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.)

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Coupany

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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

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10 7" N"olde— 4

Insert correct description of Bankers with full postal address.