NZX PARTICIPANT RULES

APPLICATION

This application should be completed by applicants seeking to become:

  • aDealer; or
  • a DMADealer.

Please return this application form and supporting documentation to:

NZX Regulation

NZX Limited

P O Box 2959

WELLINGTON

It is essential that you read this application form in conjunction with the NZX Participant Rules.

CONFIDENTIALITY

NZX will keep confidential all information provided to it by the Applicant in relation to its application, except to the extent that disclosure of any or all of the information is necessary for the exercise of its regulatory functions, or as otherwise required by law.

INSTRUCTIONS

Applicants must submit the application form (to be completed in type written form with original signatures included) along with supporting documentation or information (as outlined in the NZX Participant Rules). Supporting documentation should besupplied in typed format, in as much detail as the applicant feels appropriate to support their application, but in any event to satisfy the criteria contained in the NZX Participant Rules.

Please note that NZX may require additional information in relation to the application form or any of the supporting documentation filed in support of the application.

NZX reserves the right to decline an application notwithstanding that an Applicant meets the minimum criteria set out in the NZX Participant Rules.

APPLICANT DETAILS

1.Name, Residential Address and Telephone Number of Applicant:
2.Age of Applicant:
3.Name and contact details of the Dealer/DMA Dealer currently supervising the Applicant:
4.Details of the Applicant’s work experience and expertise (including details of where and with whom that experience was obtained) which qualifies the Applicant to become a Dealer/DMA Dealer(as applicable). In particular details should be provided to satisfy NZX that the Applicant has a thorough and up to date working knowledge of the workings and use of the Trading System and in the case of an application for DMA Dealer designation, NZX’s DMA facilities:
5.Details of Applicant’s professional and educational qualifications, including the training undertaken by the Applicant (as required by NZX and any other training undertaken by the Applicant) and/or accreditation undertaken by the Applicant as required by NZX (minimum training period is one month under constant supervision from a Dealer/DMA Dealer (as applicable). In the case of an application for designation as a DMA Dealer the results of the DMA Market Entry Test.

SUPPORTING DOCUMENTATION / INFORMATION – to be attached to the application:

(Please ensure all applicable and relevant supporting documents are attached to this Application. Please have regard to the assessment criteria outlined in the NZX Participant Rules, applicable to designation as a Dealer/DMA Dealerwhen compiling this supporting documentation).

Evidence (by way of reference or testimonial) to support the employment history and experience detailed in the application (if requested by NZX);

Evidence of qualifications and examination results, including evidence of results of DMA entry test (if applicable);

Details of any dispute the Applicant may have had with any entity for whom he or she has previously been employed or contracted;

Details of any adverse or potentially adverse matters in respect of the Applicant which have been brought to the attention of any relevant regulatory authorities during the last 6 years (where possible please provide copies of any relevant correspondence in relation to such matters);

Evidence of the Applicants integrity and high standard of business conduct, which may be via testimonials, references, referees;

Declarations as required by the NZX Participant Rules in support of the application (from the Applicant and the Trading Participant);

Any other information which the Applicant thinks may be relevant to NZX in considering this application.

DECLARATION BY APPLICANT TO NZX

______(“the Applicant”) hereby declares that:

  • All the information contained in this application form and otherwise supplied is complete, true, accurate and not misleading.
  • I have read the NZX Participant Rules and believe that this application conforms to the criteria (except as specifically notified to you with this application) for designation as a Dealer/DMADealerset out in those rules.
  • I have not been subject to any disciplinary action by a regulator or law enforcement agency in the context of financial services or corporate finance and save as set out in this application, have not been disqualified by a court from acting as a director of any company or from acting in the management or conduct of its affairs.

Signature of Applicant:

1.

Date:

Once completed this application form should be posted to:

NZX Regulation

NZX Limited

PO Box 2959

WELLINGTON

APPENDIX 2 - APPLICATION FOR DESIGNATION AS A DEALER/DMADEALERPage 1 of 3