FORM 76 Companies Act, 1965

Section 286(1)

PARTICULARS OF UNCLAIMED ASSETS PAYABLE TO COMPANIES LIQUIDATION ACCOUNT ...................................................... (NAMA SYARIKAT) To the Official Receiver, In pursuance of subsection (1) of section 286 of the Companies Act, 1965, *I/*We, ......................................, of ...................................... I/C No(s) ...................................... the liquidator(s) of ...................................... (Nama Syarikat), forward herewith to be placed to the credit of the Companies Liquidation Account the moneys of which particulars are given below and which represent (a) unclaimed dividend or other moneys which have remained unclaimed for more than six months from the date when the dividend or other moneys became payable; and (b) unclaimed or undistributed moneys arising from the property of the company after making a final distribution. PARTICULARS Name of Creditor Shareholder Or Other Person Description of Unclaimed Money or Dividend Office Use Only

Amount

Total ...

Dated this .................... day of ........................................, 20..........

................................................. (Signature of each Liquidator)

* Strike out whichever is inapplicable. Insert full particulars of each creditor and of each shareholder who dividend has been unclaimed or undistributed, and full particulars of miscellaneous amounts.