BHP Billiton Shareplus – Withdrawal Form

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BHP Billiton Shareplus – Withdrawal Form

If you wish to withdraw from Shareplus please complete the information below and return the completed form

to your HR Business Partner.

Your Shareplus contributions will cease only once this form has been received and processed by the HR Admin hub.

HR Business Partners: Please send this form to your HR Admin hub to ensure that the employee’s contributions cease and to

[email protected] to ensure that the employee receives a refund of contributions.

Once this form has been processed by Computershare Plan Managers they will advise your HR Admin Hub of the relevant refund amount (i.e. not used to purchase shares). This non-taxable amount will be returned to you in a subsequent pay run.

Please note that this form is only to be used for Withdrawals (that is employees who wish to cease their contributions for the current plan year) and NOT for employees leaving BHP Billiton.

Section 1 – Personal Details

Securityholder Reference Number (SRN)*

*(Computershare ID – begins with an I)

Business

Employee Number

Family Name/Surname

Given Name(s)

Address Line 1

Address Line 2

Address Line 3

Country

Email Address

Telephone Number (include Country Code)

Section 2 – Declaration & Signature

I no longer wish to participate in BHP Billiton Shareplus

Signature

Date

If you have inside information, you should not deal in BHP Billiton shares.

If you are an Employee Insider (under GLD.025 Securities Dealing) you will have been formally notified by Company Secretariat and you will need to submit a Securities Dealing Clearance Request Form (available on the BHP Billiton portal) to a Clearance Officer,

and obtain clearance.

I acknowledge that I am NOT an Employee Insider, or that I have obtained the required clearance.

Your withdrawal form will not be actioned until the above box is ticked.

If you have any queries on completing the form please contact the Plan Administrator at

[email protected]

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