REGISTRAR OF COMPANIES

OF

THE REPUBLIC OF FIJI

FORM A63

Section 374

of the Companies Act 2015

NOTIFICATION OF CHANGE OF DETAILS OF A CHARGE

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 (chargor) 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 ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

A. Charge details

Date the charge was created

Must be the date written in the document creating the charge (eg instrument, resolution).

Date the charge was created .................................................................................................................. / .................................................................................................................. / ..................................................................................................................

OR

Date the property was acquired .................................................................................................................. / .................................................................................................................. / ..................................................................................................................

Charge creation

How was the charge created?

□ By instrument

□ By resolution

□ By deposit

□ By other conduct. Specify below

Brief description

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

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

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

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

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Charge type

□ Fixed

□ Floating

□ Fixed and floating

If the charge is a floating charge or a fixed and floating charge, was the creation of subsequent charges restricted or prohibited before the change?

□ Yes

□ No

Property charged

Briefly describe the property charged before the change:

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

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

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

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

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

B. Details of chargee or trustee if the charge is constituted by the issue of debenture(s)

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

Company number (if incorporated in Fiji) ......................................................................................................................................................................................................................................................................................................................................................................................................................................................

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

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

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

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

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

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

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

C. Liability

Have the terms of the charge been varied with the effect of increasing the amount of the debt or increasing the liabilities (whether present or prospective) secured by the charge?

□ Yes

□ No

If yes, briefly describe the new liability (whether present or prospective) secured by the charge:

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

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

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

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

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

D. Subsequent charges

Have the terms of the charge been varied with the effect of prohibiting or restricting the creation of subsequent charges on the property?

□ Yes

□ No

If yes, briefly describe the changes:

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

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

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

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

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

E. Documents attached

If the variation(s) included on this form have been effected by an instrument, you must attach the signed original instrument or a copy of that instrument.

□ Copy of instrument evidencing the changes to the charge lodged with this form.

Signature

This form must be signed by a current officeholder of the chargor.

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 .................................................................................................................. / .................................................................................................................. / ..................................................................................................................