of the share transactions included in your claim to [email protected].

Declaration:

I confirm that:

I am the Claimant, or I am duly authorised to act on the Claimants behalf.

I acknowledge that electronic acceptance has the same effect as signing a hard copy version of the registration form.

I acknowledge that Omni Bridgeway Limited will accept this registration form as containing my signature for the purposes of the relevant electronic transactions legislation.

Please type your name:

Position (if applicable):

Solicitor Retainer

This is the retainer agreement between the Claimant and the Lawyers ("Retainer Agreement").

As you have accepted the terms of funding set out in the PDS, you will not have to pay any Lawyer's fees if the class action proceeds, unless claims are successfully resolved, in which case the fees are recovered from the Resolution Sum. There are no "out of pocket" fees payable by you.

A copy of the Retainer Agreement will be emailed to you on completion of this registration process.

Declaration:

By selecting the 'tick boxes' below and typing my name below, I confirm that:

I am the Claimant or I am duly authorised to act and enter into the above Retainer Agreement on the Claimant’s behalf.

I have read and understood the terms of the Retainer Agreement with the Lawyers.

I accept and agree to be legally bound by the terms of the above Retainer Agreement with the Lawyers.

This electronic acceptance has the same effect as if I had signed a hard copy version of the Retainer Agreement.

I expressly consent to this method of acceptance of the terms of the Retainer Agreement in accordance with s10(1) of the Electronic Transactions Act 2011 (WA) or the relevant corresponding State or Territory legislation.

Please type your name:

Position (if applicable):

Claim Complete

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Contact Details

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Claimant Details

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Investment Details

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Documents

Claim Details

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Omni Bridgeway Product Disclosure Statement Acceptance

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Omni Bridgeway Product Disclosure Statement Acceptance

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Registration Acceptance

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Solicitor Retainer

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Claim Complete