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Disclaimer: This sample completed form does not necessarily cover all scenarios that are catered for by the form. Gauteng C A 1 2 3 4 5 / 2 0 1 5 SAMPLE #

Disclaimer: This sample completed form does not necessarily cover all scenarios that are catered for by the form. This application will be brought in terms of section 124 (2) (a) of the Insolvency Act SAMPLE 2 0 1 5-0 5-0 1

STAATSKOERANT, 22 MEI 2015 No. 1 Form/Vorm 6 INSOLVENCY ACT AND COMPANIES ACTS NOTICES/ INSOLVENSIEWET- EN MAATSKAPPYKENNISGEWINGS APPLICATION FOR REHABILITATION Pursuant to section 124 of the Insolvency Act, 1936, notice is hereby given that the insolvents mentioned below will apply for his or her rehabilitation on the dates, at the times and places and upon the grounds as therein set forth opposite his or her name. The particulars are given in the following order: (1) number of estate; (2) full name and description of insolvent (including his date of birth and identity number) and place of business or residence; (3) date when estate sequestrated, and address, occupation or status of insolvent at the time of that date; (4) division of Supreme Court to which and date and time on which application will be made; (5) ground of application. AANSOEK OM REHABILITASIE Ingevolge artikel 124 van die Insolvensiewet, 1936, word hierby kennis gegee dat die insolvente persone hieronder genoem om sy of haar rehabilitasie aansoek sal doen op die datums, tye en plekke en om die redes wat daarin teenoor sy of haar onderskeie name aangedui is. Die besonderhede word verstrek in die volgorde: (1) nommer van boedel; (2) volle naam en beskrywing van insolvent (met inbegrip van sy/haar geboortedatum en identiteitsnommer) en plek van besigheid of woonplek; (3) datum waarop boedel gesekwestreer is, en woonadres, betrekking of status van insolvent ten tye van daardie datum; (4) afdeling van Hooggeregshof waarby en datum en tyd wanneer aansoek gedoen sal word; (5) rede van aansoek. CA12345/2015 (2) Doe, John, 23 February 1972, 7202237602081, Data Capturer, 45 Wind Street, Allenhof, Midrand, 123 Jesse Avenue, Totalview, Midrand, Married. Doe, Jane, 5 October 1981, 8110056481184, Call Centre Agent, 102 Water Street, Midrand, 123 Jesse Avenue, Totalview, Midrand; (3) 24 February 2009, 30 October 2009, 123 Jesse Avenue, Totalview, Midrand, Data Capturer; (4) High Court of South Africa, Pretoria, 8 June 2015, 11:00; (5) This application will be brought in terms of section 124 (2) (a) of the Insolvency Act. This gazette is also available free online at www.gpwonline.co.za

RESTRICTED 1. Form Completion Rules Government Printing Works has implemented rules for completing and submitting the electronic Adobe Forms when you, the customer, submits your notice request. Please take note of these guidelines when completing your form. No. Rule Description Explanation/example 1. All forms must be completed in the chosen language. 2. All forms must be completed in sentence case, i.e. No fields should be completed in all uppercase 3. No single line text fields should end with any punctuation, unless the last word is an abbreviation 4. Multi line fields should not have additional hard returns at the end of lines or the field itself 5. Grid fields (Used for dates, ID Numbers, Telephone No., etc.) 6. Copy/Paste from other documents/text editors into the text blocks on forms. GPW does not take responsibility for translation of notice content e.g. The company is called XYZ Production Works e.g. Pty Ltd., e.g. Do not end an address field, company name, etc. with a period (.) comma (,) etc. This causes unwanted line breaks in the final output, e.g. Do not type as: 43 Bloubokrand Street Putsonderwater 1923 Text should be entered as: 43 Bloubokrand Street, Putsonderwater, 1923 Date fields are verified against format CCYY- MM-DD Time fields are verified against format HH:MM Telephone/Fax Numbers are not verified and allow for any of the following formats limited to 13 characters: including brackets, hyphens, and spaces o 0123679089 o (012) 3679089 o (012)367-9089 Avoid using this option as it carries the original formatting, i.e. font type, size, line spacing, etc. Do not include company letterheads, logos, headers, footers, etc. in text block fields.

RESTRICTED No. Rule Description Explanation/example 7. Rich text fields (fields that allow for text Font type should remain as Arial formatting) Font size should remain unchanged at 9pt Line spacing should remain at the default of 1.0 The following formatting is allowed: o Bold o Italic o Underline o Superscript o Subscript Do not use tabs and bullets, or repeated spaces in lieu of tabs and indents Text justification is allowed: o Left o Right o Center o Full Do not use additional hard or soft returns at the end of line/paragraphs. The paragraph breaks are automatically applied by the output software o Allow the text to wrap automatically to the next line only use single hard return to indicate the next paragraph o Numbered lists are allowed, but no special formatting is applied. It maintains the standard paragraph styling of the gazette, i.e. first line is indented. e.g. 1. The quick brown fox jumps over the lazy river. The quick brown fox jumps over the lazy river. The quick brown fox jumps over the lazy river. 2. The quick brown fox jumps over the lazy river. The quick brown fox jumps over the lazy river. The quick brown fox jumps over the lazy river. Disclaimer: GPW does not accept responsibility for notice requests submitted through the discontinued channels as well as for the quality and accuracy of information, or incorrectly captured information and will not amend information supplied.