2174
[Third Schedule. Form E contd.]
No. 58 of 1911.
COMPANIES.
* Total amount of calls received, including payments on application and allotment,...
Total amount (if any) agreed to be 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,...................
Total amount of calls unpaid,..
Total amount (if any) of sums paid by way of commission in respect of shares or debentures or allowed by way of discount since date of last summary,.. $
Total amount (if any) paid on shares forfeited... $
Total amount of shares and stock for which share warrants are outstanding,...
Total amount of share warrants issued and surrendered respectively since date of last summary, $
Number of shares or amount of stock comprised in each share warrant,................
Total amount of debt due from the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies,....... $
day of
STATEMENT in the form of a balance sheet made up to the ... 19... containing the particulars of the capital, liabilities, and assets of the company.
The return must be signed at the end by the manager or secretary of the company.
Presented for filing by
* Include what has been received on forfeited as well as on existing shares. † State the aggregate number of shares forfeited (if any).