SLEKİ VARIO (4)

(1) Manner in which Indebtedoms

(it say) DOL

specified sine-

BET DE AGA

section due

from the debtor

Hojjatu ki pozivu

I overfakt.

(W) Date of obligation.

(le) Amount slaimed

+

Ima

Desember,

and Bujq

(WI) Date debi

bazama dua.

18th

1863.

24

25

8. TO BE COMPLETED BY ALL PERSONS MAKING A CLAIM.

I/WE hereby claim in accordance with the provisions of the Distribution of German Enemy Property Regulations, 1958, in respect of debtu arising from the Bonds lated herein.

I/WE declare, in respect of all the German enemy debts which are the subject of this claim, that I/we bave not, since 18th July, 1956, sold those debts or any of tham, together with the right to make a claim in respect thereof, and in the event of any such sale being effected by me/us on or before lat November, 1966, I/we undertake to notify the Administrator of the fact within one month from the date of such sale.

I/WE further declare that all the statements made by me/us in this claim forms are true and correct to the best of my/our knowledge and belief, and that this is the only claim I/we have made in respeet of debts arising out of the bands listed herein.

Date

If the person making the claim is a body of persons,

state relationship of signa-

tory to such body

Signed

FOR OFFICIAL USE ONLY

Signatures

Amount Amount Claimed Rejected

Amaunt

Weighting Admitted

Exam. Pre-audit

Council CHAMBER,

29th May, 1956.

Clerk of Councils.

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