Credit Application

ACCOUNT CREDIT APPLICATION

Section 1: Customer Trading Details

Registered Name *

Trading Name (if different from Registered Name)

ABN *

Nature of Business

Trading Address *

In business since *

Business Type *

Accounts Phone Number *

Accounts Email Address *

Name of Principal Contact *

Title *

Primary Contact Mobile Phone Number *

Primary Contact e-mail *

Section 2a: Customer Owner/Dirctor Details

1

Director Name *

Director Phone Number *

Director email address *

2

Director Name

Director Phone Number

Director Email Address

Section 2b: Trade References

1

Contact Person *

Job Title

Company Name *

Phone *

Email address *

2

Contact Person *

Job Title

Company Name *

Phone *

Email *

3

Contact Person

Job Title

Company Name

Phone

Email Address

Section 3: Services and Credit Requested

Services Requested (Please select all that apply) *

Comprehensive Pre-employment MedicalsMining Medicals ( e.g. site access to FMG, RioTinto, etc)CAT3 Rail MedicalsOGUK/OEUK MedicalsCommercial Driver MedicalsInstant Drug & Alcohol TestsLab Drug & Alcohol TestsBasic Pre-employment Medicals (office work)Injury Management Services

Approximate Volume of Services *

Credit Terms Requested *

Due on receipt (standard for less than 3 medicals per month unless approved by MD)Net 14 ( standard for 4-10 medicals per month unless approved by MD)Net 30 End of Month

Does your company require a PO# on each invoice? *

YesNo

Preferred status and results reporting *

Secure portal to view assessment status and download reports ( for nominated email addresses)E-mail to the requestorOther

GC/MS Confirmation for LabDAS *

Please do automatic LC/MS confirmation testing for any detectionsPlease call requestor before performing an LC/MS confirmation testDo nothing - just sent us the results

How did you hear about us?

Section 4: Applicant SIGNATURE

Signature *

Draw signature|Type signatureClear

Name *

Date *

Section 5: KEY TERMS & CONDITIONS

Terms and conditions of credit

1. In applying for credit with Hire Health Pty Ltd, I/we (the Customer) acknowledge that any credit (the credit facility) granted following this application will be subject to the terms and conditions stated in this application or as subsequently varied by Hire Health Pty Ltd at its discretion and notified to the Customer. The Customer further acknowledges and agrees that, if the Customer is granted credit facilities in respect of both insolvency services and PPSR services, when applying the terms and conditions each is to be treated as a separate credit facility.

2. Payment terms are “Net 14 Days”, payment being due within 14 days from the date of invoice unless alternative terms are agreed upon by Hire Health Pty Ltd in writing via email or in the HireHealth Approvals in Section 6 below

3. Any credit limit approved by Hire Health Pty Ltd and advised to the Customer must not be exceeded. Hire Health Pty Ltd periodically reviews its credit limits. The Customer agrees that Hire Health Pty Ltd may review and revise the Customer’s credit limit at anytime. Hire Health Pty Ltd may increaseorreduce the Customer’s credit limit at theCustomer’s request. Hire Health Pty Ltd may also reduce the Customer’s credit limit without request, butHire Health Pty Ltd will not reduce the Customer’s credit limit below the outstanding balance on the account at the time of the reduction withoutprior communication with the Customer

4. Hire Health Pty Ltd reserves the right to pursue collection of outstanding amounts. Relatedcosts including but not limited to external collection agent fees, legal and court costs may be added to the outstanding amount owed under the credit facility.

5. Hire Health Pty Ltd may at any time set-off amounts owed by Hire Health Pty Ltd to the Customer from the amounts owed by the Customer to Hire Health Pty Ltd. Hire Health Pty Ltd will apply payments against the outstanding amounts in the order in which they were incurred.

6. The Customer indemnifies and holds harmless Hire Health Pty Ltd and its officers, employees and agents from and against all actions, claims, proceedings or demands which may be brought or made against it or them or any of them in respect of any loss, injury, or damage arising out of any breach of these terms and conditions by the Customer or any negligent act or omission by the Customer and from and against all damages, costs and expenses incurred in defending or settling any action, claim, proceeding or demand arising from such breach, act or omission.

7. The Customer accepts and acknowledges that Hire Health Pty Ltd may disclose information disclosed in the course of this credit application to a credit reporting agency.

8. The Customer agrees to Hire Health Pty Ltd obtaining personal information from any credit reporting agency or a credit provider for the purpose of assessing any application submitted by or on behalf of the Customer for commercial credit (including information as to creditworthiness); and agrees to that agency or provider providing that information to Hire Health Pty Ltd for that purpose.

9. The Customer agrees to Hire Health Pty Ltd obtaining from, and provision by, any such credit reporting agency or credit provider further credit reports, which may assist Hire Health Pty Ltd in recovering any sums outstanding under the terms of thecredit facility to which this application may lead.

10. Hire Health Pty Ltd is not liable for any costs incurred in the completing of this form. TheCustomer is responsible for any stamp duty or other government charges levied on or in connection with this application or any associated credit facility or guarantee.

11. The Customer agrees that it is the responsibility of the Customer to advise Hire Health Pty Ltd of any change of address or contact information in writing within a timely manner and no later than 30 days from the date that the change is effective.

12. In the event of a dispute regarding an outstanding amount: (a) the Customer agrees that the dispute will be dealt withas follows: (i) the Customer will give Hire Health Pty Ltd a written notice setting out the amount and full particulars of the dispute, including the reasons the Customer disputes the amount, and the contact details of a nominated representative with authority to settle the dispute on behalf of the Customer; (ii) the Customer’s representative and Hire Health Pty Ltd will try to settle the dispute bydirect negotiation between them; (iii) the parties will attempt to achieve a speedy resolution; and (iv) if the parties have been unable to settle the dispute within 28 days either party may commence legalproceedings (b) the Customer will remain liable for the amount and fullpayment of all invoices are required by the due date (unless Hire Health Pty Ltd otherwise consents in writing); and (c) this clause does not apply to: (i) legal proceedings by either party seeking urgent interlocutory relief; or (ii) any action by Hire Health Pty Ltd under clauses 16 to 22.

13. Hire Health Pty Ltd may request the Customer to provide general purpose financial reports and other financial information for the assessment of this credit application.

Director’s Guarantee

14. If the Customer is a body corporate, Hire Health Pty Ltd may at any time before or during the operation of the credit facility require one or more of the Customer’s directors and/or officers to guarantee repayment of the credit facility. If a director/ officer who has provided such a guarantee vacates theiroffice, the Customer must notify Hire Health Pty Ltd in writing within 14 days.

Confidentiality of the Applicant’s information

15. Except as required by law, Hire Health Pty Ltd will only use or disclose the Customer’s personal information as necessary for the assessment and administration of the credit facility — for example, toaccounts receivables staff or to external auditors.

Termination, Suspension and Default

16. In the event that full payment is not received by the duedate the credit facility may be suspended or cancelledwithout notice. Reinstatement of credit terms after any suspension will be at the discretion of Hire Health Pty Ltd.

17. The Customer acknowledges that Hire Health Pty Ltd may suspend or terminate the credit facility immediately (with or without written notice), ifthe Customer: (a) obtains credit by fraud, dishonesty or omission; or (b) allows the amount of a monthly statement to remain unpaid for more than 30 days from its due date; or (c) breaches any of these terms and conditions; or (d) being an individual, commits an act of bankruptcy; or (e) being a body corporate, becomes externally administered; or if: (f) Hire Health Pty Ltd believes thatthe continued use of the credit facility may cause loss or damage to the Customer or Hire Health Pty Ltd; or (g) in the opinion of Hire Health Pty Ltd any change in circumstances, including, without limitation, changes in the Customer’s constitution, ownership, membership, control status or ability to provide security for payment of amounts which have or are likely to be charged to the credit facility, makes the continuance oftheapplication undesirable or unsatisfactory; or (h) where one or more persons guarantee the Customer’s obligations under the credit facility — that person or those persons withdraws his, her or their guarantee.

18. Subject to any relevant legislative requirement, intheevent the Customer breaches any of these terms and conditions, Hire Health Pty Ltd reserves the right to notify credit reporting agencies of thatbreach. The Customer acknowledges that any damages suffered by the Customer as a result of the listing is solely the Customer’s responsibility and holds Hire Health Pty Ltd and its officers, employees and agents safe from claim in respect of any damages.

19. If the credit facility is suspended or cancelled then Hire Health Pty Ltd may require immediate payment of all outstanding amounts. Suspension or cancellation does not affect any of the Customer’s obligations in respect of the credit facility.

20. The Customer must pay to Hire Health Pty Ltd all amounts reasonably incurred or expended by Hire Health Pty Ltd in exercising its rights as a result of a breach of these terms and conditions by the Customer or as a result ofanycircumstance referred to in clause 17.

Variations

21. Hire Health Pty Ltd may vary these terms and conditions with respect to future transactions between Hire Health Pty Ltd and the Customer: (a) by agreement between Hire Health Pty Ltd and the Customer; or (b) by Hire Health Pty Ltd giving tothe Customer not less than 21 days’ prior written notice specifying the variation and the date on which the variation becomes effective.

22. Notice of the variation under this clause need not be sent separately and may be sent with the Customer’s statement of account or as part of any othercorrespondence.