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Appendix 8.4.1 Application for Listing of Securities Arising from Exercise of Company Warrants/Convertible Preference Shares* Primary/Secondary* Listing

Cross-referenced from Rules 870(2) and 880

Name of Applicant:
__________________________________________________________

Application for listing of _______________________________________________ additional securities of $ ___________ each fully paid arising from the exercise of ______________ Company Warrants/Convertible Preference Shares*.

1) State how the additional securities rank with existing securities.
(If they do not rank pari passu, confirm that the new certificates have been endorsed accordingly, and provide a specimen copy of the endorsed certificate to the Exchange)
2) In respect of each class of securities, provide the following details:—

Class of security : ______________________

Total number of issued shares excluding treasury shares Company Warrants/Convertible Preference Shares*
  Number $   Number $
Before exercise

Add: Issued pursuant to exercise
    Before exercise

Less: Amount exercised
   
After exercise  



 



Amount outstanding  


 


3 Total number and amount of Outstanding Convertible Loan Stock/Bonds*:
$ ____________ (if more than one issue, give a breakdown)

Outstanding Options: ____________________ shares/stock units*
4 We confirm that the Company Warrants/Convertible Preference Shares* were exercised in compliance with the terms of the Deed Poll dated _____________ .

Name: Authorised Signature:



________________________



_______________
Designation: Date:



_________________



_______________

Enclosures:

(a) A copy of the Return of Allotment (Form 24) (if any) filed with the Registrar of Companies and Businesses.
(b) Confirmation of despatch of Share/Stock Certificates.
(c) Cheque for any additional listing fee, if applicable.
(d) Letter of approval from the Home Exchange granting listing and quotation to the new shares/stock units.

Note: (a) and (b) are not applicable to secondary listing applications.
(d) is not applicable to primary listing applications.

* Delete where applicable.