188 
39 & 40 Vict. Cap. 45, s. 26. 
SCHEDULE III. 
Fokm of Statement to be made out by a Society 
CARRYING ON THE BUSINESS OF BANKING. 
1. Capital of the society :— 
(a.) Amount of each share. 
(6.) Number of shares issued. 
(c.) Amount paid up on shares. 
2. Liabilities of the society on the first day of January 
(or July) last previous : — 
(«.) On judgments. 
(5.) On specialty. 
(c.) On notes or bills. 
(d.) On simple contract. 
I (e.) On estimated liabilities. 
3. Assets of the society on the same date :— 
(a.) Government securities (stating them). 
(b.) Bills of exchange and promissory notes. 
(c.) Cash at the bankers. 
(d.) Other securities. 
Form of Bond. 
(1.)—In England or Ireland. 
Know all men by these presents, that we, A.B., of 
, one of the officers ot the Society, 
Limited, established at , in the county of , 
and G.D., of (as surety on behalf of the said A.B.), 
are jointly and severally held and firmly bound to the said 
society in the sum of , to be paid to the said 
society, or their certain attorney, for which payment well 
and truly to be made we jointly and severally bind our 
selves, and each of us by himself, our and each of our heirs, 
executors, and administrators, firmly by these presents. 
Sealed with our seals. Dated the day of > 
in the year of our Lord ,