S.L. 123.54 Art. 5Exemptions may not be availed of in part. 4 [ Information Documents Description declaration to 1. Address 2. Date 3. Cost 4. Cost of 5. Deemed 6. Value 7. Excess I declare that sign this Signed for and Designation Address Identity Signature Date I declare that Signed by Address Signature Official St

The exemptions granted by this Order may not be availed of in part, and when they have been validly availed of all the parties to the transfer shall be deemed to have accepted the conditions set out in regulation 4 notwithstanding any renunciation or reservation made by any person. S.L.123.54 HOUSES TO SHAREHOLDERS EXEMPTION

SCHEDULE

and Declarations for the purposes of the Income Tax and Duty on and Transfers on Transfers of Dwelling Houses to Shareholders Exemption Order

Part A of the dwelling house and the transfer value information to be supplied and be made and signed by an individual who is an officer of the company duly authorised for this purpose ....................................................................................... when acquired by the company ............................................ at which the property was acquired by the company as recorded in the company’s records ............................................... improvements as recorded in the company’s records ........ transfer value (3 + 4) ...................................................... of consideration payable by the transferee for the transfer... (if any) of the deemed transfer value (as in 5) over the consideration (as in 6) ................................................................. the above information is correct and that I am authorised by the company to declaration. on behalf of the company by (name of officer) ................ .................................... ................................................................................................. document number .................................... ..................................... ...........................................

Part B Declaration by Certified Public Auditor the information given in Part A corresponds to the relevant records of ................................................................ for the financial years ending .............................................. . (name of Certified Public Auditor) ........................................ ................................................................................................. ............................................... ........................................ ......................................................

Part C Declaration to be made and signed by an individual who is an officer of the authorised for the purpose To be made only in the case of an excess to which item 7 of Part A

I declare that the amount of ........................ is being accounted for by the purposes of the Income Tax Act as representing a dividend paid to ....................................... (the transferee) out of its untaxed account and that the company has undertaken with the provisions of article 59(5) and of article 62 and all the other provisions relevant to the payment of a dividend out of its untaxed account.

Signed for and on behalf of the company by (name of officer) ......................................... Signature ................................................... Date .........................................................

Part D Description of shareholding and voting rights in the company Declaration to be made and signed by an individual who is an officer of the authorised for such purpose and by the transferee Name of shareholder Number of Nominal Number of Any shares held value of each votesattached relationship (*) share to each share to transferee

Total share capital (*) Shares of a different class are to be indicated separately

Signed for and on behalf of the company by (name of officer) ................................ Signature ....................................... Name of transferee .............................................................. Address ................................................................................................. Identity document number ..................................................................... Signature ............................................. Date .................................................... S.L.123.54 HOUSES TO SHAREHOLDERS EXEMPTION

Part E Declaration relating to the residence be made and signed by an individual who is an officer of the company duly authorised for such purpose and by the transferee that on 20th November 2000 and up to today ....................... ............................... occupied the dwelling house in question as his/her/their sole ordinary that the said occupier/s is/are related to the transferee as follows: ........................................................................... on behalf of the company by (name of officer): .............................

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

transferee ................................................. ................................................................................................. document number ....................................... ....................................................... .............................

Part F Declaration by Notary Public the declarations in Parts A, B (where applicable), C and D have been signed in that I, Notary, explained to the signatories the purport thereof and of the Tax Dwelling Houses to Shareholders (Income Tax and Duty on Documents and Exemption Order. (name of Notary Public) ............................................................. ........................................................................................................ .............................................. ...................................... ...................................