1964_COMPANIES_(FORMS)_REGULATIONS — Page 42

1984 Ed.]

Companies (Forms) Regulations

[CAP. 32

FORM XIB(i)

B 43

[Subsidiary]

L.N. 168/84.

Please do not write in this binding margin.

COMPANIES ORDINANCE

(Chapter 32)

Statement as to affairs (Statutory Declaration i

Pursuant to sections 300A(1)(b) and 300B

In the matter of a debenture or series of debentures registered on

19.

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

Name of company

Company number

Statement as at the

19

day of

being the date of appointment of the Receiver

We

of

and

of

a director of the above-named company

Please refer to Notes.

the secretary thereof solemnly and sincerely declare that the statement made overleaf and the several lists hereunto annexed marked +

are a full, true and complete statement as to the affairs of the above-named company

on the

day of

19

being the date of the appointment of the Receiver. And we make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Ordinance

+Note the several lists

attached are not exhibits to the declaration.

Declared at

this

day of

19

before me

A Commissioner for Oaths **

Signatures of declarants:

Presentor's name, (if any)

address and reference

For official use

Please see note 3.

**or Notary Public or Justice of the Peace or Solicitor having the powers conferred on a Commissioner for Oaths. The Commissioner is requested to read note 2.