APPENDIX F
FORM No. 42.
APPLICATION FOR SHARE WARRANTS

SHARES.

To the Directors _
~ ze

Date lodg-=..

£.’ COMPANY, LIMITED,
London Wall, London, E.C.

I/We, the undersigned, being the Holder(s) ot...
registered Shares of your Company, as per particulars at back hereof,
the Certificates whereof I/we enclose, hereby request you to issue tc
me/us the following Share Warrant(s) to Bearer, in respect thereof, and
[/we enclose remittance for *~ defrav the
charges for same as undernoted

PARTICULARS OF SHARE
WARRANTS REQUIRED.

No.

Descriptio-

TrECATI

jy Shares
over
2/6
mor
raction
hereof.

IOr each
Varrant.

+s TAMP .JIT.

3% .

. Shares
‘nly 5 per cent. of the number of Shares to be converted will be
issued in Warrants of 1 Share each at the usual fee. Share-
holders desiring a larger proportion can obtain them on pay
ment of 6d. per Warrant extra

Witness

Address

Dated °~

shareholder

Name

Address -

r~

Occupatior

Sior

t The Signa-
ture must be at-
tested by a Wit-
ness who must
add his Postal
Address after the
name. When the
Signature is af-
fixed out of Great
Britain it must
be attested by
H.M. Consul or
Vice-Consul, No-
tary Public, or
by some other
person holding
a public position.

® Three times the amount of ad valorem Stamp Duty chargeable on deed transferrine
the share(s) if consideration for transfer be nominal value of shares.