VI. and amount of any such shares or debentures and including the following particulars of the option or right— (a ) The period during which it is exercisable. (b ) The price to be paid for shares or debentures subscribed for under it. (c) The consideration, if any, given or to be given for it or for the right to it. (d ) The names and addresses of the person to whom it or the right to it was given or if given to existing members or debenture holders as such, the relevant shares or debentures. (e) Any other material fact or circumstances relevant to the grant of such option or right. (a ) Names and addresses of vendors of property purchased or acquired, or proposed to be purchased or acquired, by the company except where the contract for its purchase or acquisition was entered into in the ordinary course of the business intended to be carried on by the company or the amount of the purchase money is not material. (b ) Amount (in cash, shares or debentures) payable to each separate vendor. (c) The amount payable by way of premium, if any, on each share which has been or is to be issued stating the reasons for any such premium and where some shares have been or are to be issued at a premium and other shares at a lesser or no premium, also the reasons for the differentiation, and how any premium is to be or has been disposed of. (d ) Amount, if any, paid or payable (in cash or shares or debentures) for any such property, specifying amount, if any, paid or payable for goodwill. 3. Until 4. 5. Consideration: 6. Names and Addresses: 7. Total purchase price $ Cash...............$ Shares.............$ Debentures.....$ G oodwill......... $ (e) VII. (a ) (b ) (c) VIII. (a ) (b ) (c) (d ) IX. X. Short particulars of any transaction relating to any such property which was completed within the two preceding years and in which any vendor to the company or any person who is, or was at the time thereof, a promoter, director or proposed director of the company had any interest, direct or indirect, with particulars of such interest. Amount, if any, paid or payable as commission for subscribing or agreeing to subscribe or procuring or agreeing to procure subscriptions for any shares or debentures in the company; or Rate of commission ................................ .......................................................... The number of shares, if any, which persons have agreed for a commission to subscribe absolutely. Estimated amount of preliminary expenses By whom those expenses have been paid or are payable ................................ .. Amount paid or intended to be paid to any promoter Consideration for the payment .......................................................................... Any other benefit given or intended to be given to any promoter Consideration for giving of benefit ................................................................ .. Dates of, parties to and general nature of every material contract (other than contracts entered into in the ordinary course of the business intended to be carried on by the company or entered into more than two years before the delivery of this statement). (b ) Time and place at which the contracts or copies thereof may be inspected or (1) in the case of a contract not reduced to writing, a memorandum giving full particulars thereof, and (2) in the case of a contract wholly or partly in a foreign language, a copy of a translation thereof in English or embodying a translation in English of the parts in a foreign language, as the case may be, being a translation certified in the prescribed manner. Names and addresses of the auditors of the company, if any Amount paid Amount payable Rate per centum. $ Name of promoter: Amount $ Consideration: Name of promoter: Nature and value of benefit: Consideration: (a ) XI. Full particulars of the nature and extent of the interest, if any, of every director or promoter in the promotion of, or in the property acquired within two years of the date of the prospectus or proposed to be acquired by, the company, or where the interest of such director or promoter consists in being a member of a partnership, company, syndicate or other association of persons, the nature and extent of the interest of such partnership, company, syndicate or other association and the nature and extent of such director’s or promoter’s interest in the partnership company, syndicate or other association, with a statement of all sums paid or agreed to be paid to him or to it in cash or shares or otherwise by any person either to induce him to become, or to qualify him as, a director or otherwise for services rendered by him or by it in connection with the promotion or formation of the company. (Signatures of the persons abovenamed as directors or proposed directors or of their agents authorized in writing). Date ......................................................................................................................................... ....................................... ....................................... ............. ..........................