THE MINISTRY OF JUSTICE

OF

THE REPUBLIC OF FIJI

FORM A77

Sections 418, 419

of the Companies Act 2015

NOTICE OF CANCELLATION OF REGISTRATION AS AN AUDITOR OR LIQUIDATOR

To:

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

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

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 your registration as:

Company/Managed investment scheme name

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

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

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

has been cancelled:

□ following a request by you (section 418)

□ because you have become bankrupt or insolvent (section 419(1)(a))

□ because you have become disqualified from acting as an officer of a company under Part 12 of the

Companies Act 2015 (section 419(1)(b))

□ because you have contravened section 412 of the Companies Act 2015 (section 419(1)(c)).

Issued by The Ministry of Justice on .................................................................................................................. / .................................................................................................................. / ..................................................................................................................

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

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