(1) The statement required by section 69 is to be in the following form (or as near to it as is possible in the circumstances) -

1 Capital of the society -

(a) nominal amount of each share;

(b) number of shares issued;

(c) amount paid up on shares.

2 Liabilities of the society on the relevant date -

(a) on judgments;

(b) on specialty;

(c) on notes or bills;

(d) on simple contract;

(e) on estimated liabilities.

3 Assets of the society on the relevant date -

(a) government securities (stating them);

(b) bills of exchange and promissory notes;

(c) cash at the bankers;

(d) other securities.

(2) "The relevant date" is -