hey

1. Shareholder Information :
Name in Block Letters : _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _
Full Address : _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _
Signature : _ _ _ _ _ _ _ _
I/We, the undersigned certify that the above facts are true and bind ourselves to make good all claims,
charges, cost, damages, demands, expenses, loss and the increase in the price of share if any at the time
of such indemnification, which the said Company may sustain, incur of be liable for in consequence of
complying with request contained above and the Company will be entitled to realized all claims, charges
costs, damages, expenses and losses fromour persons or out hiers of properties, as the case may be.
Witness 1 : Surety 1 :
Name in Block Letters: _ _ _ _ _ _ _ _ Name in Block Letters _ _ _ _ _ _ _ _ _
Full Address : _ _ _ _ _ _ _ _ Full Address : _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _
Signature : _ _ _ _ _ _ _ _ Signature: _ _ _ _ _ _ _ _ _
Witness 2 : Surety 2 :
Name in Block Letters: _ _ _ _ _ _ _ _ Name in Block Letters _ _ _ _ _ _ _ _ _
Full Address : _ _ _ _ _ _ _ _ Full Address : _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _
Signature : _ _ _ _ _ _ _ _ Signature: _ _ _ _ _ _ _ _ _
NOTES : : In case of jointholdingall shareholdersshouldsign