Announcement PDF Information Form and Checklist (ASX Listing) Name of entity Fulcrum Lithium Ltd We (the entity named above) supply the following information and documents to support our application for admission to the official list of ASX Limited (ASX) as an ASX Listing. Note: by giving an Appendix 1A Application for Admission to the ASX Official List (ASX Listing) to ASX, the entity is taken to have warranted that all of the information and documents it has given, or will give, to ASX in connection with its admission to the official list and the quotation of its securities are, or will be, accurate, complete and not misleading. It also indemnifies ASX to the fullest extent permitted by law in respect of any claim, action or expense arising from, or connected with, any breach of that warranty (see Appendix 1A of the ASX Listing Rules). The information and documents referred to in this Information Form and Checklist (including any annexures to it) are covered by the warranty and indemnity mentioned above. Terms used in this Information Form and Checklist and in any Annexures have the same meaning as in the ASX Listing Rules. If an applicant is admitted to the Official List of ASX, this Information Form and Checklist will be released on the Market Announcements Platform at the time of admission. Prior to admission, and promptly after this Information Form and Checklist is submitted to ASX, certain key details regarding the upcoming listing will be published on the ASX website at: https://www2.asx.com.au/listings/upcoming-floats-andlistings. Part 1 – Key Information Instructions: please complete each applicable item below. If an item is not applicable, please mark it as “N/A”. Corporate details1 Legal name 2 Fulcrum Lithium Ltd Trading name Fulcrum Lithium Ltd Date of incorporation or establishment 6 February 2023 Place of incorporation or establishment Country Australia State (Province, County, etc.) New South Wales ABN 23 665 528 307 ACN 665 528 307 ARSN Not applicable ARBN Not applicable All Australian registration numbers (as appropriate) Foreign incorporation reference 3 number, if applicable Not applicable 1 If the entity applying for admission to the official list is a stapled group, please provide these details for each entity comprising the stapled group. 2 As registered with ASIC. If it is a foreign entity, reflect the entity legal name as registered in the country of incorporation or establishment, if applicable. 3 The equivalent registration number to an ABN or ACN in the country of incorporation or establishment, where the country of incorporation or establishment is not Australia. ASX Listing Information Form and Checklist (05/02/2024) Page 1 Legal entity identifier (LEI), if applicable Not applicable Legislation under which incorporated or established Corporations Act 2001 (Cth) Address of registered office in place of incorporation or establishment Level 2, 66 Hunter Street 4 Sydney NSW 2000 Australia Main business activity Mineral Exploration and Mining Country where main business activity is mostly carried on United States of America Other exchanges on which the entity is listed Not applicable Street address of principal administrative office Level 2, 66 Hunter Street Sydney NSW 2000 Australia Postal address of principal administrative office Level 2, 66 Hunter Street Sydney NSW 2000 Australia Telephone number of principal administrative office +61 2 9300 3377 Email address for investor enquiries info@fulcrumlithium.com Website URL www.fulcrumlithium.com Board and senior management details5 Full name and title of chairperson of directors Norman A. Seckold – Executive Chairman Full names of all existing directors Norman A. Seckold – Executive Chairman Peter J. Nightingale – Executive Director, Chief Financial Officer and Company Secretary Anthony Sgro – Non-Executive Director Foster V. Wilson – Non-Executive Director 4 The LEI is a standard identifier that provides verified data on legal entities registered on a centralised system, the Global LEI System. Providing a LEI is voluntary. If the entity does not have a LEI leave this field blank. For Issuers who choose to voluntarily provide their LEI (where available), ASX will record and link the LEI of the issuer to each International Securities Identification Number (ISIN) allocated to financial instruments issued by that issuer and quoted on ASX. ASX will also provide the ISIN-LEI mapping to the Association of National Numbering Agencies (ANNA) Service Bureau (ASB) for the purpose of the ISIN-LEI mapping initiative, and this information will then be made publicly available on both the ANNA and Global Legal Entity Identifier Foundation (GLEIF) websites. Once publically available, any person may use the LEI information (including the ISIN-LEI mapping data) for any purpose without restriction. 5 If the entity applying for admission to the official list is a trust, enter the board and senior management details for the responsible entity of the trust. ASX Listing Information Form and Checklist (05/02/2024) Page 2 Full names of any persons proposed to be appointed as additional or replacement directors Not applicable Full name and title of CEO/managing director Not applicable Email address of CEO/managing director Not applicable Full name and title of CFO Peter J. Nightingale – Executive Director, Chief Financial Officer and Company Secretary Email address of CFO PNightingale@miscorp.com.au Full name and title of company secretary Peter J. Nightingale – Executive Director, Chief Financial Officer and Company Secretary Email address of company secretary PNightingale@miscorp.com.au 6 Third party company secretarial service provider details (if applicable) Service provider entity name 7 All Australian registration numbers (as appropriate) N/A ABN N/A ACN N/A ARBN Not applicable Foreign incorporation reference 8 number, if applicable Not applicable Place of incorporation or establishment Country N/A State (Province, County, etc.) N/A Address N/A ASX compliance contact details9 Full name and title of ASX contact(s) Peter J. Nightingale – Executive Director, Chief Financial Officer and Company Secretary Business address of ASX contact(s) Level 2, 66 Hunter Street Sydney NSW 2000 Australia 6 Please provide these details if the entity seeking admission has engaged an external entity to provide company secretarial services to it. 7 As registered with ASIC. If it is a foreign entity, reflect the entity legal name as registered in the country of incorporation or establishment, if applicable. 8 The equivalent registration number to an ABN or ACN in the country of incorporation or establishment, where the country of incorporation or establishment is not Australia. 9 Under Listing Rule 1.1 Condition 13, a listed entity must appoint a person responsible for communication with ASX on Listing Rule matters. You can appoint more than one person to cater for situations where the primary nominated contact is not available. ASX Listing Information Form and Checklist (05/02/2024) Page 3 Business phone number of ASX contact(s) +61 2 9300 3377 Mobile phone number of ASX contact(s) +61 419 230 109 Email address of ASX contact(s) PNightingale@miscorp.com.au Investor relations contact details Full name and title of person responsible for investor relations Peter J. Nightingale – Company Secretary Business phone number of person responsible for investor relations +61 2 9300 3377 Email address of person responsible for investor relations PNightingale@miscorp.com.au Auditor details10 Full name of auditor KPMG Registry details11 Name of securities registry Computershare Investor Services Pty Ltd Address of securities registry Yarra Falls, 452 Johnston Street Abbotsford VIC 3067, Melbourne, Australia Phone number of securities registry 1300 850 505 Fax number of securities registry Not applicable Email address of securities registry Not applicable – online enquiries can be submitted through the poral at https://www.computershare.com/au/business/registry-services/contact-us Type of sub-registers the entity will operate12 CHESS and issuer sponsored sub-register Key dates Annual financial year end date 30 June Month in which annual meeting is usually held (or intended to be held)13 November or within 5 months of 30 June 10 In certain cases, ASX may require the applicant to provide information about the qualifications and experience of its auditor for release to the market before quotation commences (see Guidance Note 1 section 2.12). 11 If the entity has different registries for different classes of securities, please indicate clearly which registry details apply to which class of securities. 12 Example: CHESS and issuer sponsored sub-registers (see Guidance Note 1 section 3.23). 13 May not apply to some trusts. ASX Listing Information Form and Checklist (05/02/2024) Page 4 Months in which dividends or distributions are usually paid (or are intended to be paid), if applicable Not applicable – the entity does not intend to pay any dividends at this stage. Trusts – additional details Name of responsible entity Not applicable All Australian registration numbers (as appropriate) ABN Not applicable ACN Not applicable Country Not applicable State (Province, County, etc.) Not applicable Place of incorporation or establishment Legal Entity Identifier (LEI), if 14 applicable Not applicable Address Not applicable Full names of the members of the compliance committee (if any) Not applicable Entities incorporated or established outside Australia – additional details Name of the entity’s Australian agent for service of process Not applicable All Australian registration numbers of entity’s Australian agent for service of process (as appropriate) ABN Not applicable ACN Not applicable Place of incorporation or establishment of the entity’s Australian agent for service of process Country Not applicable State (Province, County, etc.) Not applicable Address of the entity’s Australian agent for service of process Not applicable If the entity has or intends to have a certificated sub-register for quoted securities, the location of the Australian sub-register Not applicable Address of registered office in Australia (if any) Not applicable 15 14 Refer to footnote 5 above for further details regarding LEIs. 15 As registered with ASIC. ASX Listing Information Form and Checklist (05/02/2024) Page 5 Entities listed or to be listed on another exchange or exchanges Name of the other exchange(s) where the entity is or proposes to be listed Not applicable Is the ASX listing intended to be the entity’s primary or secondary listing? Not applicable ASX Listing Information Form and Checklist (05/02/2024) Page 6 Part 2 – Checklist Confirming Compliance with Admission Requirements Instructions: please indicate in the “Location/Confirmation” column for each item below and in any Annexures where the information or document referred to in that item is to be found (e.g. in the case of information, the specific page reference in the Offer Document where that information is located or, in the case of a document, the folder tab number where that document is located). If the item asks for confirmation of a matter, you may simply enter “Confirmed”” in the “Location/Confirmation” column. If an item is not applicable, please mark it as “N/A”. In this regard, it will greatly assist ASX and speed up its review of the application if the various documents referred to in this Checklist and any Annexures are provided both in hard copy and in electronic form in one or more folders and/or in any other appropriate electronic form containing consecutively numbered and titled documents (e.g. ‘Attachment 1 – Certificate of Incorporation, ‘Attachment 2 – Constitution‘, etc.), together with a document index. Where this Checklist indicates that an original document is required, ASX will also accept a certified copy of the relevant document. Note that completion of this Checklist and any Annexures is not to be taken to represent that the entity is necessarily in full or substantial compliance with the ASX Listing Rules or that ASX will admit the entity to its official list. Admission to the official list is in ASX’s absolute discretion and ASX may refuse admission without giving any reasons (see Listing Rule 1.19). A reference in this Checklist and in any Annexures to the “Offer Document” means the listing prospectus, product disclosure statement or information memorandum lodged by the applicant with ASX pursuant to Listing Rule 1.1 Condition 3. If the applicant lodges a supplementary or replacement prospectus, product disclosure statement or information memorandum with ASX, ASX may require it to update this Checklist and any Annexures by reference to that document. Key supporting documents No Item 1. Entity’s certificate of incorporation, certificate of registration or other evidence of status (including any change of name) Location/Confirmation Refer to the ASIC Certificate of Registration (Tab 1). 2. Entity’s constitution (Listing Rule 1.1 Condition 2) Refer to the Company’s Constitution (Constitution) (Tab 2). 3. Either: (a) confirmation that the entity’s constitution includes the provisions of Appendix 15A or Appendix 15B (as applicable); or (b) a completed checklist that the constitution complies with the Listing Rules (Listing Rule 1.1 Condition 2)16 Confirmed. Refer to Clause 34 of the Constitution (Tab 2) for confirmation that the Constitution contains the provisions of Appendix 15A. 4. Offer Document, as lodged with ASIC (Listing Rule 1.1 Condition 3) Refer to the electronic copy of the Company’s prospectus as lodged with ASIC (Prospectus) (Tab 3). Refer to electronic copy of the Company’s supplementary prospectus as lodged with ASIC dated 18 October 2024 (Supplementary Prospectus) (Tab 3). 5. Where in the Offer Document is the prominent statement that ASX takes no responsibility for the contents of the Offer Document (Listing Rule 1.1 Condition 3)? Refer to the Important Notice Section of the Prospectus (Tab 3). Refer to the Important Notice Section of the Supplementary Prospectus (Tab 3). 6. Has (or have) the ASX contact(s) completed an approved listing rule compliance course and attained a satisfactory pass mark in the examination for that course?17 Yes 7. Executed ASX Online agreement confirming that documents may be given to Refer to Tab 16. ASX and authenticated electronically (Listing Rule 1.1 Condition 14)18 16 An electronic copy of the checklist is available from the ASX Compliance Downloads page on ASX’s website. 17 If the answer is “no”, each ASX contact must complete the course and attain a satisfactory pass mark in the examination for the course prior to the entity’s admission to the official list. 18 An electronic copy of the ASX Online Agreement is available from the ASX Compliance Downloads page on ASX’s website. ASX Listing Information Form and Checklist (05/02/2024) Page 7 No Item Location/Confirmation 8. If the entity’s corporate governance statement19 is included in its Offer Refer to Corporate Governance Document, the page reference where it is included. Otherwise, a copy of the Statement provided in section 6.6 of the entity’s corporate governance statement (Listing Rule 1.1 Condition 16) Prospectus (Tab 3). 9. If the entity will be included in the S & P All Ordinaries Index on admission to the official list,20 where in its Offer Document does it state that it will have an audit committee (Listing Rule 1.1 Condition 17)? Not applicable 10. If the entity will be included in the S & P / ASX 300 Index on admission to the Not applicable official list,21 where in its Offer Document does it state that it will comply with the recommendations set by the ASX Corporate Governance Council in relation to the composition and operation of the audit committee (Listing Rule 1.1 Condition 17)? 11. If the entity will be included in the S & P / ASX 300 Index on admission to the Not applicable official list,22 where in its Offer Document does it state that it will have a remuneration committee comprised solely of non-executive directors (Listing Rule 1.1 Condition 18) 12. If the entity’s trading policy is included in its Offer Document, the page reference where it is included. Otherwise, a copy of the entity’s trading policy (Listing Rule 1.1 Condition 19) Refer to the Company’s Trading Policy (Tab 5). 13. For each director or proposed director, the CEO or proposed CEO, and the CFO or proposed CFO (together, “relevant officers”) of the entity at the date of listing,23 a list of the countries in which they have resided over the past 10 years (Listing Rule 1.1 Condition 20 and Guidance Note 1 section 3.21)24 Over the last 10 years: • Foster V. Wilson has resided in the USA. • Peter J. Nightingale, Norman A. Seckold and Anthony Sgro have resided in Australia. 14. For each relevant officer, a list of any other names or alias they have used in the past 10 years, including any maiden name or married name25 (Listing Rule 1.1 Condition 20 and Guidance Note 1 section 3.21) Not applicable 15. For each relevant officer who is or has in the past 10 years been a resident of Australia, an original or certified true copy of a national criminal history check obtained from the Australian Federal Police, a State or Territory police service or a broker accredited by Australian Criminal Intelligence Commission which is not more than 12 months old (Listing Rule 1.1 Condition 20 and Guidance Note 1 section 3.21) Refer to the NSW Criminal Record Checks for Peter J. Nightingale, Norman A. Seckold and Anthony Sgro (Tab 6). 16. For each relevant officer who is or has in the past 10 years been a resident of a country other than Australia, an original or certified true copy of an equivalent national criminal history check to that mentioned in item 15 above for each country in which the relevant officer has resided over the past 10 years (in English or together with a certified English translation) which is Confirmed. Refer to the USA National Criminal History Check for Foster V. Wilson (Tab 6). 19 The entity’s “corporate governance statement” is the statement disclosing the extent to which the entity will follow, as at the date of its admission to the official list, the recommendations set by the ASX Corporate Governance Council. If the entity does not intend to follow all the recommendations on its admission to the official list, the entity must separately identify each recommendation that will not be followed and state its reasons for not following the recommendation and what (if any) alternative governance practices it intends to adopt in lieu of the recommendation. 20 If the entity is unsure whether they will be included in the S & P All Ordinaries Index on admission to the official list, they should contact ASX or S & P. 21 If the entity is unsure whether they will be included in the S & P / ASX 300 Index on admission to the official list, they should contact ASX or S & P. 22 If the entity is unsure whether they will be included in the S & P / ASX 300 Index on admission to the official list, they should contact ASX or S & P. 23 If the entity applying for admission to the official list is a trust, references in items 13, 14, 15, 16, 17, 18 and 19 to a relevant officer mean a relevant officer of the responsible entity of the trust. 24 The information referred to in items 13, 14, 15, 16, 17, 18 and 19 is required so that ASX can be satisfied that the relevant officer is of good fame and character under Listing Rule 1 Condition 20. 25 The sample statutory declaration referred to in item 19 below addresses this requirement. Note that if the relevant officer has used another name or alias (including a maiden name or married name) in the past 10 years, the criminal record and bankruptcy checks referred to in items 15, 16, 17, 18 must cover all of the names or aliases the relevant officer has used over that period. ASX Listing Information Form and Checklist (05/02/2024) Page 8 No Item Location/Confirmation not more than 12 months old or, if such a check is not available in any such country, a statutory declaration26 from the relevant officer confirming that fact and that he or she has not been convicted in that country of: (a) any criminal offence involving fraud, dishonesty, misrepresentation, concealment of material facts or breach of his or her duties as a director or officer of a company or other entity; or (b) any other criminal offence which at the time carried a maximum term of imprisonment of five years or more (regardless of the period, if any, for which he or she was sentenced), or, if that is not the case, a statement to that effect and a detailed explanation of the circumstances involved (Listing Rule 1.1 Condition 20 and Guidance Note 1 section 3.21) 17. For each relevant officer who is or has in the past 10 years been a resident of Australia, an original or certified true copy of a search of the Australian Financial Security Authority National Personal Insolvency Index which is not more than 12 months old (Listing Rule 1.1 Condition 20 and Guidance Note 1 section 3.21) Refer to the Personal Insolvency Searches for Peter J. Nightingale, Norman A. Seckold and Anthony Sgro (Tab 7). 18. For each relevant officer who is or has in the past 10 years been a resident of a country other than Australia, an original or certified true copy of an equivalent national bankruptcy check to that mentioned in item 17 above for each country in which the relevant officer has resided over the past 10 years (in English or together with a certified English translation) which is not more than 12 months old or if such a check is not available in any such country, a statutory declaration27 from the relevant officer confirming that fact and that he or she has not been declared a bankrupt or been an insolvent under administration in that country or, if that is not the case, a statement to that effect and a detailed explanation of the circumstances involved (Listing Rule 1.1 Condition 20 and Guidance Note 1 section 3.21) Refer to the Personal Insolvency Search for Foster V. Wilson (USA) (Tab 7). 19. A statutory declaration28 from each relevant officer specifying whether they have used any other name or alias in the past 10 years and confirming that: (a) the relevant officer has not been the subject of any criminal or civil penalty proceedings or other enforcement action by any government agency in which he or she was found to have engaged in behaviour involving fraud, dishonesty, misrepresentation, concealment of material facts or breach of duty; (b) the relevant officer has not been refused membership of, or had their membership suspended or cancelled by, any professional body on the ground that he or she has engaged in behaviour involving fraud, dishonesty, misrepresentation, concealment of material facts or breach of duty; (c) the relevant officer has not been the subject of any disciplinary action (including any censure, monetary penalty or banning order) by a securities exchange or other authority responsible for regulating securities markets for failure to comply with his or her obligations as a director or officer of a listed entity; (d) no listed entity of which he or she was a relevant officer (or, in the case of a listed trust, in respect of which he or she was a relevant officer of the responsible entity of the trust) at the time of the relevant conduct has been the subject of any disciplinary action (including any censure, monetary penalty, suspension of trading or termination of listing) by a securities exchange or other authority responsible for regulating securities markets for failure to comply with its obligations under the Listing Rules applicable to that entity; and Refer to the Statutory Declarations for: • Peter J. Nightingale; • Norman A. Seckold; • Anthony Sgro; and • Foster V. Wilson (Tab 8). 26 The sample statutory declaration referred to in item 19 below also addresses this requirement. 27 The sample statutory declaration referred to in item 19 below also addresses this requirement. 28 A sample statutory declaration is available from the ASX Compliance Downloads page on ASX’s website. ASX Listing Information Form and Checklist (05/02/2024) Page 9 No Item Location/Confirmation (d) the relevant officer is not aware of any pending or threatened investigation or enquiry by a government agency, professional body, securities exchange or other authority responsible for regulating securities markets that could lead to proceedings or action of the type described in (a), (b), (c) or (d) above, or, if the relevant officer is not able to give such confirmation, a statement to that effect and a detailed explanation of the circumstances involved (Listing Rule 1.1 Condition 20 and Guidance Note 1 section 3.21) 20. A specimen certificate/holding statement for each class of securities to be quoted or a specimen holding statement for CDIs (as applicable) Refer to the Specimen Certificate (Tab 14). 21. Please either: Confirmed. (a) enter “Confirmed” in the column to the right to confirm that the entity has not previously applied for, and been refused or withdrawn its application for, admission to the official list of another securities exchange, or (b) attach a statement explaining the circumstances and state the location of that statement 22. Please enter “Confirmed” in the column to the right to confirm that the entity has paid its initial listing fee 29 Confirmed. Group structure 23. Where in the Offer Document is there a diagram showing the group structure Refer to Section 3.1 (The Company of the entity, identifying (where applicable) each material child entity and the summary) of the Prospectus (Tab 3). nature and location of the business activities it undertakes 24. If the entity has any material child entities, where in the Offer Document is Refer to Section 3.1 (The Company there a list of all such child entities stating, in each case, its name, where it is summary) of the Prospectus (Tab 3). incorporated or established, the nature of its business and the entity’s percentage holding in it? 25. If the entity has any material investments in associated entities for which it will apply equity accounting, where in the Offer Document is there a list of all such associated entities stating, in each case, its name, where it is incorporated or established, the nature of its business and the entity’s percentage holding in it? Not applicable – the Company does not have material investments in associated entities for which it will apply equity accounting. 26. If the entity has a material interest in a joint venture, where in the Offer Document is there a description of the joint venture agreement, including the parties to the agreement and their respective rights and obligations under the agreement? Not applicable – the Company does not have a material interest in a joint venture. 27. If the entity does not hold its material assets and business operations directly itself or indirectly through a child entity, where in the Offer Document is there an explanation of why that structure has been employed and the risks associated with it? Not applicable – the Company holds its material assets through wholly owned subsidiaries as detailed in Section 3 of the Prospectus (Tab 3). See Guidance Notes 15 and 15A for the fees payable on the application. You can also use the ASX online equity listing fees calculator: http://www.asx.com.au/prices/cost-listing.htm. Payment should be made either by cheque made payable to ASX Operations Pty Ltd or by electronic funds transfer to the following account: 29 Bank: National Australia Bank Account Name: ASX Operations Pty Ltd BSB: 082 057 A/C: 494728375 Swift Code (Overseas Customers): NATAAU3202S If payment is made by electronic funds transfer, please email your remittance advice to ar@asx.com.au, describing the payment as the “initial listing fee” and including the name of the entity applying for admission, the ASX home branch where the entity has lodged its application (ie Sydney, Melbourne or Perth) and the amount paid. ASX Listing Information Form and Checklist (05/02/2024) Page 10 No Item Location/Confirmation Capital structure 28. Where in the Offer Document is there a table showing the existing and proposed capital structure of the entity, broken down as follows: (a) the number and class of each equity security and each debt security currently on issue; and (b) the number and class of each equity security and each debt security proposed to be issued between the date of this application and the date the entity is admitted to the official list; and (c) the resulting total number of each class of equity security and debt security proposed to be on issue at the date the entity is admitted to the official list; and (d) the number and class of each equity security proposed to be issued following admission in accordance with material contracts or agreements? Refer to Section 2.17 (Current Capital Structure) and 2.18 (Capital structure following completion of the Offer) of the Prospectus (Tab 3). 29. If any class of securities referred to in the table mentioned in item 28 are not ordinary securities, where in the Offer Document does it disclose the terms applicable to those securities? Refer to Section 13.3 (Terms and conditions of Performance Rights) of the Prospectus (Tab 3). 30. Where in the Offer Document does it confirm that the entity’s free float at the time of listing will be not less than 20% (Listing Rule 1.1 Condition 7)? Refer to Sections 2.8 (Allocation Policy) and 13.6 (Escrow Arrangements) of the Prospectus (Tab 3). Refer also to Section 6.3 of the Supplementary Prospectus (Capital