DESTRUCTION CERTIFICATE Topologi Pty Limited Level 2, 73 Union Street, Pyrmont, NSW 2009 AUSTRALIA support@topologi.com We, (“the licensee”) purchased a license/s for Topologi Collaborative Markup Editor: Community Edition, on (insert date here) License type: with the following registration number/s: We hereby certify that the licensed software with the above registered numbers has been destroyed or disabled to be unusable on any computer. Please forward our refund (purchase price less your service fee) to the address below. This claim is being made within 30 days of purchase as required by our license with you. Authorized Signature: Licensee’s Name: Address: Email Contact Address: