Please complete and fax (02 8215 0679) or email a copy then return an original copy to: Wealth Focus Pty Ltd, Reply Paid 760, Manly, NSW 1655 DATED: 22nd October 2014 PARTIES: …………………………........................................................................................................ (Purchaser) of (address)...................................................................................................................................... , and Wealth Focus Pty Ltd a company duly incorporated in New South Wales ABN 87 123 556 730 and having its registered office at Suite 7, 49-53 North Steyne, Manly, NSW 2095 (Wealth Focus). BACKGROUND A. B. C. D. Purchaser intends to purchase Medibank Private Ltd, MPL (‘the Product’) under a Broker Firm Offer. Wealth Focus is facilitating the investment but not providing any advice to the Purchaser Under a Broker Firm Offer, Wealth Focus is liable to purchase the Product or any part of it that the Purchaser fails to pay for The Purchaser acknowledges and understands that its order will be non-cancellable and Purchaser will be required to pay for their allocation of the Product in full immediately upon request by Wealth Focus. OPERATIVE PROVISIONS 1. PURCHASE OF PRODUCT The Purchaser hereby applies for $……………… worth of MPL. In consideration for receiving an allocation of the Product under a Broker Firm Offer, the Purchaser must pay to Wealth Focus, or such person as Wealth Focus nominates, immediately upon request by Wealth Focus and in any case not later than settlement, the amount payable for such allocation. The parties acknowledge that the settlement date is anticipated to be on or about the 14th November 2014 but in this regard time is not of the essence. The Purchaser acknowledges and understands that their order is not cancellable and although Wealth Focus will attempt to place the allocation elsewhere if the Purchaser so requests prior to settlement, if Wealth Focus is unable to find an alternate buyer before settlement then the Purchaser must pay for the allocation on settlement. 2. CONFIDENTIALITY Each party must keep the terms of this document confidential but a party may disclose the terms of this document to any professional advisers who are subject to a confidentiality obligation arising from their relationship with the disclosing party; to comply with any law or requirement of any regulatory body (including any relevant stock exchange); and to any employee or non-executive director of any Related Company, to whom it is necessary to disclose the terms. 3. REASONABLENESS The parties consider the covenants, obligations and restrictions in this document to be reasonable in all respects. Executed as a deed. Signed sealed and delivered by ______________________ (Purchaser) _________________________________ Print Name in the presence of: ____________________________ Witness ____________________________________ Print Name