COMPANIES ACT, 192g 
FIFTH SCHEDULE. 
Section 40. 
FORM OF STATEMENT IN LIEU OF PROSPECTUS TO BE DELIVERED 
TO REGISTRAR BY A COMPANY WHICH DOES NOT ISSUE 4 
PROSPECTUS OR WHICH DOES NOT GO TO ALLOTMENT ON A 
PROSPECTUS ISSUED. 
THE COMPANIES ACT, 102° 
Statement in lieu of Prospectus 
delivered for registration bv 
Insert the name of the company 
Pursuant to section 40 of the Companies Act, iy-. 
Delivered for registration bv 
The nominal 
Company. 
Divided inte 
share 
nial ¢ 
tit 
Amount (if any) of above capital 
which consists of redeemable pre 
ference shares. 
The date on or before which these 
shares are, or are liable. to be 
redeemed. 
Names, descriptions and addresses 
of directors or proposed directors. 
If the share capital of the Company 
is divided into different classes 
of shares, the right of voting at- 
meetings of the Company con- 
ferred by, and the rights in respect 
of capital and dividends attached 
to, the several classes of shares 
respectively. 
Number and amount of shares and 
debentures agreed to be issued as 
fully or partly paid up otherwise 
than in cash. 
The consideration for the intended 
issue of those shares and deben- 
tures 
Share: 
Share. 
shares 
© ad. 
share 
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