Shares held as
Number of
per settled
List.
THE HONGKONG GOVERNMENT GAZETTE, FEBRUARY 14, 1913.
No
NOTE. The receipt should be signed by the contributory person-
ally, or in the case of joint contributories. by each.
Received of the
of dollars
being the amount return of
payable to
RECEIPT.
per share held by Contributory's signature.
19
in this matter the sum and cents
in respect of the
in this comparry.
SIR,
AUTHORITY FOR DELIVERY.
PLEASE deliver to
Insert the name of the person who is to receive the cheque or money
my
me
order, or the words “ by post," at " risk," if you wish it sent
to you in that way.)
Us
the cheque or money order for the return payable to in this mat-
ter.
Contributory's signature
To the [Official Receiver and] Liquidator.
me
US
No. 70. (Rule. 139).
SCHEDULE OR LIST OF CONTRIBUTORIES HOLDING PAID-UP SHARES TO WHOM A DIVIDEND OR RETURN IS TO BE PAID.
In the matter of
No.
of 19
Total called-up value.
Total paid-up value.
s
Arrears of Calls
at date of Re-
turn.
0.
of capital ap- Previous return
propriated by Liquidator for
Arrears of Calls.
3
turn payable
Amount of Re-
at
per share.
+
Net return pay-
able.
C.
Date and parti- culars of trans- fer of interest or other varia- tion in List.