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SECRETARIAL PRACTICE
FORM No. 25.
REQUEST BY EXECUTORS OR ADMINISTRATORS
TO BE PLACED ON REGISTER IN THEIR OWN
RIGHT.

To THE ‘A’ CoMPANY, LIMITED.
LonpoN WaLL, Lonpon, E.C.

Name of deceased... wm

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Probate. INO...sssmmmssssssssssssssssssssss
I/We, the undersigned, being the (a)* Executor(s)/rix of the
*Delete words

not appropriate. . ] Lo.
Will, (b) Administrator(s) of the Estate of... i”
deceased, hereby request you to register me/us as (a)
member(s) of your Company in respect of the... umm
Shares numbered... mnt Orme NCIUSIVE [OF Loonies
Stock], now standing in the name of the said deceased.

Dated thiS.eed@Y Of cnssssnsssssnsmsssssmsessssssssssmsssssssssssss I Qenensssssne

Usual signature
NAME IN FULL cocmmmonmsmsmmmsnsmssmasssssssssssasssssssssssssssssssssases
AAALEES. crnsimemssisiiiisssisssss mim —
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Usual signature
NATE 0 TUL cinnamon:
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Description esr ————— A

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Note.—The Share or Stock Certificates must be lodged at the
Company's offices with this request, accompanied also by the Probate
or Administration Letter if not previously lodged. No stamp is
necessary where the above form is used.