COMPANIES (FORMS) ORDER

53’
Form No. 58.

No. of Company...
THE COMPANIES ACT, 1929.

7
3

4 55. Companies
Registration Fee
Stamp must be
imbressed herve
STATEMENT OF THE AMOUNT OR RATE PER CENT. OF THE COMMISSION
PAYABLE IN RESPECT OF SHARES AND OF THE NUMBER OF SHARES
WHICH PERSONS HAVE AGREED FOR A COMMISSION TO SUBSCRIBE
ABSOLUTELY.

Pursuant to Section 43 (1) (c) (ii) and (d).
Name

of
Compar.
Presente.

Name of Company ...
Tne
Article of Association authorising
Commission.

Particulars of amount payable as
Commission for subscribing, or
agreeing to subscribe, or for
procuring or agreeing to pro-
cure, subscriptions for any
shares in the Company; or,

Rate of such Commission...

Date of Circular or Notice (if
any), not being a prospectus,
inviting subscriptions for the
shares and disclosing the
amount or rate of the Com-
mission ..

Number of shares which persons
have agreed for a commission to
subscribe absolutely.

Toy

Rat:

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(Signatures of all the Director:
or of
their agents auth-
in wuritivr-

Dated

the