GUIDE TO THE OFFER APPLICATION FORM YOU SHOULD READ THE PROSPECTUS CAREFULLY BEFORE COMPLETING THIS APPLICATION FORM. How to complete this form A. Shares applied for. Insert the number of shares you wish to apply for at item A (not less than 10,000 shares). B. Application monies. Multiply the number of shares by the issue price of $0.20. Minimum application is $2,000 and applications for less than this amount may be rejected. C. Application names Enter the full name to appear in the share register. This must be either your own name or the name of a company. Refer to the table below for the correct forms of registrable title. Applications using the wrong form of names may be rejected. CHESS participants should complete their names as registered in the CHESS system. D. Postal address All communications to you from the share registry will be mailed to the person(s) and address on the form. E. CHESS participant HIN If applying under the Priority Offer, please insert the Shareholder Reference Number (SRN) or Holder Identification
Number (HIN) of your holding in Broken Hill Prospecting Limited. If applying under the General Offer and you wish your holding to be CHESS sponsored, please insert your Holder Identification Number (HIN) beginning with “X”. The registration details provided must match your CHESS account exactly. F. Tax file number or ABN Enter your TFN or ABN or exemption category, if you are an Australian resident. Collection of TFNs is authorised by taxation laws. Quotation of your TFN is not compulsory. G. Cheque payment details. Make yours cheque(s) payable to Cobalt Blue Holdings Limited. Cheques must be in Australian currency and drawn on an Australian bank or credit union. Complete cheque details in the boxes provided. Cheques will be processed on the day of receipt, and so sufficient cleared funds must be held in your account as cheques returned may not be re-presented and may result in your application being rejected. H. Contact details Enter your phone numbers and email address.
Lodgement
Mail or personally deliver your completed application form with cheque(s) attached to the following address so that it is received no later than 5.00pm (Sydney time) on 9 December 2016: Mailing address: Cobalt Blue Holdings Limited C/- Next Registries PO Box H195 Australia Square NSW 1215
Delivery address: Cobalt Blue Holdings Limited C/- Next Registries Level 16, 1 Market Street Sydney NSW 2000 Australia
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 Next Registries at: Phone: +61 2 9276 1700
Fax:
+ 61 2 9251 7138
Email: mail@nextregistries.com.au
Correct forms of registrable title Only legal entities are allowed to hold shares. Application forms must be in the name(s) of a natural person(s), company or other legal entity acceptable to the Company. Natural persons should be registered under their full names. Applications cannot be completed by persons less than 18 years of age. The table below shows examples of the correct form of registrable title. Type of Investor Individual: use full names Trusts: use trustees’ names Deceased estates: use executors’ names Partnerships: use partners’ names Unincorporated bodies: use officebearers’ names Superannuation funds: use trustees’ names Person under 18: use the name of a responsible adult
Correct Form of Registration Mr John David Smith Mr John David Smith <Smith Family A/c> Mr Michael Peter Smith <Est Late John Smith A/c> Mr John David Smith & Mr Ian Lee Smith Mr John David Smith <ABC Tennis Association A/c> Mr John Smith & Mrs Mary Smith <Smith Super Fund A/c> Mr John Alfred Smith <Peter Smith A/c>
Incorrect Form of Registration J A Smith Smith Family Trust John Smith (deceased) John Smith & Son ABC Tennis Association Smith Super Fund Master Peter Smith
By submitting this application form: • you declare that this application is complete and lodged according to the Prospectus dated 3 January 2017, and the declarations/statements on this form: • you declare that all the details and statements made by you are complete and accurate, and • you agree to be bound by the Constitution of Cobalt Blue Holdings Limited. Privacy Statement Next Registries advises that Chapter 2C of the Corporations Act 2001 requires information about you as a shareholder (including name, address and details of shares held) to be included in a public register of the Company. Information is collected to administer your shareholding and if some of the information is not collected it might not be possible to administer your shareholding. Your personal information may be disclosed to the Company. You can obtain access to your personal information by contacting us at the address or telephone number shown on the Offer Application Form. Our privacy policy is available at http://www.nexia.com.au/privacy