The Woodsford - Nuix - Litigation Funding Scheme

Annexure A: Application Form

The Woodsford Nuix Litigation Funding Scheme

This Application Form relates to the Woodsford Nuix Litigation Funding Scheme (ARSN 655 927 521) (Scheme). By submitting a completed Application Form the applicant applies for a 'Participating Interest' in the scheme.
Persons who acquired Nuix Limited securities (ASX:NXL) during the period 26 November 2020 to 29 June 2021 (inclusive) (Qualifying Shares) are eligible to apply.

The Scheme, including the nature of a Participating Interest, is described in the Product Disclosure Statement (PDS) issued by Woodsford Australia Limited (AFS licence no. 527367) (Responsible Entity).

This Application Form is part of the PDS or can be separately downloaded here:

Please read the PDS, this Application Form and the Constitution (available on request from the Responsible Entity) carefully, as they contain terms that will be legally binding on you if your application for a Participating Interest in the Scheme is accepted by the Responsible Entity.

Persons who may fill out and sign the Application Form include:

  1. the Claimant (including where the Claimant is a trustee who held the Qualifying Shares on behalf of a beneficial owner); or
  2. a person legally authorised to act on behalf of the Claimant and make the declarations below. See Part D Below.

Part A: Contact Details

Contact Name:



Telephone:        Mobile:


Postal Address:

Part B: Claimant Details

Claimant is a/an:

If Other :

Claimant Name:

Company Number:  

Claimant Postal Address:

Part C: Details of Share Ownership

The Claimant

If the Claimant holds the Qualifying Shares on behalf of the
beneficial owner, what is the name of the beneficial owner of the Qualifying Shares:



Please attach a PDF schedule of Beneficial Owners (if appropriate)

Registered Owner's Holder Identification / Shareholder Registration Number (if known):  

Part D: Capacity of the person signing this Application Form

If the Claimant is:

1. An individual or individuals (for example joint shareholders) who own the Qualifying Shares on their own behalf, each individual must sign the Application Form.

2. A trustee that holds the Qualifying Shares on behalf of a beneficial owner (including where the Qualifying Shares are held through a superannuation fund), the trustee(s) must sign the Application Form.

a. If the trustee(s) are individuals, each individual trustee must sign the Application Form.

b. If the trustee is a company, authorised signatories (such as directors) of the company must sign the Application Form.

3. A company, including a responsible entity, nominee or custodian, authorised signatories (such as directors) of the company must sign the Application Form.

Capacity in which you are signing this Application Form:

If as an agent who is legally authorised please specify:

Part E: Agreement and signature

By signing below, you (as a legally authorised person) and the Claimant declare and agree that:

  • in the event that you are completing this Application Form on behalf of a Retail Client, you are executing this form pursuant to a power of attorney;
  • the Claimant(s) acquired the Qualifying Shares, as described above;
  • you are duly authorised to act in relation to the Qualifying Shares and to sign this Application Form on behalf of the Claimant(s) and have identified the capacity in which you act above);
  • you have read and understood this PDS and the Constitution (including the funding terms set out in Annexure C of the PDS);
  • the Responsible Entity is not bound to accept the application;
  • you acknowledge the existence (or potential existence) of competing class actions referred to in the PDS and agree to opt out the Claimant from those competing class actions and any other Class Action relating to the same subject matter as the Nuix Class Action as long as the Nuix Class Action continues to be prosecuted;
  • the Claimant(s) will be bound by the Constitution (a summary of which is set out in Annexure B of the PDS) and the terms of the Scheme, including the funding terms;
  • all information provided by you in the Application Form is true and correct and you will inform the Responsible Entity of any changes to the information supplied as soon as practicable;
  • the Responsible Entity will disclose personal information that you provide to its related bodies corporate and to the Lawyer Member in accordance with its Privacy Policy;
  • the Responsible Entity or the Lawyer Member may contact you using any contact information provided in the Application Form; and
  • you will provide any further documents or information requested by the Responsible Entity to enable the Responsible Entity to comply with its obligations under any applicable laws, including anti-money laundering and counter-terrorism financing legislation and tax reporting legislation.

Date: 5 March 2024      Position/Capacity:  

Company Seal (If applicable):

SIGNED by or on behalf of and with the authority of the Claimant.

Leave this empty:

Signature arrow sign here

Signature Certificate
Document name: The Woodsford - Nuix - Litigation Funding Scheme
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Timestamp Audit
14 April 2022 21:41 GMTThe Woodsford - Nuix - Litigation Funding Scheme Uploaded by Steven Savage - IP