Guarantee Application Form

GUARANTEE APPLICATION FORM

WHEREAS

WHEREAS the Applicant desires that the Creditor consider extending credit, a facility or other financial accommodation to the Principal Debtor and the Creditor requires a guarantee in support of such obligations;

WHEREAS the Applicant represents and warrants that the information provided in this application is true, complete and accurate and will be relied upon by the Creditor in deciding whether to accept a guarantee from the Applicant;

WHEREAS the Applicant acknowledges that submission of this application does not obligate the Creditor to accept or execute any guarantee but authorises the Creditor to investigate and process this application and obtain credit information and references.

APPLICANT INFORMATION

Individual Company Trust

PRINCIPAL DEBTOR / OBLIGOR

SCOPE OF WORK

Scope of Guarantee: describe the obligations, debts or facilities to be guaranteed, limits and special conditions. This description will form the operative scope of any guarantee accepted by the Creditor.

CREDIT FACILITY AND GUARANTEE AMOUNT

Maximum liability for which guarantee is sought (inclusive of principal, interest, fees and costs):

Currency:

PAYMENT TERMS

Guarantee fee (if applicable): payable:

Late payment fee or interest on unpaid fees:

Applicant acknowledges that fees, interest and enforcement costs may be charged to the extent permitted by law and recovered from the Applicant pursuant to any executed guarantee.

TERM AND TERMINATION

Requested commencement date:

Requested expiry date or review date:

Notice period for termination by either party (days):

Any accepted guarantee will specify termination mechanics including discharge upon full satisfaction of the guaranteed obligations and any required written notice by the Creditor or applicant.

SECURITY, COLLATERAL AND SUPPORTING INFORMATION

REFERENCES

DECLARATIONS, CONSENTS AND CERTIFICATIONS

By signing this application the Applicant certifies that all information supplied is true and correct, and acknowledges that the Creditor may rely on such information in deciding whether to accept or execute a guarantee. The Applicant further agrees that any guarantee executed by the Creditor may be enforceable notwithstanding any change in the Principal Debtor's circumstances unless otherwise agreed in writing by the Creditor.

The Applicant expressly consents to the Creditor obtaining credit reports, trade references and other information about the Applicant and its related entities, and to the Creditor disclosing information to associated companies, legal advisers and insurers where necessary to assess, document or enforce any guarantee.

Applicant indemnifies the Creditor against any loss, liability or cost arising from inaccurate information knowingly provided in this application or from the Applicant's failure to perform any obligation under an executed guarantee, to the extent permitted by applicable law.

CONFIDENTIALITY

All information provided in this application will be treated as confidential by the Creditor, except as required or permitted by law. The Applicant consents to disclosure of information to auditors, legal advisors, insurers, and to the extent necessary, to prospective assignees of the Creditor's rights.

GOVERNING LAW

This application and any executed guarantee arising from it shall be governed by and construed in accordance with the laws of the jurisdiction specified by the Creditor at the time of acceptance. The Applicant submits to the exclusive jurisdiction of the competent courts in that jurisdiction for any dispute arising under or in connection with any guarantee.

ENTIRE AGREEMENT

This application, together with any written acceptance and the executed guarantee documents (if any), constitutes the entire agreement between the parties relating to the subject matter herein and supersedes all prior negotiations, understandings and representations not reduced to writing and signed by the parties.

ACKNOWLEDGEMENT

I/We declare that we have authority to make this application and that the statements and information contained in this application are true and complete. I/We acknowledge that submission of this application authorises the Creditor to make enquiries and to disclose information as set out above.

Sign Now