30684-1913-Companies-Winding-up-Rules — Page 67

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.