N.B.—This form can be printed on
thin paper and bound interleaved
with plain paper for use with
carbons, in which case the counterfoil
 can be dispensed with.

Tue ‘A’ Co., LTD.
LoNDON Warr, LonpoN, E.C.

De snsresseasenseniiini, eoeswmiiiiiis TQ rsronsusinse
BaraNceE RECEIPT FO eres snes S NAT €S [ STOCK.

PAN
on
or

[ssued to Messrs. .....

[ag ‘A’ CompaNy, LIMITED

Noe

No. of Certificate ... for f£.. stock

" .. shares].

Name. A. B.

Amount of Balance £..... stock [....shares|

[SSUEA tO oan

Distinctiv

Name of Shareholder.

ATOM

for Registrar

Certificate to be ready...
NoTe.—This receipt does not in any way constitute a title to the
shares (stock) therein referred to and is not negotiable. The Company
will not be in any way responsible for any purpose for which it may be
ased otherwise than the Certification of further Deeds of Transfer
or exchange for a Definitive Balance Certificate.
No Transfer for any of the Balance of Stock (shares) above referred to
will be certified, neither will a Balance Certificate be issued, without the
production of the relative receipt.

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