1964_COMPANIES_(FORMS)_REGULATIONS

B 54

[Subsidiary]

Please do not write in this binding margin.

CAP. 32]

Companies (Forms) Regulations

[1984 Ed.

LIST 'D' (consisting of

pages)

Statement of Affairs

Please complete legibly, preferably in black type, or bold block lettering.

List of debenture holders secured by a floating charge

The names to be arranged in alphabetical order and numbered consecutively

No. Name of holder Address Amount Description of assets over which security extends S C

Signed

Date

)

(