CM 12 Statement of Payment of Commission on shares
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Form CM 12
REPUBLIC OF NAMIBIA
BUSINESS AND INTELLECTUAL PROPERTY AUTHORITY - BIPA
COMPANIES ACT 2004
(Section 86(2)) (Regulation 25(1))
STATEMENT OF PAYMENT OF COMMISSION ON SHARES
N.B. - To be lodged with the Registrar of Business before commission is paid
Name of Company
Authorised capital N$ ………………………
Authorised no par value shares
Number
Class
Nominal value per share
Number
Class
ISSUED SHARE CAPITAL
Amount of share capital of par value N$………………….
Stated capital N$ ……………………
Number
Class
Total amount paid
Number
Class
Issue price per share
SHARE CAPITAL TO BE ISSUED
Amount N$ ....................................
Number of no par value shares N$ ..............................
Number
Class
Issue price per share
Number
Class
Issue price per share
COMMISSION PAID ON SHARES ISSUED WITHIN THE TWO YEARS PRIOR TO THE DATE OF THIS STATEMENT
Date
Number
Class
Issue price, par
value shares
Issue price, no par
value shares
Rate of commission
paid
Total amount of
commission paid
COMMISSION TO BE PAID ON THE SHARES TO BE ISSUED IN TERMS OF THIS STATEMENT
Number
Class
Rate of commission
to be paid
Amount of com-
mission to be paid
Name, business and postal address of person to whom commission will be paid
Article of association authorising commission .......................................................................................................................
Reason for the payment of commission .................................................................................................................................
.................................................................................................................................................................................................
________________________________________________________________________________________________________________________________________________________________
Date ................................................................... .........................................................................................
Rubber stamp of company, if any, or of secretaries. Signature of Director/Manager/Secretary
Perforated
(To be completed by company)
Date of registration
____________________________________________________
The statement of payment of commission on shares in respect of the company
mentioned below has been registered on this day.
Name of company
Postal address
Registrar of Business
Date stamp of Business
Email address
Registration Office
Copyright: Business and Intellectual Property Authority, Namibia
Registration Number of Company
N$ 20,00 fee payable in terms of the Act and as set out in the regulations