Victoria Co-operative Act 1996 CEPA CO-OPERATIVE LIMITED -------------------------------------------------------------------------------------------------------------------------------- APPLICATION FOR MEMBERSHIP -------------------------------------------------------------------------------------------------------------------------------- Surname of Applicant ............................................................................................. Christian Name ......................................................................................................... Occupation ................................................................................................................ Telephone (Home) .............................................Telephone (Business).............................................. Residential Address................................................................................................................................ Postal Address......................................................................................................................................... .................................................................................................................................................................... 1. I hereby apply to be admitted as a member of the CEPA CO-OPERATIVE LIMITED and to be allottted TWENTY FIVE [25] shares therein; and in respect of such application I lodge herewith in accordance with the rules the sum of $60.00, being $50.00 for shares ad $10.00 for annual membership fees. 2. If this application be approved and the sahres as afoirsaid be allotted to me, I agree to pay all charges required by the Co-operative and I agree to be bound by the rules of the Co-operative and by any amendments thereof registered in accordance with the above-named Act. Account Refrences 1. Business Name ....................................................................................... Telephone Number.................................................................................. 2. Business Name........................................................................................ Telephone Number.................................................................................. Please Supply Details Below Size of Property................................................................. Animals/Birds/Etc.. ................................................................ Proposed By............................................................... [Account Number].................................................. Signature .................................................................................... Signature of Applicant .............................................................................. Date of Application .................................................................................... Date of Acceptance.....................................................................................