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REGISTRAR OF COMPANIES
OF
THE REPUBLIC OF FIJI
FORM A34
of the Companies Act 2015
NOTIFICATION OF STATEMENT OF SPECIAL RIGHTS CARRIED BY SHARES
If there is insufficient space in any section of the form, you may photocopy the relevant page(s) of the form or complete an annexure and submit the relevant page(s) or annexure as part of this lodgement.
Company details
Company name ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
Company number ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
Lodgement details
Who should the Registrar contact if there is a query about this form?
Firm/Organisation ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
Contact name ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
Position description ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
Telephone number (during business hours) ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
E-mail address (optional) ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
Level/Office building ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
Street number and street ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
Town/City ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
Island ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
Documents lodged
Attach this form to each document (including an agreement, consent or resolution) required to be lodged under section 189(1) (c) that does any of the following:
Tick box
□ Attaches rights to issued or unissued shares
□ Varies or cancels rights attaching to issued or unissued shares
□ Varies or cancels rights of members in a class of members of a company that does not have
a share capital or binds a class of members
Effective date .................................................................................................................. / .................................................................................................................. / ..................................................................................................................
Signature
This form must be signed by a current officeholder of the company.
I certify that the information in this form is true and complete and the attached documents marked ( ) are true copies.
Name ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
Capacity
□ Director
□ Company secretary
Signature ......................................................................................................................................................................................................................................................................................................................................................................................................................................................
Date signed .................................................................................................................. / .................................................................................................................. / ..................................................................................................................