THE RESERVE BANK OF FIJI

FORM B7

Section 275

of the Companies Act 2015

NOTICE OF CANCELLATION, SUSPENSION OR RESTRICTION OF SECURITIES INDUSTRY LICENCE

To:

Surname ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

First name(s) ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

OR

Company number (if applicable) ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Company name ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Country of incorporation (if not Fiji) ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Level/Office building ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Street number and street ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Town/City ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Island/State/Territory ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Postcode ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Country (if not Fiji) ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Details of notice

This is a notice that the (type of licence) which is a securities industry licence, licence number (number), granted to the following person under the Companies Act 2015:

Surname ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

First name(s) ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Former name ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

OR

Company name ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Company number (if applicable) ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Country of incorporation (if not Fiji) ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

has been:

□ cancelled

□ suspended under the Companies Act 2015 from the date of this notice until .................................................................................................................. / .................................................................................................................. / ..................................................................................................................

□ restricted as follows:

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......................................................................................................................................................................................................................................................................................................................................................................................................................................................

......................................................................................................................................................................................................................................................................................................................................................................................................................................................

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and/or the person has been directed to:

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Issued by the Reserve Bank of Fiji on ......................... ......................... / ......................... ......................... / ......................... ......................... ......................... .........................

Name ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Position ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

Signature ......................................................................................................................................................................................................................................................................................................................................................................................................................................................