| Date
of Change of [Select Option] |
|
| Name of
Registered Holder |
|
| Circumstance(s) giving
rise to the interest or change in interest |
[Select Option] |
| # Please specify details |
|
| Information relating to
shares held in the name of Registered Holder |
| No. of [Select Option] held
before the change |
|
| As a percentage of
issued share capital |
|
| No. of Options which
are subject to this notice |
|
| As a percentage of
issued share capital |
|
Amount of consideration
(excluding
brokerage and stamp duties) per share paid or received |
|
| No. of Options held
after the change |
|
| As a percentage of
issued share capital |
|