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CREDIT ACCOUNT APPLICATION FORM

The following information is given in support of an application to open an account with United Protectorate Foreign Nations Of Aotearoa Ltd. All details will remain in strict confidence unless otherwise needed for legal purposes.

YES
NAME IN FULL

NO

LIMITED LIABILITY COMPANY?

TRADING NAME (IF DIFFERENT)

POSTAL ADDRESS

DELIVERY ADDRESS

REGISTERED OFFICE ADDRESS

PHONE NUMBER

MOBILE NUMBER

FAX NUMBER

EMAIL ADDRESS

BUSINESS ACTIVITY

COMPANY REGISTRATION DATE

COMPANY NUMBER

GST NUMBER

PRINCIPAL COMPANY DIRECTOR NAMES

PHONE NUMBERS

PRINCIPAL SHAREHOLDER NAME

HOME PHONE NUMBER

SOLICITOR NAME

PHONE NUMBER

ACCOUNTANT NAME

PHONE NUMBER

CREDIT REFERENCES

PHONE NUMBERS
IOUNZ-CAF-001

UNITED PROTECTORATE FOREIGN NATIONS OF AOTEAROA LTD - PAGE 1 / 3

APPLICATION FOR CREDIT ACCOUNT

The applicant(s) apply to United Protectorate Foreign Nations Of Aotearoa Ltd Limited for credit on the terms and conditions set out below:

You warrant that all information given to us is true and correct. You agree to notify us within 5 days of any change affecting your legal entity, structure, management or control. You agree that our terms and conditions of sale as in force from time to time apply to the supply of services by us to the exclusion of all other terms and conditions of sale or purchase and that any variation must be agreed by us in writing. You acknowledge that we may: refuse your application for credit facilities; withdraw or vary credit facilities at our absolute discretion without prior notice; withhold supply irrespective of whether an order has been accepted or not if for any reason we determine in our absolute discretion that no further credit is to be extended to you. You acknowledge and agree that: we may obtain credit reports from credit reporting or other credit providers for the purpose of assessing this and any other application which you may make for commercial credit; we may obtain information from any other credit providers from time to time for the purpose of reviewing and assessing your commercial creditworthiness; we may disclose to or discuss with any credit providers or any credit reporting agencies, any prospective guarantor and any person or body agreeing or considering whether to agree to be liable for any credit to be made available to you, any information maintained or in our possession relating to your application and the administration of your credit facility; The authorisations contained in this document will continue to remain in full force and effect until all credit facilities cease to be made available to you by us; The personal information provided in this application is collected by us and will be held in a safe and secure manner; If the signatory(s) or any other person named in this application fails to provide any information requested in this application or during the processing of this application we may be unable to process this application; We may use the information supplied to compile mailing lists and the provision of promotional material to you; The signatory(s) and any other person named in this application may have the right under the Privacy Act 1993 to access, and request correction of, any personal information held by us concerning yourselves. Each signatory warrants that he or she has the full authority of the applicant or applicants to sign on their behalf.

For office use:

Account Name:

Account Number:

United Protectorate Foreign Nations Of Aotearoa Ltd employs the services of IOUNZ, New Zealands leading online Credit Control organisation.

UNITED PROTECTORATE FOREIGN NATIONS OF AOTEAROA LTD - PAGE 2 / 3

GUARANTEE AND INDEMNITY


IN CONSIDERATION of United Protectorate Foreign Nations Of Aotearoa Ltd (the Company) supplying services to ________________________________ (the Customer) I/WE JOINTLY AND SEVERALLY: GUARANTEE the payment on demand to the Company of all moneys now owing to the Company by the Customer and all further sums of money from time to time owing to the Company by the Customer in respect of services supplied or to be supplied by the Company to the Customer or any other liability of the Customer to the Company. HOLD HARMLESS AND INDEMNIFY the Company on demand, as a separate obligation, against any liability (including but not limited to damages, costs, losses and legal fees) incurred by or assessed against the Company in connection with: The supply of services to the Customer; or The recovery of moneys owing to the Company by the Customer including the enforcement of this guarantee; or Moneys paid by the Company with the Customers consent in settlement of a dispute that arises or results from a dispute between the Company, the Customer, and a third party, or any combination thereof, over the supply of services by the Company to the Customer. ACKNOWLEDGE this Guarantee and Indemnity shall constitute an unconditional and continuing guarantee and indemnity and accordingly shall be irrevocable and remain in full force and effect until the whole of moneys owing to the Company by the Customer and all obligations herein have been fully paid, satisfied and performed. FURTHER ACKNOWLEDGE that no granting of credit, extension of further credit, or granting of time and no waiver, indulgence or neglect to sue on the Companys part (whether in respect of the Customer or any one or more of any other guarantor(s) or otherwise) and no failure by any named guarantor to properly execute this deed shall impair or limit the liability under this Guarantee and Indemnity of any guarantor. Without affecting the Customers obligations to the Company, each guarantor shall be a principal debtor and liable to the Company accordingly. I/We irrevocably authorise the Company to obtain from any person or company any information which the Company may require for credit reference purposes. I/We further irrevocably authorise the Company to provide to any third party, in response to credit reference and inquiries about me/us or by way of information exchange with credit reference agencies, details of this guarantee and any subsequent dealings that I/We may have with the Company as a result of this guarantee being actioned by the Company. I/We further acknowledge that the above information is to be used by the Company for all purposes in connection with the Company considering this guarantee and the subsequent enforcement of the same.

CUSTOMER SIGNATURE

Signed on behalf of the customer by:

SIGNATURE SIGNED BY (PRINT NAME) POSITION (DIRECTOR / SECRETARY / ATTORNEY / AUTHORISED SIGNATORY)

SIGNATURE SIGNED BY (PRINT NAME) POSITION (DIRECTOR / SECRETARY / ATTORNEY / AUTHORISED SIGNATORY)

WITNESS SIGNATURE
Signed in the presence of:

WITNESS SIGNATURE WITNESS NAME WITNESS ADDRESS


UNITED PROTECTORATE FOREIGN NATIONS OF AOTEAROA LTD - PAGE 3 / 3

WITNESS OCCUPATION

IOUNZ-CAF-001