APPENDIX F 
175 
FORM No. 38. 
SPECIMEN SIGNATURE AND DIVIDEND REQUEST 
This Form may be sent out with Certificate in the case 
of all new holdings.) 
THE ** 
Coupany 
ET 
TH 
NO 
Lonpn 
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T3 
“an .Ca, 
asses Coase 
To. 
_ wes_i sates 
FOR L 
NTY 
Please favour me with a specimen of 
your ordinarv signature below, returning 
this form to me. 
11 you desire that Dividends or 
[nterest on your Shares [or Stock] 
should be paid to your Bankers direct, 
please also fill up and sign the form at 
foot her: ~ 
Certific 
* Share: 
mount 
Stock 
Secretary. 
Ordinary Signature of 
Shareholder or Stockhold 
PAPERS EEN PARNR $2 0ac eR NETA BIRGER ARSI PER IPL ESe 
To THE ‘A 
PLEASE PAY all Dividends, Interest or Bonuses which 
[ am now or mav be hereafter entitled to receive to the? 
CoMPANY, LIMITED. 
caepeen ran, 
werd SOP ROS SPR NRO OUS RRR RGROCRUE PPR ROOO ORRIN SNES IR INNTSLGTGAI EIS RRS IPUSIII TORN IIPI SI RIRIUE PEER eN eNO PEO FER l sae IPReS 
Bank at nee. 
whose acknov'-d~ment = la 
Da 
NOTE.- 
In ‘he ca 
10 7" N"olde— 4 
Insert correct description of Bankers with full postal address.