CAP. 32]

Companies.

And I/we further request that the cheque or cheques drawn in respect of such dividends may be made payable to the order of the said M

whose receipt shall be sufficient authority to you for the issue of such cheque or cheques in his name.

It is understood that this authority is to remain in force until revoked by me/us in writing.

Signatures

Witness to the signature of

Witness to the signature of

Date

Specimen of signature of person appointed as above. Witness to the signature of

Witness to the signature of person appointed as above.

FORM 73. (rule 143).

NOTICE OF RETURN TO CONTRIBUTORIES.

Cheques are cancelled at the expiration of six months from date of issue, and money orders at the expiration of twelve months from month of issue.

[Please bring this notice with you.]

(Title.)

Return of $ per share.

[Address]

[Date]

return of

Notice is hereby given that a per share has been declared in this matter, and that the same may be received at my office, as above, on the day of 19 except Saturday, between the hours of

or on any subsequent day,

Upon applying for payment this notice must be produced entire, together with the share certificate. If you do not attend personally you must forward the share certificate and fill up and sign the subjoined forms of receipt and authority to deliver, when a cheque or money order payable to your order will be delivered in accordance with the authority.

(Signed)

Liquidator.

NOTE. The receipt should be signed by the contributory personally, or in the case of joint contributories by each, and in the case of a limited company by an officer of the company, so described.

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