5 ona 
ff 
SECRETARIAL PRACTICE 
FORM No. 34. 
DIVIDEND NOTICE AND WARRANT. 
(The details required bys. 33 of the Finance Act, 1924, see Chap. XX VI 
must be stated by companies incorporated in Great Britain, including 
those of them making ‘free of tax’ payments.) 
Serial 
Nmap = 
NO, 
THE ‘A’ COMPANY, LIMITED. 
LoxpboN E.C..oenn IQ. 
FinarL D ; : tof th 
INTER DIVIDEND Of... ween PET Share in respect o e year 
ended... IQs OluvrssrisrrivsnrnSDATES OFnvrsvinen€@Ch held by you. 
Dividend .. “e 
Less Income Tax '. 
reread £0 
N Gai. 
a ———— 
I certify that the Income Tax on the profits out of which the above- 
mentioned dividend is paid, has been, or will be, duly accounted for 
by the Company to the proper Officer for the receipt of Taxes. 
N.B.— Proprietors claiming exemption from or abatement of Income Tax are informed that the 
Inland Revenue Commissioners will accept this statement as a Certificate of the deduction 
of Income Tax. It should therefore be carefully preserved. A charge of (x/-) will be made 
for each duplicate issued. 
Secretary. 
LESS. 
\essasaase PERFORATED] 0080000000000000000a ii .L InaRscaacEIRRRRRSIE00RS 
[Continued on next page. 
[For Form of Dwidend Notice where Dominion Income Tax allowance is 
provided for. see Chapter XX VI?