Confidential Client Due Diligence Form

This questionnaire helps us understand your business, the capital raising opportunity, and any matters that may impact investor participation. All information will be treated confidentially.

Please answer all questions as accurately and completely as possible.

1. Company & Contact Information

Legal Entity Name

ABN / ACN

Registered Address

Operating Address (if different)

Primary Contact Person

Title

Email

Phone

Website

Year Business Founded

Jurisdiction(s) of operation

AustraliaInternational

If International, please specify

2. Capital Raising Overview

Amount of Capital Being Raised (AUD)

Type of Capital Raise

EquityConvertible NoteDebtHybridOther

If Other, please specify

Proposed Pre-Money Valuation (if applicable) (AUD)

Minimum Investment Size (AUD)

Target Investor Type

Sophisticated investorsWholesale investorsFamily officesStrategic investorsVenture capitalOther

If Other, please specify

Use of Funds (approximate allocation)
Please list purpose and amount or percentage for each item.

Expected timeline for raise

Immediate (0–3 months)3–6 months6–12 months

3. Corporate Structure

Please provide details of the structure

Parent Company (if applicable)

Subsidiaries / Related Entities
Please include entity, jurisdiction, and ownership %.

Is the capital being raised in:

Operating companyHolding companySpecial Purpose Vehicle (SPV)Other

If Other, please specify

4. Shareholders & Ownership

Please list all current shareholders
Please include shareholder name, entity/individual, and ownership %.

Are there shareholder agreements in place?

YesNo

If yes, please confirm:

Drag/Tag rights existPre-emptive rights existShare transfer restrictions exist

Have any shares been issued in the past 24 months?

YesNo

5. Existing Investors & Capital

Total capital raised to date (AUD)

Previous investor types

Angel investorsVenture capitalPrivate equityFriends & familyStrategic investors

Are any investors:

On the boardHolding special rightsEntitled to liquidation preference

6. Debt & Financial Obligations

Does the company have any of the following?

Bank loansConvertible notesDirector loansGovernment loans or grantsTrade debtLeases or equipment financing

Please list major liabilities
Please include creditor, amount, and security.

Are there any charges registered on PPSR or ASIC?

YesNo

Any guarantees provided by founders or directors?

YesNo

7. Financial Reporting

Latest financial statements available for:

Current year management accountsLast financial yearPrevious financial year

Have accounts been audited?

YesNo

If yes, auditor name

Are tax obligations up to date?

YesNo

Including:

Company taxGSTPAYGPayroll tax

8. Advisors

Accountant / CFO

Firm

Contact

Legal Advisor

Firm

Contact

Corporate Advisor / Broker

Firm

Contact

Other advisors (if relevant)

9. Intellectual Property

Please identify key intellectual property assets

TrademarksPatentsCopyrightSoftware codeTrade secretsProprietary technologyBrand assets

For each key asset
Please include asset, owner, and whether it is registered.

Are any of the following held personally by founders rather than the company?

TrademarksDomain namesSoftware/IPPatents

If yes, please explain

Primary domains used by the business

10. Material Contracts

Please confirm whether the business has:

Major customer contractsSupplier agreementsDistribution agreementsLicensing agreementsJoint venturesGovernment contracts

Are any contracts dependent on a specific founder or individual?

YesNo

11. Regulatory & Legal Matters

Is the company currently subject to:

LitigationRegulatory investigationPending legal disputeEmployee disputesEnvironmental claims

If yes, please provide details

12. Founder / Director Declarations

Each founder/director must confirm the following. Have you ever:

Been declared bankruptBeen a director of a company placed into liquidationBeen disqualified as a company directorBeen convicted of a criminal offence (excluding minor traffic offences)

If yes, please provide details

13. Compliance & Integrity

All information provided is accurate and completeThe company is not aware of any undisclosed liabilitiesNo material information relevant to investors has been withheldThe business complies with applicable laws and regulations

14. Supporting Documents

Please attach where available:

• Company constitution

• Cap table

• Latest financial statements

• Corporate structure diagram

• Investor presentation / IM

• Key contracts

• IP register (if available)

Upload Supporting Documents

15. Declaration

I confirm that the information provided in this questionnaire is accurate and complete to the best of my knowledge.

Name

Title

Company

Signature

Date

Declaration

The company confirms that all information provided to investors will be truthful and not misleading.The company confirms it has board approval and legal authority to undertake a capital raising.