Return Of Allotment (Post Incorporation) Page 3

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2.
Name
No of shares
Type of shares
Address
City
State
3.
Name
No of shares
Type of shares
Address
City
State
4.
Name
No of shares
Type of shares
Address
City
State
5.
Name
No of shares
Type of shares
Address
City
State
6.
Name
No of shares
Type of shares
Address
City
State
_________________________
___________________________
Signature of Director
Signature of Director
_________________________
___________________________
Name of Director
Name of Director
& Tel. No.
& Tel. No.
Note:
If there is insufficient space on the form to provide the information required, please attach a separate form containing the
information required in the prescribed format.
Presented for filing by:
Name: __________________________________________________ Accreditation Number: ________________________________
Address: ____________________________________________________________________________________________________
Tel. No. & E-mail: ________________________________________________ Signature & Date: ____________________________

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