CONTRACTOR COMPANY DETAILS

The following information is to be supplied ANNUALLY by any contractor who is engaged to perform work on a Hellmann site or for and on behalf of Hellmann. For any work or part of the work that will be subcontracted out, full details of the subcontractor must be supplied separately. Vendor Code
(If known. This is assigned by Hellmann)

Full Name of Company ALLALONG TRUCKING AGENTS PTY LTD Registered Business Address POST BOX 367 Suburb REVESBY NORTH State NSW ABN Number 68 001 217 009 Post Code 2212 ACN Number 001 217 009

Name of Director/s, Individuals JOHN CANT , RAY CANT Business Entity Incorporated Company Individual or Sole Trader Business Trading Name ALLALONG TRANSPORT Business activities TRANSPORTING FREIGHT INTERSTATE Partnership

DECLARATION
Do you perform this type of work for anybody other than Hellmann? If yes, approximately what percentage of your work is performed for Hellmann? Will you be engaging any subcontractors to perform work for Hellmann? At the time of orientation to a Hellmann site do you agree to supply, upon request, documentation including risk assessments, training records, fatigue management records, equipment service records or material safety data sheets, or any other documentation which will ensure the safety of people on Hellmann sites. Company Contact Name JOHN CANT, GENERAL MANAGER Contact Numbers Office 02 9792 8787 Mobile YES YES NO

5% NO

YES

NO

Email Address info@allalong.com.au

Signature ..

Date ..

AF 172 (v1)

RFC No. JABE -8ERVJ2

Page 1 of 3

CONTRACTOR INSURANCE DETAILS

PUBLIC LIABILITY
Do you hold a Public Liability Insurance Policy in respect of the work you will be performing for Hellmann?
If yes please provide the following details: YES NO

Name of Insurer ZURICH AUSTRALIAN INSURANCE LTD Policy Number 17086723XGLG Amount of the Cover $ 10,00,000.00 Limit of Indemnity $ 5,00,000.00 Amount of any Excess $ 500 Does this policy indemnify principals?
YES NO

Due Date 20/08/2011 (Use format dd/mm/yyyy)

Certificate of Currency attached?

Can be obtained from your insurer or broker. A Tax Invoice is not a Certificate of Currency

YES

NO

WORKERS COMPENSATION
Do you employ workers, or do you intend to employ workers for this contract?
YES NO

If yes, your company is required by law to have adequate Workers Compensation cover for all employees. YES NO Do you hold a Workers Compensation Policy covering all

potential liabilities under the relevant state legislation?

If yes please provide the following details:

Which state/territory do you work for Hellmann. Please tick one or more boxes

NSW

QLD

VIC

ACT

WA

SA

TAS

NT

PLEASE NOTE THAT WHERE A COMPANY WILL BE CARRYING OUT WORK FOR HELLMANN IN MORE THAN ONE STATE OR TERRITORY, PROOF OF WORKERS COMPENSATION INSURANCE FOR EACH STATE OR TERRITORY WILL BE REQUIRED.

Name of Insurer EMPLOYERS MUTUAL & ALLIANZ Policy Number 21222016 & LWL0009974 Limit of Indemnity $ $10.00MILLION Certificate of Currency attached?
Can be obtained from your insurer or broker. A Tax Invoice is not a Certificate of Currency

Due Date 30/06/2011 (Use format dd/mm/yyyy)

YES

NO

AF 172 (v1)

RFC No. JABE -8ERVJ2

Page 2 of 3

PERSONAL INJURY / INCOME PROTECTION

Do you (the contractor) have personal injury / income protection insurance?
YES NO

This is suitable for Individuals, individual sole traders and partnerships, but this is not compulsory.

Name of Insurer Policy Number Amount of the Cover $ Amount of any Excess $ Certificate of Currency attached?
Can be obtained from your insurer or broker. A Tax Invoice is not a Certificate of Currency

Due Date

(Use format dd/mm/yyyy)

YES

NO

MOTOR VEHICLE
For all vehicles that will be used to perform the work on behalf of Hellmann

Are all vehicles that will be used, insured against Third Party Property Damage If yes please provide the following details: Name of Insurer Policy Number 332983346vft Limit of Indemnity $30.00 MILLION Amount of any Excess $ VARYING Are there any special conditions? Certificate of Currency attached?
YES NO

YES

NO

Due Date 20/08/2011 (Use format dd/mm/yyyy)

If so, please specify:

(Attach separate page if required)

Can be obtained from your insurer or broker. A Tax Invoice is not a Certificate of Currency

YES

NO

PLANT & EQUIPMENT

Are all plant & equipment that will be used in the performance of the work, insured against Third Party Property Damage
YES NO

If yes please provide the following details: Name of Insurer ZURICH AUSTRALIAN INSURANCE LIMITED Policy Number 332983346VFT Limit of Indemnity $30.00 MILLION Amount of any Excess $ VARIOUS Are there any special conditions? Certificate of Currency attached?
YES NO If so, please specify:
(Attach separate page if required) Can be obtained from your insurer or broker. A Tax Invoice is not a Certificate of Currency

Due Date 20/08/2011 (Use format dd/mm/yyyy)

YES

NO

AF 172 (v1)

RFC No. JABE -8ERVJ2

Page 3 of 3