APPENDIX F

FORM No. 32.

INDEMNITY AND REQUEST FOR DUPLICATE
DIVIDEND WARRANT.
To THE ‘A’ CoMPANY, LIMITED.

IN consideration of The ‘A’ Company issuing to me a
duplicate Warrant for the [Interest or Dividend] to the
[30 June or 31 December, 19....], amounting to fo... co.
on the [amount of holding, e.g. £100 ordinary stock] registered
in my name, in lieu of the original Warrant No.....dated...........
which has been lost, destroyed, or mislaid, I hereby undertake
and engage for myself, my Executors, Administrators and
Assigns, to hold the said Company, and the Directors and
Officers thereof, harmless and indemnified against all losses
and expenses which may be incurred in the event of the said
original Warrant being paid or forthcoming at any future
lime, or otherwise in consequence of the said Company
issuing a duplicate to me as aforesaid, and I request that
such duplicate Warrant may be issued to me accordingly
and I engage to return the original should it be found.

Dated this........day of...

rvs Josie

Stonatur....

+“ STH

nd

Witness:

ddrecs ........

Signature wr.

Address...

EEA uC PIER PRS I PERE BER. OL

OCCUD ALLOW reese

Note.—Where there are circumstances involving the slightest suspicion or the amount
involved is substantial, the holder's bankers should be requested to join in the indemnity.