MEMORIAL of the name of the General Agent and Attorney in New Zealand of the Phoenix Assurance Company of London, to be filed in the [High Court] of New Zealand pursuant to The Phoenix Assurance Company of London Act 1887: [Here insert name in full, location of head office, &c] AB, General Agent and Attorney for the Colony of New Zealand. I, AB, of &c, do solemnly and sincerely declare that the above memorial contains the name of the present General Agent and Attorney of the above-named company in New Zealand. Declared at , this day of , 18 , before me, CD, A Justice of the Peace for the Colony of New Zealand.