Post Code Country* Issued Shares Preferential Shares Ordinary Shares Other Share Types Number of Shares issued* Amount (if any) unpaid (in US$) Amount paid (in US$) Shareholder - Individual Personal Details Provide details of the shareholder of the company. Title* Forenames* Surname* Former Country of Residence* Nationality* Date of Birth* Business Occupation Service Address Provide Post Box number or address at which communication may be effectively serve by postal service. Address* P.O. Box Number Post Code Country* Issued Shares Preferential Shares Ordinary Shares Other Share Types Number of Shares issued* Amount (if any) unpaid (in US$) Amount paid (in US$)
Post Code Country* Issued Shares Preferential Shares Ordinary Shares Other Share Types Number of Shares issued* Amount (if any) unpaid (in US$) Amount paid (in US$) Shareholder - Individual Personal Details Provide details of the shareholder of the company. Title* Forenames* Surname* Former Country of Residence* Nationality* Date of Birth* Business Occupation Service Address Provide Post Box number or address at which communication may be effectively serve by postal service. Address* P.O. Box Number Post Code Country* Issued Shares Preferential Shares Ordinary Shares Other Share Types Number of Shares issued* Amount (if any) unpaid (in US$) Amount paid (in US$)
INC-02-PLC_FS_V20.docx