1697

SIXTH SCHEDULE.

FORM OF ANNUAL RETURN OF A COMPANY HAVING A SHARE CAPITAL.

Sections

107 and 347.

Annual Return of the

made up to the

Company, Limited

day of

19

(being the date of the first or only ordinary general meeting in 19 ).

The address of the registered office of the Company is as follows:-

Summary of Share Capital and Shares,

Nominal Share Capital $

divided into*

shares of

ench. shares of

each.

Total number of shares taken up to

the

day of

19

being the date of the return (which number must agree with the total shown in the list as held by existing members).

Number of shares issued subject to

payment wholly in cash.

Number of shares issued as fully paid

up otherwise than in cash.

Number of shares issued as partly paid

up to the extent of

otherwise than in cash.

+Number of

issued at a discount.

per share

shares (if any)

Total amount of discount on the issue

of shares which has not been written

off at the date of this Return.

There has been called up on

each of shares.

§There has been called up on

each of shares.

$There has been called up on

each of shares.

Total amount of calls received, in-

cluding payments on application and allotment.

Total amount (if any) agreed to bo

considered as paid on

shares

which have been issued as fully paid up otherwise than in cash.

Total amount (if any) agreed to be

considered as paid on

shares

which have been issued as partly paid up to the extent of

per

share otherwise than in cash.

Total amount of calls unpaid

Total amount of the sums (if any) paid by way of commission in respect of any shares or debentures or allowed by way of discount in respect of any debentures since the date of the last Return.

*Where there are shares of different kinds or amounts (e.g., Preference and Ordinary or $100 and $10) state the number and nominal values separately.

tif the shares are of different kinds, state them separately.

§ Where various amounts have been called, or there are shares of different kinds, state them separately.

**Include what has been received on forfeited as well as on existing shares.

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