Format Corporation

Statement of Changes in Shareholders' Equity

For the Year Ended December 31, 20CY

Share Capital Accumulated Profits Treasury Shares

Preference Ordinary Reserves Unappropriated Appropriated Total

Balances, January 1, 20CY xxxxx xxxxx xxxxx xxxxx xxxxx (xxxxx) xxxxx

Issuance of _____ shares of P_____ par _____% preference share xxxxx xxxxx xxxxx

Subscribed Preference Share, _____ shares xxxxx xxxxx xxxxx

Subscriptions Receivable - Preference (xxxxx) (xxxxx)

Share Dividend Distributable - Preference, _____ shares xxxxx xxxxx (xxxxx)

Issuance of _____ shares of P_____ par ordinary share xxxxx xxxxx xxxxx

Subscribed Ordinary Share, _____ shares xxxxx xxxxx xxxxx

Subscriptions Receivable - Ordinary xxxxx (xxxxx)

Share Dividend Distributable - Ordinary, _____ shares xxxxx xxxxx (xxxxx)

Sale of donated share xxxxx xxxxx

Net income for the period xxxxx xxxxx

Cash dividends declared and paid:

Cash dividends - Preference (xxxxx) (xxxxx)

Cash dividends - Ordinary (xxxxx) (xxxxx)

Reversal of appropriation for the cost of treasury share xxxxx (xxxxx)

Current appropriations for:

Cost of treasury share (xxxxx) xxxxx

Contingencies (xxxxx) xxxxx

Plant/Building Expansion (xxxxx) xxxxx

Treasury Share: (indicate number of shares bought and sold)

Purchase of _____ shares at P_____ per share (xxxxx) (xxxxx)

Sale (Selling Price of Treasury Share exceeds cost) of _____ shares at P _____ per share xxxxx xxxxx xxxxx
Sale (Cost of Treasury Share exceeds Selling Price; Share Premium from Treasury Share is enough) of
shares at P _____ per share
(xxxxx) xxxxx xxxxx
Sale (Cost of Treasury Share exceeds Selling Price; Share Premium from Treasury Share is not enough) of
_____ shares at P _____ per share (xxxxx) (xxxxx) xxxxx xxxxx
Sale (Cost of Treasury Share exceeds Selling Price; no Share Premium from Treasury Share) of _____
shares at P _____ per share (xxxxx) xxxxx xxxxx

Balances, December 31, 20CY xxxxx xxxxx xxxxx xxxxx xxxxx (xxxxx) xxxxx