Name of scheme:

Period of return:

From:

To:

Balance of unallotted securities under scheme(s) from previous return:

Plus: The amount by which the block scheme(s) has been increased since the date of the last return (if any increase has been applied for):

Less: Number of securities issued/allotted under scheme(s) during period (see LR3.5.7G):

Equals: Balance under scheme(s) not yet issued/allotted at end of period:

Telephone number of contact: