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TEST REQUISITION FORMOffice Use Only(Australia Residents Only) BSF025 REV.009 111416795 San Antonio Road Palo Alto CA 943034801 T: (800) 8323200 F: (650) 4241196 www.igenex.com Processing of tests

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Individuals who are legally residing in Australia and need to provide proof of their residency status may need to fill out the 'Australia Residents Only' form. This form could be required for various purposes such as applying for government benefits, obtaining certain licenses or permits, or gaining access to restricted services or facilities exclusively available to Australian residents.

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Australia residents only refers to individuals who live in Australia and are subject to Australian taxation laws.

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