STATUTORY DECLARATION OF DIRECTOR

ATTENTION:Head of Market Supervision

NZX Market Supervision

NZX Limited

PO Box 2959

Wellington

Note: Terms used herein which are not otherwise defined have the meaning given to them in the Rules. Principles of construction set out in Rule 1.2 of the Rules are hereby incorporated into this statutory declaration mutatis mutandis.

I, [name of the Director] of [residential address of the Director], do solemnly and sincerely declare to NZX that:

(a)I became a Director of[name of Participant for which application is sought](“Company/Partnership/commensurate entity”), a designated [type of Participant for which application is sought], on [date when Director entered their position] and still hold that office;

(b)I am a fit and proper person without any record of dishonest or fraudulent activities;

(c)I am of sound mind;

(d)I have not been declared a bankrupt by the High Court of New Zealand or any other overseas regulatory body;

(e)I have not had any charges brought against me as a result of a breach of the Rules or Procedures, and/or any other NZX Market rules, or any commensurate rules of NZX or any Alternative Regulator or other Regulator that I am, or was, a member of;

(f)I have not had any disciplinary action bought against me by any government and/or Regulatory Authority;

(g)The [Company/Partnership/commensurate entity] meets with the requirements of the Rules and Procedures and any directions issued by NZX as applicable to the type of Participant for which the [Company/Partnership/commensurate entity] is designated at the date of this Statutory Declaration;

(h)As a Director of the [Company /Partnership /commensurate entity] I will take all necessary and reasonable steps to ensure that the [Company/Partnership/commensurate entity] abides by all applicable the Rules and Procedures and any directions issued from time to time by NZX;

(i)I have not been found liable for insider trading or any other breach of the provisions of the Securities Legislation or any crime involving dishonesty (as defined in section 2(a) of the Crimes Act 1961);

(j)I have not been prohibited from managing, or being a director or promoter of a company; and

(k)I have not been an officer of a company that has been ordered by the High Court of New Zealand to be wound up or put into liquidation, in each case because it is insolvent while I was an officer of the company.

AND I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957.

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Signature of declarent

Declared atthis day of20

Before me:

……………………………………………………

A person authorised by the Oaths and Declarations Act 1957 to take a declaration