Document:

exv10w22

EXHIBIT 10.22

October 21, 2010

Ms. Katrina Thompson

5751 Copley Drive, Suite B

San Diego, CA 92111

Dear Ms. Thompson:

Reva Medical, Inc. (the “Company”) is pleased to have you continue to serve as an employee of the
Company in the position of Chief Financial Officer, reporting to the Company’s Chief Executive
Officer. This letter (this “Agreement”) sets forth the terms of your continued employment and
amends and restates any offer letter executed between you and the Company on or prior to the
commencement of your employment in its entirety. The terms of your continued employment are the
following:

	 	1.	 	Start Date: Your position as a full-time employee of the Company commenced on
October 6, 2003.
	 
	 	2.	 	Salary: You annual salary will be increased to $230,000 commencing on the execution
of this Agreement, to be paid monthly in accordance with the Company’s standard payroll
policies (subject to normal required withholding), and the Compensation Committee of the
Board, will continue to review your salary level annually.
	 
	 	3.	 	Targeted Bonus: Beginning in 2011, you will be eligible to receive a discretionary
annual bonus targeted for 30% of your annual salary upon meeting certain goals mutually
set on an annual basis by the Compensation Committee of the Board. Any bonus payable
hereunder shall be paid prior to March 15 of the calendar year following the calendar year
to which such bonus relates.
	 
	 	4.	 	Additional Equity Grant: Upon execution of this Agreement and approval by the Board
of Directors, you will be granted additional options ( “Options”) to purchase 190,000
shares of Company common. Your Options will have a per share exercise price equal to the
fair market value of Company common stock on the date of grant, as determined by the
Board, shall be immediately exercisable and shall vest based upon your continued service
to the Company with 25% of the shares subject to the Options vesting on the first
anniversary of the date of grant and 1/36th of the total number of shares
subject to the Options vesting each month thereafter such that the Options will be fully
vested on the fourth anniversary of the date of grant.
	 
	 	5.	 	Severance: In the event that your employment with the Company is terminated without
Cause as defined in this Agreement or if you resign for Good Reason, you will be entitled
to receive six months of base salary and COBRA (medical and dental insurance coverage), in
each case, payable in substantially equal installments in accordance with the Company’s
payroll practices, as severance, in

 

 

	 	 	 	exchange for you signing and not revoking a severance agreement and general release against
the Company and its affiliates within 60 days following your termination of employment
(“Severance Agreement”). For purposes of this Agreement, Cause is defined as: (i) willful
failure by the Employee to substantially perform his duties hereunder, other than a failure
resulting from the Employee’s complete or partial incapacity due to physical or mental
illness or impairment, (ii) a willful act by the Employee which constitutes gross
misconduct and which is injurious to the Company, (iii) a willful breach by the Employee of
a material provision of this Agreement, (iv) a material and willful violation of a federal
or state law or regulation applicable to the business of the Company, or (v) termination of
your employment in connection with the bankruptcy, insolvency, liquidation, or similar
winding-up of the business of the Company. No severance benefits would be paid or provided
to the Employee under this Agreement on account of a termination for Cause.
	 
	 	 	 	 “Good Reason” shall mean solely and specifically: (i) any reduction by more than ten
percent in your base salary or any guaranteed bonus, (ii) a material diminution of your job
duties or responsibilities, or (iii) a change in the location of your employment of more
than 35 miles (which is material) from its current location unless such relocation is
within 50 miles of your principal residence.
	 
	 	6.	 	Notice and Opportunity to Cure: Notwithstanding the foregoing, in order to terminate
your employment for Good Reason (i) you shall first give the Company written notice
stating with reasonable specificity the basis for the termination with Good Reason within
ninety (90) days of the first occurrence of the event giving rise to Good Reason, (ii)
give the Company a period of thirty (30) days to cure or remedy the problem, unless such
problem cannot be cured or remedied within thirty (30) days, in which case the period for
remedy or cure shall be extended for a reasonable time (not to exceed an additional thirty
(30) days) and (iii) terminate your employment within thirty (30) days following the
expiration of such cure period.
	 
	 	7.	 	Benefits: You shall be entitled to the Company’s basic employment benefits available
to all Company Employees.
	 
	 	8.	 	At-Will Employment. Your employment with the Company will be
“at-will,” meaning that either you or the Company will be entitled to terminate your
employment at any time and for any or no reason, with or without cause. Although your job
duties, title, compensation and benefits, as well as the Company’s personnel policies and
procedures, may change from time to time, the “at will” nature of your employment may only
be changed in an express written agreement signed by you and a duly authorized officer of
the Company. Your participation in any stock purchase or benefit program is not to be
regarded as assuring you continuing employment for any particular period of time.

 

 

	 	9.	 	Agreements: You previously signed the Company’s standard Employee Agreement. You
agree to abide by such Employee Agreement and by the Company’s policy that prohibits any
new employee from bringing with him or her from any previous employer any confidential
information, trade secrets, or proprietary materials or processes of such former employer.
You will agree to follow the Company’s policy that employees must not disclose any
information regarding salary, bonuses, or stock purchase or option allocations to other
employees, either directly or indirectly.
	 
	 	10.	 	Section 409A: Notwithstanding anything in this Agreement to the contrary, any
compensation or benefits payable under this Agreement that constitutes “nonqualified
deferred compensation” (“Deferred Compensation”) within the meaning of Section 409A of the
Internal Revenue Code of 1986, as amended (the “Code”), and which is designated under this
Agreement as payable upon your termination of employment shall be payable only upon your
“separation from service” with the Company within the meaning of Section 409A of the Code
(a “Separation from Service”) and, except as otherwise provided under this paragraph, any
such compensation or benefits shall not be paid, or, in the case of installments, shall
not commence payment, until the sixtieth (60th) day following your Separation from
Service. Any installment payments that would have been made to you during the sixty (60)
day period immediately following your Separation from Service but for the preceding
sentence shall be paid to you on the sixtieth (60th) day following your Separation from
Service and the remaining payments shall be made as provided in this Agreement.
Notwithstanding any provision herein to the contrary, if you are deemed by the Company at
the time of your Separation from Service to be a “specified employee” for purposes of
Section 409A(a)(2)(B)(i) of the Code, to the extent delayed commencement of any portion of
the benefits to which you are entitled under this Agreement is required in order to avoid
a prohibited distribution under Section 409A(a)(2)(B)(i) of the Code, such portion of your
benefits shall not be provided to you prior to the earlier of(i) the expiration of the
six-month period measured from the date of your Separation from Service with the Company
or (ii) the date of your death. Upon the first business day following the expiration of
the applicable Code Section 409A(a)(2)(B)(i) period, all payments deferred pursuant to the
preceding sentence shall be paid in a lump sum to you (or your estate or beneficiaries),
and any remaining payments due to you under this Agreement shall be paid as otherwise
provided herein. To the extent that any reimbursements under this Agreement are subject
to the provisions of Section 409A of the Code, any such reimbursements payable to you
shall be paid to you no later than December 31 of the year following the year in which the
expense was incurred, the amount of expenses reimbursed in one year shall not affect the
amount eligible for reimbursement in any subsequent year, and your right to reimbursement
under this Agreement will not be subject to liquidation or exchange for another benefit.
Your right to receive any installment payments under this Agreement, including without
limitation any continuation salary payments that are payable on Company payroll dates,
shall be treated as a right to receive a series of separate payments and,

 

 

	 	 	 	accordingly, each such installment payment shall at all times be considered a separate and
distinct payment as permitted under Treasury Regulation Section 1.409A-2(b)(2)(iii).
	 
	 	11.	 	Entire Agreement: This Agreement, together with your Employee Agreement, constitutes
the entire agreement between the parties with respect to your employment with the Company,
superseding all other agreements or understandings.

We are delighted to have you continue with our team. We’ve got a lot to accomplish, and I’m
confident that you’ll continue to prove to be a major contributor to a successful outcome at the
Company.

Sincerely,

Robert J. Stockman

Chairman & CEO

Accepted and Agreed:

/s/ Katrina Thompson
                       

Katrina Thompson

Date:
10/21/2010exv10w24

Exhibit 10.24

Application Form

This Application Form is important. If you are
in doubt as to how to deal with it, please contact
your stockbroker or professional adviser without
delay. You should read the entire Prospectus dated
12 November 2010 consisting of 168 pages, carefully
before completing this Application Form. To meet the
requirements of the Corporations Act, this
Application Form must not be distributed to another
person unless included in, or accompanied by, the
Prospectus dated 12 November 2010. A person who gives
another person access to this Application Form must,
at the same time and by the same means, give the
other person access to the Prospectus. The Company
will send you a free paper copy of the Prospectus if
you have received an electronic prospectus and you
ask for a paper copy before the Prospectus expires on
12 December 2011.

	 
	Registry Use Only

	 
	 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 

	Broker Code	 	 	 	Adviser Code
	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 

	 	 	 
	 	 

	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 
	 	 	 

	A	 	I/we apply for (Insert Number of CDIs)

																														
	 	 

	 

	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 
	 

	B	 	I/we lodge full Application Money

																																				
	 	 

	 

	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 
	 

Number of CDIs in REVA Medical, Inc (Company) at A$1.10 per CDI. Each CDI represents
one-tenth of a share of common stock in the Company.

Note: Minimum of 2,000 CDIs (A$2,200, equivalent to 200 Shares) to be applied for, and thereafter
in multiples of 1,000 CDIs (A$1,100, equivalent to 100 Shares)

	 	 	 
	C	 	Individual/Joint applications — refer to naming standards overleaf for correct forms of registrable title(s)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Title or Company Name	Given Name(s)	 	 	 	Surname
	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 
	 	 

	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 
	 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Joint Applicant 2 or Account Designation	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 

	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 

	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 
	 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Joint Applicant 3 or Account Designation	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 

	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 

	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 
	 

	 	 	 

	D	 	Enter your postal address — Include State and Postcode

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Unit	 	Street Number	 	Street Name or PO Box /Other Information
	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 

	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 

	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 

	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 

	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 
	 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	City / Suburb / Town	State	 	Postcode	 
	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 

	 	 

	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 

	 	 	 
	E	 	Enter your contact details

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Contact Name	 	 	 	 	 	Telephone Number — Business Hours / After Hours
	 	 

	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 

	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 
	 	 	 

Email Address

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 

	 

	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 
	 

	 	 	 
	F	 	CHESS Participant

Holder Identification Number (HIN)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 

	 	 	 
	 	 	 
	 

	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 
	 

Please note that if you supply a CHESS HIN but the name and address details on your form do not
correspond exactly with the registration details held at CHESS, your application will be deemed to be
made without the CHESS HIN, and any securities issued as a result of the Offer will be held on the Issuer
Sponsored subregister.

Payment details – Please note that funds are unable to be directly debited from your bank
account

	 	 	 	 	 	 	 	 	 	    	 	 	 	 	 	 	 	 	 	 	 	 	 
	G
	 	Drawer	 	 	 	 	Cheque/Bank Draft Number 	 	BSB Number	 	 	 	Account Number	 	 	 	 	Amount of Cheque/Bank Draft	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 

Make your cheque or bank draft payable to “REVA Medical — Offer”

	1)	 	By submitting this Application Form and applying for CDIs, I/we declare that this
application is completed and lodged according to the Prospectus and the
declarations/statements on the reverse of this Application form and I/we declare that all
details and statements made by me/us (including the declaration on the reverse of this
Application Form) are complete and accurate. I/we agree to be bound by the Bylaws and
Certificate of Incorporation of the Company.
	 
	2)	 	I/We enclose my/our cheque and/or bank draft for an amount shown being payment at A$1.10 per
CDI (each CDI equivalent to one-tenth of a Share or A$11.00 per Share), and understand that no
interest will be paid on Application Monies.
	 
	3)	 	By completing this Application Form and applying for CDIs, I/we declare that I/we have received the
complete electronic Prospectus dated [XX Month 2010]
consisting of [XX] pages or a print out of it and the complete electronic copy of the
US prospectus dated [XX Month 2010] contained in the Registration Statement
or a print out of it.

See back of form for completion guidelines

 

How to complete this form

Please complete all relevant white sections of the Application Form in BLOCK LETTERS, using
black or blue ink. These instructions are cross referenced to each section of the form.

The CDIs to which the Application Form relates are CDIs over Shares in the Company. Further
details about the CDIs are contained in the Prospectus dated 12 November 2010 issued by the
Company and the US prospectus dated 12 November 2010 contained in the
Registration Statement. This Application Form is included in the Prospectus. The Prospectus
contains important information about investing in CDIs. You should read the Prospectus
before applying for CDIs. The Company will send paper copies of the Prospectus, the
US prospectus, any supplementary documents and the Application Form, free of charge on request if
you contact the REVA Offer Information Line on 1800 197 827 (from within Australia) or +61 3 9938
4372 (from outside Australia). Australian and New Zealand investors should not rely on any
information which is not contained in the Prospectus in making a decision as to whether to
acquire securities in the Company under the Offer.

	A	 	 	CDIs Applied for
	 
	 	 	Enter the number of CDIs you wish to apply for. The application must be for a minimum of 2,000
CDIs (equivalent to 200 Shares) (A$2,200) and in multiples of
1,000 CDIs (equivalent to 100 Shares) (A$1,100) thereafter. You may be issued all of the CDIs
applied for or a lessor number. The issue price is A$1.10 per CDI.
	 
	B	 	 	Application Monies
	 	 	Enter the amount of Application Monies. To calculate the amount, multiply the number of CDIs by
the A$1.10 per CDI offer price. Please make sure the amount of your cheque and/or bank draft equals
this amount.
	 
	C	 	 	Applicant Name(s)
	 	 	Enter the full name you wish to appear on the holding statement for your CDIs. This must be
either your own name or the name of a company. Up to 3 joint Applicants may register. You should
refer to the table below for the correct forms of registrable title. Applications using the wrong
form of names may be rejected. Clearing House Electronic Subregister System (CHESS) participants
should
complete their name identically to that presently registered in the CHESS system.

	D	 	 	Postal Address
	 	 	Enter your postal address for all correspondence. All communications to you from the Company
and the Registry will be mailed to the person(s) and address as shown. For joint Applicants, only
one address can be entered.
	 
	E	 	 	Contact Details
	 	 	Enter your contact details. These are not compulsory but will assist us if we need to
contact you.
	 
	F	 	 	CHESS
	 
	 	 	REVA Medical, Inc (the Company) will apply to the ASX to participate in CHESS, operated
by ASX Settlement Pty Limited, a wholly owned subsidiary of Australian Securities Exchange Limited.
In CHESS, the company will operate an electronic CHESS Subregister of security holdings and an
electronic Issuer Sponsored Subregister of security holdings. Together the
two Subregisters will make up the Company’s principal register of securities. The Company
will not be issuing certificates to applicants in respect of CDIs allotted. If you are a CHESS
participant (or are sponsored by a CHESS participant) and you wish to hold CDIs allotted to you
under this Application on the CHESS Subregister, enter your CHESS HIN. Otherwise,

leave this section blank and on allotment, you will be sponsored by the Company and allocated
a Securityholder Reference Number (SRN).
	 
	G	 	 	 Payment
	 
	 	 	Make your cheque or bank draft payable to “REVA Medical — Offer” in Australian currency and
cross it Not Negotiable. Your cheque or bank draft must be drawn on an Australian Bank.
	 
	 	 	 	Complete the cheque details in the boxes provided. The total amount must agree with the amount
shown in box B. Please note that funds are unable to be directly debited from your bank account.
	 
	 	 	 	Cheques will be processed on the day of receipt and as such, sufficient cleared funds must be held
in your account as cheques returned unpaid may not be re-presented and may result in your
Application being rejected. Paperclip (do not staple) your cheque(s)
to the Application Form where indicated. Cash will not be accepted. Receipt for payment
will not be forwarded.

By returning this Application Form with your Application Monies, you agree to these statements.
I/We:

	•	 	have read the Prospectus in full;
	•	 	have completed the Application Form accurately and completely;
	•	 	acknowledge that once the Company accepts my/our Application, I/we may not withdraw it;
	•	 	apply for the number of CDIs that I/we apply for (or a lower number allocated in a way
allowed under the Prospectus);
	•	 	acknowledge that my/our Application may be rejected by the Company in consultation with the
Lead Manager in their absolute discretion;
	•	 	authorise the Lead Manager and the Company and their respective officers or agents, to do
anything on my/our behalf necessary (including the completion and execution of documents) for
the CDIs to be allocated to me/us;

	•	 	am/are over 18 years of age;
	•	 	agree to be bound by the By-laws and Certificate of Incorporation of the Company;
	•	 	acknowledge that neither the Company nor any person or entity guarantees any particular rate
of return on the CDIs, nor do they guarantee the repayment of capital;
	•	 	represent, warrant and agree that I/we am/are not in the United States or a US person, and
am/are not acting for the account or benefit of a US person; and
	•	 	represent, warrant and agree that I/we have not received the Prospectus outside Australia and
am/are not acting on behalf of a person resident outside Australia unless the CDIs may be
offered in my/our jurisdiction without contravention of the security laws of the jurisdiction
or any need to register the Prospectus, the CDIs or the Offer.

Lodgement of Application

Application Forms must be received by Computershare Investor Services Pty Limited (“CIS”) Melbourne
by no later than 5:00PM (AEDT) on Monday, 6 December 2010. You should allow sufficient time for
this to occur. Return the Application Form with cheque(s) attached to:

Computershare Investor Services Pty Limited

GPO Box 7115

SYDNEY NSW 2001

Neither CIS nor the Company accepts any responsibility if you lodge the Application Form at any
other address or by any other means.

Privacy Statement

Personal information is collected on this form by Computershare Investor Services Pty Limited
(“CIS”), as registrar for securities issuers (“the issuer”), for the purpose of maintaining
registers of
securityholders, facilitating distribution payments and other corporate actions and communications.
Your personal information may be disclosed to our related bodies corporate, to external service
companies such as print or mail service providers, or as otherwise required or permitted by law. If
you would like details of your personal information held by CIS, or you would like to correct
information
that is inaccurate, incorrect or out of date, please contact CIS. In accordance with the
Corporations Act 2001, you may be sent material (including marketing material) approved by the
issuer in addition to general corporate communications. You may elect not to receive marketing
material by contacting CIS. You can contact CIS using the details provided on the front of this
form or e-mail privacy@computershare.com.au

If you have any enquiries concerning your Application, please contact Computershare Investor
Services Pty Limited on 1800 197 827.

Correct forms of registrable title(s)

Note that ONLY legal entities are allowed to hold CDIs. Applications must be made in the
name(s) of natural persons, companies or other legal entities in accordance with the Corporations
Act. At least one
full given name and the surname is required for each natural person. The name of the beneficial
owner or any other registrable name may be included by way of an account designation if completed
exactly
as described in the examples of correct forms of registrable title(s) below.

	 	 	 	 	 	 	 
	 	 	 	 	 	 	 
	Type of Investor	 	 	Correct Form of Registration	 	 	Incorrect Form of Registration
	 	 	 	 	 	 	 
	
	 	 		 	 	
	Individual

	 	 	Mr John Alfred Smith
	 	 	J.A Smith
	- Use given name(s) in full, not initials
	 	 	 	 	 	 
	 	 	 	 	 	 	 
	
	 	 		 	 	
	Joint

	 	 	Mr John Alfred Smith &
	 	 	John Alfred &
	- Use given name(s) in full, not initials

	 	 	Mrs Janet Marie Smith
	 	 	Janet Marie Smith
	 	 	 	 	 	 	 
	
	 	 		 	 	
	Company

	 	 	ABC Pty Ltd
	 	 	ABC P/L
	- Use company title, not abbreviations

	 	 	 	 	 	ABC Co
	 	 	 	 	 	 	 
	Trusts
	 	 	 	 	 	 
	- Use trustee(s) personal name(s)

	 	 	Ms Penny Smith
	 	 	Penny Smith Family Trust
	- Do not use the name of the trust

	 	 	<Penny Smith Family A/C>	 	 	 
	 	 	 	 	 	 	 
	Deceased Estates
	 	 	 	 	 	 
	- Use executor(s) personal name(s)

	 	 	Mr Michael Smith
	 	 	Estate of Late John Smith
	- Do not use the name of the deceased

	 	 	<Est John Smith A/C>	 	 	 
	 	 	 	 	 	 	 
	
	 	 		 	 	
	Minor (a person under the age of 18)

	 	 	Mr John Alfred Smith
	 	 	Peter Smith
	- Use the name of a responsible adult with an appropriate designation

	 	 	<Peter Smith A/C>	 	 	 
	 	 	 	 	 	 	 
	Partnerships

	 	 	Mr John Smith &	 	 	 
	- Use partners personal name(s)

	 	 	Mr Michael Smith
	 	 	John Smith & Son
	- Do not use the name of the partnership

	 	 	<John Smith & Son A/C>	 	 	 
	 	 	 	 	 	 	 
	Clubs/Unincorporated Bodies/Business Names
	 	 	 	 	 	 
	- Use office bearer(s) personal name(s)

	 	 	Mrs Janet Smith
	 	 	ABC Tennis Association
	- Do not use the name of the club etc

	 	 	<ABC Tennis Association A/C>	 	 	 
	 	 	 	 	 	 	 
	Superannuation Funds
	 	 	 	 	 	 
	- Use the name of trustee of the fund

	 	 	John Smith Pty Ltd
	 	 	John Smith Pty Ltd Superannuation Fund
	- Do not use the name of the fund

	 	 	<Super Fund A/C>

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00180-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00180-of-00352.parquet"}]]