S.I. No. 161/1991 - Companies (Forms) Order, 1991.

Particulars of Directors (including shadow directors)

Names and particulars of the persons who are to be the first directors of the company

Surname note two

Forename note two

Former Surname note three

Former Forename note three

Date of birth:

Day

Month

Year

Business Occupation

Nationality

Home Address note two

Other directorships note four

Registered at note five

Company number

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I hereby consent to act as director of the aforementioned company

Signature

Date

Note four Company name and number of other bodies corporate, whether incorporated in the State or elsewhere, except for

bodies of which the person has been a director at any time during the past ten years

bodies of which the company is (or was at the relevant time) a wholly owned subsidiary

bodies which are (or were at the relevant time) wholly owned subsididiaries of the company

Surname note two

Forename note two

Former Surname note three

Former Forename note three

Date of birth:

Day

Month

Year

Business Occupation

Nationality

Home Address note two

Other directorships note four

Registered at note five

Company number

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Note five Place of incorporation if outside the State

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I hereby consent to act as director of the aforementioned company

Signature

Date

Surname note two

Forename note two

Former Surname note three

Former Forename note three

Date of birth:

Day

Month

Year

Business Occupation

Nationality

Home Address note two

Other directorships note four

Registered at note five

Company number

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I hereby consent to act as director of the aforementioned company

Signature

Date

Surname note two

Forename note two

Former Surname note three

Former Forename note three

Date of birth:

Day

Month

Year

Business Occupation

Nationality

Home Address note two

Other directorships note four

Registered at note five

Company number

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I hereby consent to act as director of the aforementioned company

Signature

Date

Signed by or on behalf of the subscribers to the memorandum

Signature

□ Subscriber □ Agent

Date

Signature

□ Subscriber □ Agent

Date

Signature

□ Subscriber □ Agent

Date

Signature

□ Subscriber □ Agent

Date

Signature

□ Subscriber □ Agent

Date

Signature

□ Subscriber □ Agent

Date

Signature

□ Subscriber □ Agent

Date

Declaration of compliance

I name

of home address

Note six "A solicitor engaged in the formation " or " a person named as director/secretary"

do solemnly and sincerely declare that I am (note six)

of company

and that all the requirements of the Companies Acts, 1963 to 1990 in respect of the registration of the said company, and of maters precedent and incidental thereto have been complied with. And I make this solemn declaration conscientiously believing the same to be true and by virtue of the Statutory Declarations Act, 1938 .

Declared before me by

who is personally known to me or who is identified to me by

Signature of Declarant

who is personally known to me at

Commissioner for Oaths

□ Commissioner for Oaths

□ Notary Public □ Peace Commissioner

this

day of

19

Annual Return

Companies Acts 1963 to 1990

Registration fee stamp to be affixed above

Section 125 or 126, Companies Act, 1963

B1

Company number

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Please complete using black block capitals or typewriting

Company name in full

Limited

Return made up to note one

day of

19

Financial year note two

from

to

Note one The date should be 14 days after the A.G.M. of the company.

Address of registered office

Note two Give the dates of the commencement and completion of the financial year of the accounts presented to the A.G.M.

Other Addresses

Places where the register of members, register of debenture holders and directors' service contracts/memoranda are kept, if other than the registered office

Address

Description of address

Note three Insert full name (initials will not suffice) and usual residential address. Where all the partners in a firm are joint secretaries the name and principal office of the firm may be stated

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Note four Former forename or surname does not include the following:

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Secretary

In the case of a person usually known by a title different from his surname, the name by which he was known previous to the adoption of or succession to the title;

Surname note three

Forename note three

Former surname(s) note four

Former forename note four

Home address note three

In the case of any person, a former forename or surname where that forename or surname was changed or disused before the person bearing the name attained the age of 18 years or has been changed or disused for a period of not less than 20 years;

Indebtedness

Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908.

£

In the case of a married woman, the name or surname by which she was known previous to her marriage.

Presenter's Name

Address

Telephone Number

Reference

Note five

Where appropriate references to shares will be taken as references to stock and references to numbers of shares as references to amount of stock

Capital — Nominal note five

Nominal Share Capital £

£_____________________

Class

Number

Value Per share

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Capital — Issued

Issued Amounts

Note six

Total Issued Capital  £___________

Paid up on shares issued for cash

£

Give the total number of shares held by each member

Considered paid on other shares

£

Total calls unpaid

£

Shares issued

Consideration — all cash

Note seven applicable to private companies only.

Particulars of shares ???? since the date of the last return or, in the case of a first return, the date of incorporation, by persons who are still members and persons who have ceased to be members. Give the date of registration of each transfer and the number transferred on each date.

Class

Number

Amount called up per share

Amount paid per share

Total amount paid

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Note eight

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Name should be given in alphabetical order or an indix should be annexed.

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Totals

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Consideration — not all cash

Class

Number

Amount called up per share

Amount considered paid per share

Total amount paid

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Totals

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Total number of shares issued (A) and (B)

This total must agree with the total number of shares held by existing members as stated in the "List of past and Present Members" section of the return

Other Share/Debenture Details

Details of shares forfeited, shares/debentures issued at a discount, or on which a commission was paid including share class, number of shares and amounts in each case

List of persons holding shares on the 14^th day after the annual general meeting for19____, and of persons who have held shares therein at any time since the date of the last return, or in the case of the first return, the date of the incorporation of the company

Share Class

Numbers Held note six

Numbers Transferred and Date note seven

Particulars of Transferee

Name notes three and eight

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Address notes three and eight

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Folio No.

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Name notes three and eight

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Address

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Folio No.

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Name notes three and eight

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Address

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Folio No.

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Name notes three and eight

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Address

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Name notes three and eight

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Address notes three and eight

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Folio No.

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Name notes three and eight

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Address

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Folio No.

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Name notes three and eight

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Address

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Folio No.

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Name notes three and eight

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Address

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Name notes three and eight

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Address notes three and eight

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Folio No.

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Name notes three and eight

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Address

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Folio No.

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Name notes three and eight

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Address

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Folio No.

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Total number of shares held must agree with the total number of issued shares given in the "Shares Issued" section of the return

Total number held note ten

Earlier full listing

When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and shares transferred since that date need be furnished. If full particulars are not now given, specify the date the relevant annual return was made up to.

Return made up to note one

day of   19

Note nine Company name and number of other bodies corporate, whether incorporated in the State or elsewhere, except for

Surname note three

Forename note three

Former Surname note four

Former Forename note four

Business occupation

Date of birth:

Day    Month   Year

Bodies of which the person has not been a director at any time during the past ten years

Home address note three

Nationality

Bodies of which the company is or was at the relevant time a wholly owned subsidiary

Other directorships note nine

Registered at note ten

Company number

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Bodies which are (or were at the relevant time wholly owned subsidiaries of the company

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Note ten

Surname note three

Forname note three

Place of incorporation if outside the State

Former Surname note four

Former Forename note four

Business occupation

Date of birth:

Day   Month  Year

Home address note three

Nationality

Note eleven mark "X" in the relevant box(es)

Other directorships note nine

Registered at note ten

Company number

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Documents Annexed note eleven

Surname note three

Forename note three

Mark "X" in the box relative to each annexed document

Former Surname note four

Former Forename note four

Balance Sheet  □ S. 128, Companies Act, 1963 (CA — '63): S. 7 and S. 18, Companies (Amendment) Act, 1986 CAA — '86)

Business occupation

Date of birth:

Day   Month  Year

Home address note three

Nationality

Profit and Loss    □

A/C S. 7 and S. 18, CAA — '86

Directors Report    □

S. 128, CA — 63: S. 7 and S. 18, CAA — '86

Other directorships note nine

Registered at note ten

Company number

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Auditors Report    □

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S. 128, CA — '63; S. 7 and S. 18, CAA — '86

Guarantee       □

S. 17, CAA — '86

Declaration..      □

Surname note three

Forename note three

S. 17, CAA — ''86

Notification to shareholders of Guarantee S. 17, CAA — '86

Former Surname note four

Former Forename note four

Business occupation

Date of birth:

Day   Month   Year

Note stating      □ company has availed of exemptions in S. 17, CAA — '86

Home address note three

Nationality

Other directorships note nine

Registered at note ten

Company number

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We hereby certify that this form contains the particulars in respect of the company as at the date up to which the return is made and that note eleven

The Company is not a private company

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The Company is a private company and has not since the date of the last annual return (or the date of incorporation if this is the first return) issued any invitation to the public to subscribe for any shares or debentures in the company

March 19, 1999

The Company is a private company with more than 50 members. The excess of the number of members over 50 consists wholly of persons who, under section 33 (1) (+b) of the Companies Act, 1963 , are not to be included in reckoning the number of 50

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