RECEIPT TO ACCOMPANY SHARE CERTIFICATE

of
ENTER COMPANY NAME

On this date, ENTER NAME has purchased ENTER QUANTITY

shares of common stock in this company, represented by share
certificate number ENTER CERTIFICATE NUMBER. The
shareholder has transferred to the company the following assets, with
a fair market value of £ENTER MARKET VALUE AMOUNT, in
consideration for the receipt of the shares:

ENTER ASSETS TRANSFERRED TO COMPANY

Payment in full has been received for these shares and the share
certificate representing the shares has been issued by the company
to the shareholder. Record of this transaction has been recorded in
the share transfer book of this company.

Date ENTER DATE

________________________________________
Secretary of the company

________________________________________
Shareholder
 Receipt to Accompany Share Certificate Instructions

Do not send this form to Companies House. This is for information only

1. In the receipt complete all of the fields as indicated in blue

2. Print the form
3. Get the company secretary and the shareholder to sign the form
4. Once the completed receipt has been signed it should be kept on record by
the company. The shareholder may also want to keep a copy of this receipt.