Number of shares of each class issued subject to payment wholly in cash. Number of shares of each class issued as fully paid up for a consideration other than cash. The nature of the consideration given for such shares. Number of shares of each class issued as partly paid up for a consideration other than cash and extent to which each such share is so paid up. The nature of the consideration given for such shares. Number of shares, if any, of each class issued at a discount. ..................................... ..................................... ..................................... ..................................... ..................................... ..................................... ..................................... ..................................... ..................................... ..................................... .................................... ................................ shares ................................ shares ................................ shares ................................ shares ................................ shares ................................ shares ................................ shares ................................ shares ................................ shares ................................ share s ................................ Number Class ..................................... ................................ shares issued as paid up to the extent of $ .......................... per share ..................................... .......................... ...... shares issued as paid up to the extent of $ .......................... per share .................................... ................................. shares issued as paid up to the extent of $ .......................... per share .................................... ................................. shares issued as paid up to the extent of $ .......................... per share ................................................................................... ................................................................................... .................................... ................................ shares .................................... ................................ shares .................................... ................................ shares .................................... ................................ shares Amount of discount on the issue of shares which has not been written off at the date of this return. .............................................................. $................................................................................. Amount called up on number of shares of $.............. per share on ....................................... .................................shares each class. $.............. per share on ....................................... .................................shares $.............. per share on ....................................... .................................shares $.............. per share on ....................................... .................................shares Total amount of calls received, including payments on application and allotment and any sums received on shares forfeited. ........................ $................................................................................. Total amount, if any, agreed to be considered as paid .................. ......................... shares on number of shares of each class issued as fully .................. ......................... shares $........................ on paid up for a consideration other than .................. ......................... shares cash .................. ......................... shares Total amount, if any, agreed to be considered as paid .................. ......................... shares on number of shares of each class issued as partly .................. ......................... shares paid up for a consideration other than cash. $........................ on .................. ......................... shares .................. ......................... shares Total amount of calls unpaid $..................................................................... Total amount of the sums , if any, paid by way of commission in respect of any shares or debentures $..................................................................... Number Class Total amount of the sums, if any, allowed by way of discount in respect of any debentures since the date of their last return $..................................................................... Total number of shares of each class forfeited .............................. ...................................... shares .............................. ...................................... shares .............................. ...................................... shares .............................. ...................................... shares Total amount paid, if any, on shares forfeited $................................................................................. } } { { B. Particulars of Directors, Auditors and Secretaries Names and Addresses of the Directors, Auditors and Secretaries of the ............................., Limited, on the ........... day of ......................, 19.................. Directors Names Addresses Other Directorships Auditors Names Addresses Secretary