Additions / Changes:

Item 1

AGENT

Name/s: …………………………………………………………………………………………………………………

Address: …………………………………………………………………………………………………………………

ABN:   …………………… Phone:……………………  Fax:   ………………………   Mobile: ………………….

Contact: …………………………………………………………………………. Licence No.: ..…….………….....

Email:  …………………………………………………………..………………………. GST Registered: Yes/ No

Additions / Changes:

Item 10

Either party may terminate this Authority on the giving of not less than ………. days written notice to the other. Such termination will be without prejudice to either parties existing rights, duties or obligations.