Subsidised Form

WARNING: Providing false information to Government is an offence under the False Information Act 2016. If you are found guilty of providing false information to Government, you may be fined up to $20,000 or sentenced to imprisonment for up to 10 years

Fill out this Application Form if you wish to apply to receive 250 Non-Voting Shares in the capital of Energy Fiji Limited :

Please read the Offer Document.
Follow the instructions to complete this Application Form.
Type clearly in ENGLISH and in CAPITAL LETTERS
By completing and Submitting an Application, you appoint the Permanent Secretary (as defined in the Offer Document) as your attorney to execute a Master Transfer Form to effect the transfer of 250 Non-Voting Shares.

A ) Number of shares You are applying to recieve

B ) Enter the Account Holders Customer Number with EFL

Enter 7 digits/numbers without - or spaces

C ) Write the name of the Account Holder here. The Non-Voting Shares will be registered in this name

At least one full given name and surname is required

D ) Write the postal address of the Account Holder here

E ) Contact telephone number (daytime/mobile)

F ) Enter Email

G ) Bank Details

H ) Fijian Citizenship Details
Account Holder's Citizenship and Residential Details.
Please note that either one of Voter ID or Passport Number is required.

Voter ID Number

Voter ID Attachment

Passport Number

Passport ID Attachment

Tax Identification Number (TIN)

Enter 9 digits/numbers without - or space

TIN ID Attachment

Residential Address

The Account Holder confirms that they are a Subsidised Account Holder eligible to complete this Subsidised Account Holder Application Form (Please tick)

By submitting this Application Form, I/We declare that this Application is completed and lodged according to the Offer Document and the instructions on the reverse of the Application Form and declare that all details and statements made by me/us are complete and accurate. I/We agree to be bound by the Articles of Association of Energy Fiji Limited (the Company). I/We was/were given access to the Offer Document together with the Application Form. I/We represent, warrant and undertake to the Company that our subscription for the above Non-Voting Shares will not cause the Company or me/us to violate the laws of Fiji or any other jurisdiction which may be applicable to this subscription for Shares in the Company. I/We represent, warrant and undertake to the Company the person listed in paragraph C of this Application Form is an Eligible Fijian Resident as described in the Offer Document.

Subsidised Form

Energy Fiji Limited

RCBS2018L9676

Subsidised Account Holder Application Form

Fill out this Application Form if you wish to apply to receive 250 Non-Voting Shares in the capital of Energy Fiji Limited :