Application Form (online)

* Indicates required field

A. I/we apply for *

Minimum 100,000,000 shares @ 10c per share, fully paid.
You may be allocated all of the above Shares or a lesser number.

B. I/we lodge full Application Money $ *

Upon Application $10,000,000.00

C. Individual/Joint applications - refer to naming standards for correct forms of registrable title(s)

click here for
naming standards

Title or Company Name *

Given Names *

Surname *

Joint Applicant 2 or Account Designation *

Joint Applicant 3 or Account Designation *

D. Enter your postal address - Include State and Zipcode

Address *

Line 1

Line 2

City

State

Zip Code

Country

SOPHISTICATED INVESTOR CERTIFICATE *

Please complete the Sophisticated Investor Certificate, using the WORD document here (click to open). After completing - print, sign, scan and save to your computer. Then using the "Upload File" below, attach. Once you click the "Submit" button it will be sent with your Application Form.

Upload File *

Max file size: 20MB

E. Enter your contact details

Contact Name *

First

Last

country code *

area code *

telephone *

Mobile *

Email *

Company *

A Direct Debit transfer can be made to:
Integrated Energy Corporation
BSB: 012-006 | A/C: 2132-58136
Swift Code: ANZBAU3M

Cheque details - Make your cheque or bank draft payable to:
Integrated Energy Corporation - Project 2020

F. Drawer 1 *

Cheque Number *

BSB Number *

Account Number *

Amount of cheque $ *

Drawer 2 *

Cheque Number *

BSB Number *

Account Number *

Amount of cheque $ *

By submitting this Application Form, I/we declare that this application is completed and lodged according to the Executive Brief (EB) and the declarations/statements on page 17 of the EB and I/we declare that all details and statements made by me/us (including the declaration on page 17 of the EB are complete and accurate. I/we agree to be bound by the Constitution of the Company. See page 17 of the EB for completion guidelines.

This Application Form is important. If you are in doubt as to how to deal with it, please contact your stockbroker or professional adviser without delay. You should read the entire Executive Brief (EB) and Important Notice (IN) carefully before completing this form. To meet the requirements of the Corporations Act, this Application Form must not be distributed unless included in, or accompanied by, the EB and IN.

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