Change Request Form
PLEASE READ CAREFULLY
This form is for Royalty Entitlements for Security Holders as at 12 January 2024 for ASX:MDC, only.
This form is only for those parties who had shares in Medlab Clinical LTD on the record date of 12 January 2024. This record date serves as the commencement of potential royalties under the private company Medlab Group Pty Ltd (MDG), pursuant to the resolutions passed at the Medlab Clinical LTD, Extra-ordinary Meeting dated 22 December 2023.
IF YOU WERE NOT A SECURITY HOLDER OF AT THE TIME OF 12 JAN 2024, DO NOT COMPLETE THE FORM.
This form allows you to request changes to:
your physical address
your email address
your banking instructions
Royalty holders can not change their:
HIN/SRN , This number was previously used to purchase MDC's share as per the record date - this HIN/SRN number should be visible on past correspondence from the share registry, and part of your login to the share registry portal.
Beneficiary Name, The beneficiary name is not changeable as royalty rights are not changeable. The beneficiary name is the name you originally bought the MDC securities under and should be visible on the historical notification the share registry sent you.
These two non-changeable entries are how we validate true ownership of the royalty benefit, and subsequently, payment amounts if royalties are payable.
If you did not hold securities in ASX:MDC on 12 January 2024, do not complete this form.
Please ensure you have the correct HIN/SRN and Beneficiary Name before completing this form; otherwise, the form request may be deleted.
For security reasons, we can not disclose any information until verification is completed. Each request requires verification.
IF YOU DO NOT HAVE YOUR HIN OR SRN AND THE BENEFICIARY NAME, DO NOT COMPLETE THE ATTACHED FORM.
On receipt of this form, a verification process will be undertaken to ensure an exact match of certain records before any update is synchronised to the master lists.
Please be advised that the accuracy of your data is your responsibility. Please ensure you have the correct details available before requesting any changes.
Please Note:
Medlab Group Inc. or its associated companies ARE NOT Medlab Clinical Limited. We are not affiliated with Medlab Clinical Limited, nor do we have knowledge of their current operations or future plans. Medlab Group Inc. will not answer questions related to Medlab Clinical Limited.
This Royalty agreement with the former shareholders of Medlab Clinical Limited, as at 12 January 2024, expires at the close of business on 12 January 2028 AEDT.
BY COMPLETING THE ATTACHED FORM YOU STATE YOU UNDERSTAND AND AGREE TO THE ABOVE STATEMENT.
Complete the following