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 atmeetings
 of the Company conferred
 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 debentures


Share:

Share.

shares
© ad.
share

LN

va

n

A Noro

"1001

WiilC
> shore