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TE FOR POWER OF ATTORNEY: If this form is signed under a Power of Attorney, please enclose a certified copy of the Power of Attorney with this form if not previously lodged. Please also note that if the Attorney is not an existing client of Bell Potter Securites, they must complete the Agent Identity verification process. If signed under power of Attorney, the attorney certifies that he/she has not received notice of revocation of that power. 1. CLIENT DETAILS Bell Potter Account Number(s).

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