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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 —
DESCIIDHION ovvecersoncesssnrssssssssmsssssensasss. 1a senses. o

Usual signature

NATE 0 TUL cinnamon:
AQATESS cesmsecsmsssessasssessissesssssmmmssssssssssasssssssssssssssssssissssssessssass
Description esr ————— A

chee astsnOuRIATIeNIRsEIRaNsEeRieensIatesastiestiesnIerrTesIel

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.