Botanic Wellness Limited

Pre-IPO application form

This investment is only suitable for Wholesale investors under s708 of the Corporations Act 2001.

Start applicationInformation memorandum

Instruction to applicants

Applications must be made on by filling out the online Application Form below. OR by filling out the paper copy here. If you wish to fill out the paper application, please email the completed form to [email protected]

Please complete all parts of the Application Form. Insert the number of Shares you wish to apply for. The Applicant(s) agree(s) upon and is subject to the terms of the Offer to take any number of Shares equal to or less than the number of Shares indicated in a box that may be allotted to the Applicants declare(s) that all details of statements made are complete and accurate.Applicants agree to be bound upon acceptance by the Company of the Application.


Applications for Shares must be accompanied by the application money of twenty cents ($0.20) per share (in Australian currency). Cheques should be made payable to “XXX” and crossed “Not Negotiable”. Direct Deposits should be completed as per the instructions below. Direct Deposit details will be provided to you via email upon submitting the below application

Should an Application Form be completed incorrectly, the Company in its sole discretion may elect to accept or reject the Application and how to construe, amend or complete it but in no case whatsoever shall any Applicant be treated as having offered to acquire more shares than is indicated by the amount of the cheque or direct deposit for the application monies.

Correct Form of Registrable Title

Applications must be in the name(s) of:

  • A Natural Person(s);
  • A Company;
  • A Trust (including Trustees); or
  • Another type of legal entity recognised under the relevant legislation.

At least one first name and surname is required for each natural person.

The name of the Beneficiary or any other Non-Registrable name may be included by way of an Account Designation, if completed exactly as described in the example of the correct forms of Registrable Title:

+ View correct forms of registrable titles

Type of investor

Correct form of Registrable Title

Incorrect form of Registrable Title


John Alfred Brown, Use given names, not initials

(no more than 3 individuals can be registered)

JA Brown


ABC Pty Ltd

Use Company title, not abbreviations



Sue Brown, Sue Brown Family A/C

Use Trustee(s) personal name(s)

Sue Brown Family Trust

Do not use the name of the Trust

Deceased Estates

Jane Brown, Est John Brown A/C

Use Executor(s) personal name(s)

Estate of late John Brown


John Brown + Michael Brown

Use partners’ personal names

John Brown and Son

Do not use the name of the partnership

Clubs/ Incorporated Bodies/ Business Name

Michael Brown, ABC Tennis Association A/C

Use Office Bearer(s) personal name(s)

ABC Tennis Association

Do not use the name of the club

Superannuation Funds

Jane Brown Pty Ltd Super Fund A/C

Use the name of the Trustee of Fund

Jane Brown Pty Ltd Superannuation Fund

Do not use the name of the Fund

Application form

This Application Form is important. If you are in doubt as to how to deal with it, please seek professional investment advice without delay. You should read the Information Memorandum dated November 2020 before completing this Application Form.

ANumber of shares applied for

Number of shares in Botanic Wellness Limited at $0.20 per Share or such lesser number of Shares which may be allocated to me/us on a pro-rata basis.

BApplication monies

CApplicant name(s)

You may add up to 3 applicants.

DPostal address

EContact details


By submitting this application, I accept the terms and conditions