EXPERIENCED / SOPHISTICATED INVESTOR QUESTIONNAIRE

In order to be classified as a non-retail investor, Titan Securities Pty Ltd (Titan) must be satisfied on reasonable grounds that you have sufficient experience in using financial services and investing in financial products (investments) so that you are able to assess: 1. The merits of a financial product or service 2. The value of a financial product or service 3. The risks associated with holding the financial product 4. Your own information needs 5. The adequacy of information given by Titan to you. In order for Titan to be satisfied of these factors, it is necessary that you answer the questions below, in your own handwriting. You must answer the questions yourself, because Titan needs to be satisfied that you have the relevant experience.

Summary of Investment Experience

Personal Details Name Address

Relevant Qualifications

Relevant Work Experience Employer Job Role Time Spent

Employer Job Role Time Spent

Relevant Investment Experience in financial products Portfolio Size ($) Less than $50,000 $200,000 Average number of Less than 5 financial products held Period Annual Transactions Gearing used? Derivatives used? Additional relevant information 5 - 10 More than 10 $50,000 - $200,00 more than

Less than 2 years Less than 5 Yes Yes No No 5 - 10

2 - 5 years

more than 5 years

more than 10

A. Describe below your investment experience. Please list the various financial products which you have invested in during the last 10 years. Attach a separate list if required. Financial product, including name and description of the type of financial product Approximate date you entered into the financial product and the date you exited the financial product if applicable Capacity in which you invested was this done in your own name, through a trust or so on

B. What factors do you take into account when assessing the value of a financial product?

C. What aspects of the financial product appeals to you?

D. What do you understand to be the risks associated with the financial product?

E. What information would you require to determine if you should acquire or hold a financial product?

Acknowledgement by Client I acknowledge that the financial product i. ii. Is not a general insurance, superannuation or retirement savings account product; The financial product or service is not provided for use in connection with a business, and

iii. Titan has relied on information provided by me in order to form the opinion that I have the required relevant previous knowledge and

experience to determine whether I will be classified as an experienced / sophisticated investor. The Corporations Act 2001 permits Commonwealth Government licensed Australian Financial Services licensee's to provide certain financial products and financial services, which may be more complex and sophisticated financial products and financial services, to a class of clients referred to as sophisticated investors who meet the benchmarks set out in section 761GA of the Corporations Act 2001. If you have been assessed by Titan as meeting those benchmarks, you will be offered the opportunity to deal with Titan as a sophisticated investor and you will be able to obtain financial products and financial services that are not available to ordinary retail clients. Warning However, there can be a trade-off in relation to being classified as a sophisticated investor. You should be aware that many of the mum-and-dad type consumer protection and disclosure provisions that apply to retail clients will not apply to you if you deal with Titan as a sophisticated investor. You should therefore consider this issue carefully before choosing to deal with Titan as a sophisticated investor. . Print Name . Signature . Insert date

Post this completed form to: Titan Securities Pty Ltd, 20 Wells Street, Bellevue WA 6056 Acceptance of Client as an Experienced Investor
(Section 708(10) and section 761GA of the Corporations Act 2001)

Based on the following summary of your investment experience: For the reasons outlined in the foregoing Summary, we consider you eligible to be accepted as a wholesale client of Titan in relation to the following types of investments: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________

__________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ________________________________________________________________________________

Approved by: _________________________________ Date ________________________