FORM C & F 2011

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Name of Company: ....………………………………………………………………… ……………………………..……………………………………………………………... P10 P11 Director I Director II Director III Other address if P9 does not apply Directors’ Name Postcode State C >>>>>>> >>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>> Town >> >>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> P12 Director I Director II Director III Directors’ identity card / passport no. >>>>>>>>> >>>>>>>>> >>>>>>>>> P13 Directors’ telephone no. >>>>>>>>> >>>>>>>>> >>>>>>>>> P14 Director I Director II Director III Directors’ income tax no. SG / OG SG / OG SG / OG < < < >>>>>>>> >>>>>>>> >>>>>>>> P15 Directors’ equity shareholding (%) _> . _> . _> . P16 Director I Director II Director III Directors’ salary / bonus _>>_>> , , _>>_>> , , _>>_>> , , P17 Directors’ fee / commission / allowance _>>_>> , , _>>_>> , , _>>_>> , , 12
Name of Company: ....………………………………………………………………… ……………………………..……………………………………………………………... PART Q: PARTICULARS OF FIVE MAJOR SHAREHOLDERS OF CONTROLLED COMPANY C >>>>>>> Q1 Q2 Q3 Q4 Q5 Identity Card / Passport / Company Registration No. Name Direct shareholding (%) >>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> Country of origin _> . < (Use the Country Code) Identity Card / Passport / Company Registration No. Name Direct shareholding (%) >>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> Country of origin _> . < (Use the Country Code) Identity Card / Passport / Company Registration No. Name Direct shareholding (%) >>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> Country of origin _> . < (Use the Country Code) Identity Card / Passport / Company Registration No. Name Direct shareholding (%) >>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> Country of origin _> . < (Use the Country Code) Identity Card / Passport / Company Registration No. Name Direct shareholding (%) >>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>>>>>> Country of origin _> . < (Use the Country Code) 13
Page 1 and 2: URUSAN SERI PADUKA BAGINDA BAYARAN
Page 3 and 4: Name of I company [Submit Form 13 i
Page 5 and 6: Name of Company: ....…………
Page 13: Name of Company: ....…………
Page 19 and 20: REMITTANCE SLIP FOR FORM C REMITTAN

FORM C & F 2011

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