Cross-referenced from Rule 720(1) and Appendix 7F
To: Singapore Exchange Securities Trading Limited
c/o__________(Insert the name of the Issuer)
In consideration of the listing and quotation of the securities of__________ (insert the name of the Issuer) (the "Issuer") on the Official List of the SGX Catalist:—
(a) In the exercise of my powers and duties as a director or executive officer of__________
(Insert the name of the Issuer
) I, the undersigned, shall:—
(i) use my best endeavours to comply with the requirements of Singapore Exchange Securities Trading Limited (the "Exchange") pursuant to or in connection with the SGX-ST Listing Manual from time to time in force; and
(ii) use my best endeavours to procure that the Issuer shall so comply;
 I hereby irrevocably appoint the Issuer as my agent, for so long as I remain a director of the issuer or executive officer of the Issuer, for receiving on my behalf any correspondence from and/or service of notices and other documents by the Exchange.
 Any correspondence from and/or service of notices and other documents by the Exchange may be sent to my correspondence address set out below. In the event of any change to my correspondence address, I undertake to promptly inform the Issuer and update the correspondence address set out below.
Correspondence Address: _____________________
*Please tick accordingly.
(c) I understand the possible consequences of giving to the Exchange information including those referred to in this Form which is false or misleading pursuant to section 330 of the Securities and Futures Act, Chapter 289 of Singapore; and
(d) I undertake to the Exchange in the terms set out in this Form.
Name of director/executive officer:_____________________[full name (including non-English characters as reflected in identification documents)]
Singapore NRIC Number:_____________________
In case of a non-Singapore NRIC cardholder, state the passport number or any identification number and name of issuing authority:
If you have any queries you should consult the Exchange or your professional adviser immediately.
Added on 7 October 2015 and amended on 30 April 2016.