184

Form  B-Déclaration

  to  be  signed  by  a  Banker  or  Marchant  presenting  Coupons
in  London  on  behalf  of  a  Foreigner  residing  abroad.  {To  accompany
Déclaration  on  Form  A.)

déclaré  that  hâve  received  from  the  persons
named  below  the  Coupons  specified  in  the  annexed  Déclarations  which
hâve  been  made  before  a  British  Consul,  Vice-Consul,  or  Notary  Public,
and  on  the  ground  of  those  Déclarations  daim  to  hâve  the
Coupons  paid  free  of  Income  Tax,  and  hereby  undertake  to
refund  to  the  Board  of  Inland  Revenue  any  Income  Tax  which  may  be
allowed  under  this  Déclaration  through  any  inaccuracy  of  statement  in  the
said  Déclarations  as  to  Ownership  of  the  Bonds  and  Coupons,  the  numbers
of  which  are  therein  contained.
Signature  of  Banker  t
or  Merchant  J
Address

Date..

Spécification  of  Coupons.

From  whom
Coupons  were
received.

Name  of  Owner  of
the  Bonds.
To  be  clearly  written.

Description  of
Bonds.

Total

-  £

Aggregate  amounts  of
Coupons  of  each
description  of  Bond.

£

d.