1. Title Mr Mrs Miss Ms Dr Other
2. please specify
3. First names
4. Surname
5. Date of birth D12345678910111213141516171819202122232425262728293031M123456789101112Y19941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930
6. Phone
7. Fax
8. Mobile
9. Email
10. Gender select Male Female
11. Investor Number

1. Title Mr Mrs Miss Ms Dr Other
2. please specify
3. First names
4. Surname
5. Date of birth D12345678910111213141516171819202122232425262728293031M123456789101112Y19941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930
6. Phone
7. Fax
8. Mobile
9. Email
10. Gender select Male Female
11. Investor Number

1. Address
2. Suburb
3. City or town
4. Postcode (postcode finder)

Postal Address Same as residential

1. Address
2. Suburb
3. City or town
4. Postcode (postcode finder)

1. Investor IRD number
2. Withholding tax rate (please tick)
3. 10.5% 17.5% 30% * 30% ** 33%
   NRWT AIL 2% Exempt
4. Please note if your IRD number and/or an election is not indicated your investment will be taxed at 38% p.a. If exempt from resident withholding tax, please attach a copy of a Certificate of Exemption. If applying for an Approved Issuer Levy, please complete the Approved Issuer Levy section and read the AIL conditions below. * Available for companies only ** Available for individuals and trustees only

1. Non-Resident address (full overseas address must be provided if a non-resident tax rate or Approved Issuer Levy is required)
3. Please invest my/our funds as set out in this application, subject to the terms and conditions of the Trust Deed and the current Prospectus. I/We understand that UDC reserves the right to decline any application. Please read the AIL conditions below before signing the application form.

Application for deduction of cost of Approved Issuer Levy on non-resident income

1. By completing the Approved Issuer section above, the investor authorises UDC to deduct the cost of the Approved Issuer Levy (currently 2%) from all payments of non-resident income made to the investor on registered securities held in the investors name by UDC.
   
   The investor authorises this deduction on the basis that Approved Issuer Levy will be paid by UDC to the Commissioner of Inland Revenue, as provided for in New Zealand law, in respect of the non-resident income payment from which the deduction has been made.
   
   The authorisation may be revoked by the investor at any time by notice in writing which is received by UDC at the address below ten (10) or more days prior to a payment of non-resident income at which time UDC will deduct any applicable withholding taxes from future payments.

1. Amount (minimum $5,000)
2. Interest rates for the UDC Telephone call Account are variable. Indicative interest rates are published on the first day of each calendar month and are available from UDC's website www.udc.co.nz or by calling toll free on 0800 652 832. Automatic payments can only be loaded to your UDC Telephone Call Account from your nominated bank account.

1. Password
2. Hint

1. Bank
2. Branch
3. Account name
4. Bank account number

1. Set up a Direct Debit and you can make payments to your UDC Secured Telephone Call Account with a single phone call. Click here to download a Direct Debit authority form, then print, complete and enclose it with your application.