Application Form

This Application Form represents an offer to purchase shares in Senior Trust Capital Limited. Having received and read the current Product Disclosure Statement (PDS) dated 3 November 23 I/We hereby apply for ordinary Shares in Senior Trust Capital Limited as set out below, upon the terms and conditions of the registered PDS.

If you require assistance filling in this Application Form, please call us on Freephone: 0800 609 600.

Fill in the form and we’ll get back to you promptly.


Please enter names as they appear on your Drivers License or Passport
Residential Address (Not a PO Box)
If this is a joint application please fill in the details below of the second Applicant Please enter names as they appear on your Drivers License or Passport
Details of the second Applicant


Applicants must provide details of their drivers license or passport which will be used for AML/CFT Act verification purposes along with the Date of Birth and Residential address provided above.
Applicant One
Applicant Two


Payment is to be made by Direct credit in New Zealand dollars to the Senior Trust Capital Applications Account.
The account number is: 02 -0192-0149044-02
Please use your name as a reference. The Direct Credit should be made at the same time as the application is submitted. Refunds will be repaid to unsuccessful Applicants within five Business Days after the allocation of Shares or after an Application has been declined (as applicable). Interest will not be paid on any Application Monies refunded to Applicants.

Quarterly Distributions: Please provide bank details for Dividend Distribution Payments

PLEASE NOTE: No distribution payments will be made by cheque or to banks outside of New Zealand. Payments will be withheld until such time a bank account is provided



IRD NUMBER (Both IRD numbers are required in respect of a joint application)
ird check boxes
Please advise of country you are a Tax Resident of and Tax Identification Number if available.



By clicking the "submit and logout" button on this Application Form:
  1. I / We agree to subscribe for shares upon and subject to the terms and conditions of this Application Form and I / we agree to be bound by the provisions thereof.
  2. I / We declare that all details and statements made by me / us in this Application Form are complete and accurate.
  3. I / We certify that, where information is provided by me / us in this Application Form about another person, I / we are authorised by such person to disclose the information to you and to give authorisation.
  4. I/We consent to the Company verifying my/our identity electronically using my/our details provided above and below by providing those details to a credit reporting agency or any other person or entity for the sole purpose of identity verification.
  5. I / We acknowledge that an application cannot be withdrawn or revoked by me / us once it has been submitted.
  6. I / We acknowledge that the Offer is only made in New Zealand, and by applying for shares, I / we agree to indemnify the Company and its respective directors, officers, employees and agents in respect of any liability incurred by the Company as a result of my / our breach of securities laws in any jurisdiction other than New Zealand.

The information in this Application Form is provided to enable the Company to process your application, and to administer your investment. By submitting this Application Form, you authorise the Company to disclose information in situations where the Company are required or permitted to do so by any applicable law or by a governmental, judicial or regulatory entity or authority in any jurisdiction. If you are an individual under the Privacy Act 1993, you have the right to access and correct any of your personal information.

You should read the Product Disclosure Statement before you make an application for shares. Please click here to access our Product Disclosure Statement.