oriental merchant pty ltd

Oriental Merchant Pty LtdABN 34 007 368 92510 Westgate Drive, Laverton North, VIC 3026Phone: (03) 9250 8133 Fax: (03) 9560 1316ACCOUNT APPLICATION FORM

REGISTERED COMPANY/BUSINESS NAME: Salt n Spice Indian and Polynesian Supermarket

ABN/CAN 601677614

TRADING AS TYPE OF BUSINESS:(Tick1): SOLE PROPRIETOR PARTNERSHIP PROPRIETARY COMPANY

REGISTERED ADDRESS 7/109 Grand Plaza Drive Browns Plains 4118

BUSINESS ADDRESS Same As Above

REGISTRATION DATE: 6/09/2014

NATURE OF BUSINESS Retail

AUTHORIZED CAPITAL STOCK:: .:.PAID UP CAPITAL

PROPRIETOR(S)/DIRECTOR(S) CONTACT NO. BIRTHDATE/ D.LICENSE #:. PERSONAL ADDRESS:

1)Shabin Shaista Dean (0433642525) 02/06/1993 13/45-47 Defiance Road Woodridge 4114 ...2) . ___/___/______-.............. .....3) . ___/___/______-.............. ... ...SECRETARYS FULL NAME CONTACT NO. BIRTHDATE/ D.LICENSE #:. PERSONAL ADDRESS: . ___/___/______-.............. .... ...

DELIVERY ADDRESS 7/109 Grand Plaza Drive Browns Plains 4118

POSTAL ADDRESS: Same as Above

CONTACT0433642525; 0433068181 EMAIL: saltnspicesupermarket@gmail.com PH/FAX: 0738001950ORIENTAL MERCHANT PTY LTD ACCOUNT APPLICATIONPage 2 of 2ACCOUNT APPLICATION (Continued)

TRADE REFERENCES: CONTACT PHONE1) ..2) ...3) ...

CREDIT LIMIT REQUEST: $........................ TERMS: ...............................................

Terms and ConditionsI/We hereby confirm we have read, accepted and agreed to all the terms and conditions specified below:1. Credit facility is only available upon receipt of signed acceptance offered by Oriental Merchant Pty Ltd(Oriental Merchant).2. Accounts must be settled in full as they fall due within the trading terms granted by Oriental Merchantstipulated on statement and/or invoice.3. Default in payment will automatically revert account to COD.4. Ownership of the goods sold belongs to Oriental Merchant until full settlement of invoice. The risk of lossor damage to the goods shall be entirely at our risk upon delivery of the goods to us.5. No claim of any kind shall be entertained by Oriental Merchant after seven (7) days from the date ofdelivery.6. Acknowledgment/Receipt of goods is proof of delivery.I /We agree to be responsible to Oriental Merchant for all balances which are due or may be from thetime hereafter owed by the applicant, for goods and services supplied by Oriental Merchant to theapplicant. Interest on the applicants overdue payments, costs incurred by Oriental Merchant in thecourse of recovering and/or enforcing judgments for monies due and payable by the applicant are fullyborne by the applicant.

Shabin Shaista Dean

Name & Signature of Proprietor/Partner/Director Name & Signature of Proprietor/Partner/Director

Date 24/02/2015

PRIVACY STATEMENT: Oriental Merchant Pty Ltd (Oriental Merchant) is committed to protecting your privacy and theconfidentiality and security of personal information provided by you to us. The information you provide is necessary to process yourapplication and will be stored as record and profile information. The information provided by you will be used to contact you, yourbanker, and your referees. The information in this application form will be furnished to credit organizations for credit checks, and in theevent of your default and non compliance with the default notice, may be disclosed to a debt collection agency, and the overdueaccount published with a credit reporting agency. Please contact Oriental Merchants Privacy Office if you would like to access orupdate information we hold about you or your company. For more information on Oriental Merchants Privacy Statement, visit ourwebsite at www.oriental.com.au

AUTHORITY IN RELATION TO CREDIT INFORMATIONI/We authorise Oriental Merchant to obtain a credit report containing information about me/us from a credit reporting agency, and anyinformation about my/our commercial creditworthiness from my/our banks and referees, for the purpose of assessing my/our applicationfor commercial credit. I/We authorise Oriental Merchant to disclose my/our credit information to other credit providers and creditreporting agencies. I/We authorise Oriental Merchant to disclose my/our credit information to its collecting agents including debtcollection agencies and its solicitors to enable collection of my/our overdue payments. I/We authorise Oriental Merchant to notify acredit reporting agency if I/ we become overdue in making payments and list me/us in default.

Signature of Proprietor/Partner/Director

Print Full name: Shabin Shaista Dean

Date: 24/02/2015

PLEASE EMAIL COMPLETED FORM TO: For Internal use only:NEW ACCOUNTS Sales Rep: .ORIENTAL MERCHANT PTY LTD10 WESTGATE DRIVE Sub Group:.LAVERTON NORTH VIC 3026Or Fax: (03) 92508111 Price Code:.For Internal use only:Sales Rep:_______________Subgroup:_______________Price code:_______________Replacement of: __________