FAIR ENTITLEMENTS GUARANTEE RECOVERY PROGRAM – FUNDING APPLICATION

1. General

1.1 Name and ACN of the company in liquidation (Company)

1.2 Liquidator(s)

(a) Name(s)

(b) Postal address

(c) Email address

(d) Telephone number

(e) Date(s) of appointment

1.3 Type of winding up (i.e. voluntary or court-ordered)

2. Asset and liability position of the Company

2.1 Asset position of the Company

(a) Total assets of the Company

(i) book value

(ii) estimated realisable value

(iii) estimated value (if proposed action not pursued)

$

$

$

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(b) Cash at bank and cash on hand $

(c) Other non-contingent assets

(i) book value

(ii) estimated realisable value

$

$

(d) Contingent assets

(i) book value

(ii) estimated realisable value

$

$

2.2 Liability position of the Company

(a) Total liabilities of the Company

(i) book value

(ii) estimated value

$

$

(b) Creditors (non-priority and unsecured)

(i) claim value

(ii) admitted value

$

$

(c) Creditors (secured)

(i) claim value

(ii) admitted value

$

$

(d) Contingent liabilities – estimated value $

2.3 Please separately provide copies of the Company's accounts, report as to affairs (Form 507) or Presentation of accounts and statement (Form 524) most recently lodged with ASIC.

3. Commonwealth - Department of Jobs and Small Business

3.1 Is the Commonwealth a creditor of the Company?

Yes

No

3.2 Has the Commonwealth lodged a proof of debt in the liquidation of the Company?

Yes

No

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If so:

(a) What is the amount of the Commonwealth's proof of debt?

(b) Has the proof of debt been admitted for dividend purpose?

Yes

No

(c) What is the amount for which the proof of debt has been admitted?

(d) What is the amount of the interim dividend (if any) that has been paid to date to the Commonwealth in respect of its proof of debt?

(e) If the proposed action, the subject of this application, were not pursued, what is likely to be the total amount of dividend(s) (both past and future) that the Commonwealth will receive in respect of its proof of debt? When is the Commonwealth likely to receive its next payment of dividend or dividends?

(f) If the proposed action, the subject of this application, were pursued and successful, what is likely to be the total amount of dividend(s) (both past and future) that the Commonwealth will receive in respect of its proof of debt?

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4. Other priority creditors

4.1 What is the total amount of payments made to date in respect of priority claims under section 556 of the Corporations Act (other than the Commonwealth's claim)? Please provide a breakdown of those payments by reference to the subparagraphs in section 556(1) of the Corporations Act.

4.2 What is the total unpaid amount of priority claims under section 556 of the Corporations Act (other than the Commonwealth's claim)? Please provide a breakdown of those claims by reference to the subparagraphs in section 556(1) of the Corporations Act.

4.3 What are the current charge-out rates of yourself and other staff as relevant to the proposed action?

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4.4 What is the estimated amount of future costs and expenses that will be incurred in the winding up (excluding costs associated with the proposed action)? Please explain how those costs and expenses might arise.

5. Existing litigation funding arrangements and recovery proceedings

5.1 Are there any existing funding or indemnity arrangements between yourself (as liquidator of the Company) and one or more creditors or other persons? If so, please identify the funder(s) or indemnifier(s) and provide details of those arrangements.

5.2 Are you (as liquidator of the Company) and/or the Company currently engaged in, or proposing to commence, any recovery proceedings or litigations other than the proposed action, the subject of this application? If so, please provide details of those proceedings.

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6. Proposed action

6.1 Please identify the cause(s) of action to which this application relates.

6.2 Please identify the defendant(s) to those cause(s) of action.

6.3 What is the total claim amount for each cause of action? Please provide details.

6.4 Please identify any relevant limitation period in respect of each cause of action of which you are aware.

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6.5 Please provide an outline (in a separate document) the particulars of the cause(s) of action, including, without limitation:

(a) the facts and circumstances giving rise to the claim(s);

(b) an evaluation of the merits of the claim(s);

(c) an evaluation of the prospects of success; and

(d) any peculiarity or complexities associated with the claim(s), of which you are aware.

6.6 Please provide a brief description (in a separate document) of the supporting evidence, including, without limitation:

(a) evidence that is in your possession or custody or is otherwise available;

(b) evidence, or relevant information and documents, which you are aware of, but which are not currently in your possession or custody;

(c) any actions which you have taken for the purposes of gathering evidence; and

(d) any actions which you propose to take to obtain further evidence.

6.7 Have you already obtained an advice on the prospects of success of the cause(s) of action?

Yes

No

6.8 What is your estimate of the likely duration of the proposed action? Please provide sufficient information to explain your estimate.

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6.9 What is your estimate of the total costs (including your professional fees and legal costs) that are likely to be incurred in connection with the proposed action (if it were pursued to judgment)? Please provide sufficient information to explain your estimate.

6.10 In this application, are you applying for funding from the Commonwealth in respect of the entire amount of the estimated total costs (identified in your answer to question 6.9 above)? If not, please specify the other intended source(s) of funding for the proposed action (including any assets of the Company which you intend to realise and apply towards funding the proposed action).

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6.11 Please provide details of any steps you have already taken to investigate and pursue the cause(s) of action (for example, has any letter of demand been issued or public examinations conducted?).

6.12 Have you already engaged solicitor(s) and/or legal counsel in relation to the proposed action? If so, please provide their details and their hourly/daily rates.

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6.13 Please provide details of the asset position of the defendant or defendant(s), to the extent that you are aware. If available, please also provide copies of any evidence of the defendants' asset position.

6.14 If the defendant(s) to the proposed action are director(s) or officer(s) of the Company, please provide details of any known D&O insurance policy of which the defendant(s)/officer(s) are beneficiaries. If available, and subject to any confidentiality restrictions, please also provide copies of all relevant policy documents.

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6.15 If the defendant(s) to the proposed action are director(s) or officer(s) of the Company, please provide details of any known indemnity arrangement whereby the Company agrees to indemnify the director(s)/officer(s) for liabilities incurred in their capacity as such and/or their legal costs and expenses. If available, please also provide copies of all relevant indemnity documents.

7. Other information

7.1 Please separately provide copies of:

(a) an historical company extract in respect of the Company; and

(b) any reports prepared in respect of the Company, pursuant to sections 439A, 476 or 533 of the Corporations Act.

7.2 Please provide any other information and supporting documents which may be relevant to your application for litigation funding.

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8. Signature and declaration by liquidator

9. Submission

Once completed and signed, please submit this Funding Application Form (together with all annexures and supporting documents) to the Commonwealth Department of Jobs and Small Business by email to FEGRecoveryapplications@jobs.gov.au or by post to:

FEG Recovery Team Department of Jobs and Small Business GPO Box 9880 CANBERRA ACT 2601

Updated: February 2018

I declare that the information provided in the application form is true and correct to the best of my knowledge and belief.

Signed:

Dated:

Full name:

Capacity: