Document:

The Alkaline Water Company Inc. - Exhibit 10.3 - Filed by newsfilecorp.com

NON-NEGOTIABLE 
PROMISSORY NOTE 

	$750,000.00 	January 25, 2016 
	  	Scottsdale, AZ 

      
     For value received THE
ALKALINE WATER COMPANY INC.,
a Nevada Corporation (the “Payor”) promises to pay to
TURNSTONE CAPITAL INC. (the
“Holder”) the principal sum of $750,000.00 together with simple
interest on the outstanding principal amount at the rate of fifteen percent
(15%) per annum. Interest shall commence on the date that this Note is issued
(the “Effective Date”) by the Holder to the Payor and shall continue on
the full outstanding principal until paid in full. Interest shall be computed on
the basis of a year of three hundred sixty-five (365) days for the actual number
of days elapsed.

            1.       
Term. Unless otherwise converted as set forth below, all
outstanding principal and interest shall be due and payable on or before March
31, 2016 or such date as is mutually agreed upon by the Payor and the Holder.

            2.       
Payments. All payments of interest and advanced principal shall
be in lawful money of the United States of America.

            3.       
Prepayment. The Payor may prepay this Note, in full or in part,
at any time, without penalty.

            4.       
Restrictions on Transfer. The Holder shall not sell, transfer,
pledge, negotiate or otherwise dispose of this Note. 

            5.       
Default. If there shall be any Event of Default (as defined
below) hereunder, at the option and upon the declaration of the Holder and upon
written notice to the Payor (which election and notice shall not be required in
the case of an Event of Default under Section 5.2 or 5.3 below), this Note shall
accelerate and all principal and unpaid accrued interest shall become due,
payable and collectible. The occurrence of any one or more of the following
shall constitute an “Event of Default” hereunder: 

                      
5.1       
the Payor fails to pay timely any of the principal amount due under
this Note on the date the same becomes due and payable or any accrued interest
or other amounts due under this Note on the date the same becomes due; 

                      
5.2        the Payor files
any petition or action for relief under any bankruptcy, reorganization,
insolvency or moratorium law or any other law for the relief of, or relating to,
debtors, now or hereafter in effect, or makes any assignment for the benefit of
creditors or takes any corporate action in furtherance of any of the foregoing;
or 

                       
5.3       
an involuntary petition is filed against the Payor (unless such
petition is dismissed or discharged within sixty (60) days) under any bankruptcy
statute now or hereafter in effect, or a custodian, receiver, trustee, assignee for the
benefit of creditors (or other similar official) is appointed to take
possession, custody or control of any property of the Payor. 

1 

            6.       
Attorneys’ Fees. In any litigation or other proceeding in
connection with the interpretation of this Note, or the exercise or enforcement
of any right under this Note, the non-prevailing party shall pay or reimburse
the prevailing party for all expenses, including court costs and attorneys’
fees, incurred by the prevailing party in connection with such litigation or
proceeding (whether incurred at the trial, appellate, or administrative levels,
and in any bankruptcy case, arbitration or other proceeding), all of which may
be incorporated into and be a part of any judgment or decision rendered in such
proceeding. 

            7.       
Waiver of Notice. The Payor hereby waives demand, notice,
presentment, protest and notice of dishonor. 

            8.       
Governing Law. This Note shall be governed by construed under
the laws of the State of Nevada, without giving effect to conflicts of laws
principles. 

            9.       
Lost, Stolen, Destroyed or Mutilated Note. In case this Note
shall be mutilated, lost, stolen or destroyed, the Payor shall issue a new Note
of like date, tenor and denomination and deliver the same in exchange and
substitution for and upon surrender and cancellation of any mutilated Note, or
in lieu of any Note lost, stolen or destroyed, upon receipt of evidence
satisfactory to the Payor of the loss, theft or destruction of such Note. 

[THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK] 

2 

            10.      Amendment;
Waiver. Any term of this Note may be amended and the observance of any
term of this Note may be waived (either generally or in a particular instance
and either retroactively or prospectively), only with the written consent of the
Payor and the Holder. 

	 	THE ALKALINE WATER COMPANY INC. A
      Nevada corporation 
	 	 
	 	By: /s/Richard A.
      Wright                                                    
       
	 	 
	 	Name: Richard A.
      Wright                                                     
      
	 	 
	 	Title:Vice-President, Secretary, Treasurer
      and Director   

	AGREED TO AND ACCEPTED: 	 
	 	 
	TURNSTONE CAPITAL INC. 	 
	 	 
	By:/s/Yenny
      Martinez                                                       
       	 
	 	 
	Name: Yenny
      Martinez                                                     
       	 
	 	 
	Title:
      Director                                                                     
       	 

3The Alkaline Water Company Inc. - Exhibit 10.4 - Filed by newsfilecorp.com

ESCROW AGREEMENT 

THIS AGREEMENT made as of the 25th day of January, 2016. 

BETWEEN: 

TURNSTONE CAPITAL INC., having
an address at 25 Mason Complex, Stoney Ground, PO Box 193, Stoney Ground The
Valley, British Anguilla 

(the “Lender”) 

AND: 

CLARK WILSON LLP, having an
address at Suite 900 – 885 Georgia Street W., Vancouver, British Columbia V6C
3H1, Canada 

(the “Escrow Agent”) 

AND: 

THE ALKALINE WATER COMPANY
INC., having an address at 7730 E. Greenway Road, Suite 203, Scottsdale,
Arizona 85260, U.S.A. 

(the “Company”) 

WHEREAS: 

A.                   
Pursuant to the terms and conditions of a Loan Agreement of even date herewith
between the Company and the Lender (the ”Loan Agreement”) and the terms
and conditions of this Agreement, the Company has agreed to issue 1.5 million
shares of common stock in the capital of the Company (the “Shares”) to
the Lender; and 

B.                   
The Lender and the Company wish to appoint the Escrow Agent to accept, hold and
release the Shares pursuant to the terms of this Agreement. 

NOW THEREFORE THIS AGREEMENT WITNESSES that for and in
consideration of the terms and conditions set out herein and other good and
valuable consideration, the receipt and sufficiency of which is hereby
acknowledged, the parties agree as follows: 

1.                   
DEPOSIT INTO ESCROW 

1.1                 
The Company will, upon the closing of the Loan Agreement, deliver one (1) share
certificate representing the Shares (the “Certificate”) and a
cancellation resolution (the “Cancellation Resolution”) to effect the
cancellation of the Shares, substantially in the form set out in Schedule A,
to the Escrow Agent. 

1.2                 
The Lender will, upon the closing of the Loan Agreement, deliver a duly executed
and medallion guaranteed stock power of attorney (the “Stock Power”) to
effect the cancellation of the Shares, substantially in the form set out in
Schedule B, to the Escrow Agent. 

- 2 - 

1.3                 
The Escrow Agent will hold the Certificate, the Cancellation Resolution, and the
Stock Power (collectively, the “Stock Cancellation Documents”) in escrow
subject to the terms and conditions of this Agreement. 

1.4                 
The Company and the Lender hereby appoint the Escrow Agent as the agent for and
on behalf of the Company and the Lender in respect of the Stock Cancellation
Documents, on the terms and subject to the conditions set forth in this
Agreement. 

2.                  
 ESCROW PROVISIONS 

2.1                 
The Lender and the Company hereby direct the Escrow Agent to retain the Stock
Cancellation Documents and not to cause anything to be done to release the same
from escrow except in accordance with this Agreement. 

2.2                 
In the event that there is any Event of Default (as defined in the promissory
note issued pursuant to the Loan Agreement) that is not cured in accordance with
the Loan Agreement, the Lender will deliver a written notice to the Company and
the Escrow Agent acknowledging such event, and if the Company does not object
within five (5) business days, the Escrow Agent will deliver the Certificate and
Stock Power to the Lender. 

2.3                 
In the event that the Company repays the loan pursuant to the Loan Agreement and
there is no Event of Default that is not cured in accordance with the Loan
Agreement at the time of repayment, the Company will deliver a written notice to
the Lender and the Escrow Agent acknowledging such event, and if the Lender does
not object within five (5) business days, the Escrow Agent will deliver the
Stock Cancellation Documents to the transfer agent of the Company (the
“Transfer Agent”) and request the Transfer Agent to cancel the Shares.

2.4                 
If either of the Company or the Lender objects to the deliveries contemplated in
Section 2.2 or 2.3, then the Escrow Agent will continue to retain the Stock
Cancellation Documents until such objection is resolved between the Lender and
the Company. Notwithstanding this Section 2.4, the Escrow Argent will still be
able to deliver and interplead the Stock Cancellation Documents in accordance
with Section 4.12 of this Agreement. 

2.5                 
The Escrow Agent is authorized by each of the Company and the Lender to make the
deliveries required by this Section 2. 

2.6                 
In the event the Escrow Agent has not received any written notices pursuant to
this Section 2 by the end of the fourth (4th) month (or such other longer time
as is determined by the Company in its sole discretion) from the date hereof,
the Escrow Agent will deliver the Stock Cancellation Documents to the Transfer
Agent and request the Transfer Agent to cancel the Shares. 

3.                  
 INDEPENDENT LEGAL ADVICE 

3.1                 
With respect to the preparation of this Agreement and the rights and obligations
herein, each of the Lender and Company acknowledge that each has been advised to
seek independent legal advice with respect to this Agreement and the documents
delivered pursuant hereto and that Clark Wilson LLP is not protecting the rights
and interests of any party to this Agreement. 

- 3 - 

4.                   
ESCROW AGENT 

4.1                 
In exercising the rights, duties and obligations prescribed or confirmed by this
Agreement, the Escrow Agent will act honestly and in good faith and will
exercise that degree of care, diligence and skill that a reasonably prudent
person would exercise in comparable circumstances. 

4.2                 
The Company and the Lender agree from time to time and at all times hereafter to
save, defend, hold harmless and fully indemnify the Escrow Agent, its successors
and assigns from and against all loss, costs, charges, suits, demands, claims,
damages and expenses which the Escrow Agent, its successors or assigns may at
any time or times hereafter bear, sustain, suffer or be put unto for or by
reason or on account of its acting pursuant to this Agreement or anything in any
manner relating thereto or by reason of the Escrow Agent’s compliance in good
faith with the terms hereof. 

4.3                 
In case proceedings should hereafter be taken in any court respecting the Stock
Cancellation Documents, the Escrow Agent will not be obliged to defend any such
action or submit its rights to the court until it has been indemnified by other
good and sufficient security in addition to the indemnity given in Section 4.2
against its costs of such proceedings. 

4.4                 
The Escrow Agent will have no responsibility in respect of loss of the Stock
Cancellation Documents except the duty to exercise such care in the safekeeping
thereof as it would exercise if the Stock Cancellation Documents belonged to the
Escrow Agent. The Escrow Agent may act on the advice of counsel but will not be
responsible for acting or failing to act on the advice of counsel. 

4.5                 
The Escrow Agent will not be bound in any way by any contract between the other
parties hereto whether or not it has notice thereof or of its terms and
conditions and the only duty, liability and responsibility of the Escrow Agent
will be to hold the Stock Cancellation Documents as herein directed and to
deliver the same to such persons and to comply with other such conditions as are
herein set forth. The Escrow Agent will not be required to pass upon the
sufficiency of any of the written notices pursuant to Section 2 or the Stock
Cancellation Documents to ascertain whether or not the person or persons who
have executed, signed or otherwise issued or authenticated the said documents
have authority to so execute, sign or otherwise authorize, issue or authenticate
the said documents or any of them, or that they are the same persons named
therein or otherwise to pass upon any requirement of such instruments that may
be essential for their validity, but it shall be sufficient for all purposes
under this Agreement insofar as the Escrow Agent is concerned that the said
documents are deposited with the Escrow Agent as specified in this Agreement.

4.6                 
In the event that the Stock Cancellation Documents are attached, garnished or
levied upon under any court order, or if the delivery of the Stock Cancellation
Documents is stayed or enjoined by any court order or if any court order,
judgment or decree is made or entered affecting the Stock Cancellation Documents
or affecting any act by the Escrow Agent, the Escrow Agent may, in its sole
discretion, obey and comply with all writs, orders, judgments or decrees so
entered or issued, whether with or without jurisdiction, notwithstanding any
provision of this Agreement to the contrary. If the Escrow Agent obeys and
complies with any such writs, orders, judgments or decrees, it will not be
liable to any of the parties hereto or to any other person, firm, corporation or
other entity by reason of such compliance, notwithstanding that such writs,
orders, judgments or decrees may be subsequently reversed, modified, annulled,
set aside or vacated. 

4.7                 
Except as herein otherwise provided, the Escrow Agent is authorized and directed
to disregard, in its sole discretion, any and all notices and warnings which may
be given to it by any of the parties hereto or by any other person, firm, association or
corporation. It will, however, at its sole discretion, obey the order, judgment
or decree of any court of competent jurisdiction, and it is hereby authorized to
comply with and obey such orders, judgments or decrees and, in case of such
compliance, it shall not be liable by reason thereof to any of the parties
hereto or to any other person, firm, association, corporation or other entity,
even if thereafter any such order, judgment or decree may be reversed, modified,
annulled, set aside or vacated. 

- 4 - 

4.8                 
If the Escrow Agent receives any valid court order contrary to the instructions
contained in this Agreement, the Escrow Agent may continue to hold the Stock
Cancellation Documents until the lawful determination of the issue between the
parties hereto. 

4.9                 
If written notice of protest is made by either of the Company and/or the Lender
to the Escrow Agent to any action contemplated by the Escrow Agent under this
Agreement, and such notice sets out reasons for such protest, the Escrow Agent
may, at its sole discretion, continue to hold the Stock Cancellation Documents
until the right to the Stock Cancellation Documents is legally determined by a
court of competent jurisdiction or otherwise. 

4.10                The
Escrow Agent may resign as Escrow Agent by giving not less than five (5) days’
notice thereof to the Company and the Lender. The Company may terminate the
Escrow Agent by giving not less than five (5) days’ notice to the Escrow Agent.
The resignation or termination of the Escrow Agent will be effective and the
Escrow Agent will cease to be bound by this Agreement on the date that is five
(5) days after the date of receipt of the termination notice given hereunder or
on such other date as the Escrow Agent and/or the Company may agree upon. All
indemnities granted to the Escrow Agent herein will survive the termination of
this Agreement or the termination or resignation of the Escrow Agent. In the
event of termination or resignation of the Escrow Agent for any reason, the
Escrow Agent shall, within that five (5) days’ notice period, deliver the Stock
Cancellation Documents to the new escrow agent to be named by the Company. 

4.11                Notwithstanding
anything herein to the contrary, the Escrow Agent may act upon any written
instructions given jointly by the Company and the Lender. 

4.12                Notwithstanding
anything herein to the contrary, in the event of any dispute arising between
either of the Company and/or the Lender pertaining to this Agreement or any
matters arising pursuant hereto, the Escrow Agent may, in its sole discretion,
deliver and interplead the Stock Cancellation Documents into court and such
delivery and interpleading will be an effective discharge to the Escrow Agent.

5.                  
 FEES 

5.1                 
The Company will pay all of the compensation of the Escrow Agent and will
reimburse the Escrow Agent for any and all reasonable expenses, disbursements
and advances made by the Escrow Agent in the performance of its duties
hereunder, including reasonable fees, expenses and disbursements incurred by its
counsel. 

6.                  
 GENERAL 

6.1                 
Except as otherwise provided in this Agreement, no alteration, amendment, change
or addition to this Agreement will be binding upon the parties hereto unless
reduced to writing and signed by the parties. 

- 5 - 

6.2                 
This Agreement will enure to the benefit of and be binding upon the parties and
their respective heirs, executors, administrators and successors. 

6.3                 
The parties will execute and deliver all such further documents, do or cause to
be done all such further acts and things, and give all such further assurances
as may be necessary to give full effect to the provisions and intent of this
Agreement. 

6.4                 
This Agreement will be governed by and construed in accordance with the laws of
the Province of British Columbia and the federal laws of Canada applicable
therein, and the parties acknowledge that the courts of the Province of British
Columbia shall have exclusive jurisdiction with respect to any matter arising
under or related to this Agreement and the parties to this Agreement hereby
irrevocably attorn and submit to such jurisdiction. 

6.5                 
Any notice required or permitted to be given under this Agreement will be in
writing and may be given by delivering, sending by electronic facsimile
transmission or other means of electronic communication capable of producing a
printed copy, or sending by prepaid registered mail, the notice to the following
address:

                
To the Company 

7730 E. Greenway Road, Suite 203

Scottsdale, Arizona 85260 

Attention:                 
Richard A. Wright, Vice-President,
Secretary, 
                                    Treasurer
and director

Email:                        
Ricky@wtfcpa.com 

To the Lender: 

Turnstone Capital Inc. 
25 Mason
Complex, Stoney Ground 
PO Box 193 
Stoney Ground The Valley, British
Anguilla 
Email: <> 

To the Escrow Agent: 

Clark Wilson LLP 
900 – 885 West
Georgia Street 
Vancouver, British Columbia 
Canada V6C 3H1 

Attention:                 
Virgil Z. Hlus

Email:                        
VHlus@cwilson.com

Facsimile:                 
(604) 687-6314 

(or to such other address as any party may specify by notice in
writing to another party). Any notice delivered or sent by electronic facsimile
transmission or other means of electronic communication capable of producing a
printed copy on a business day will be deemed conclusively to have been
effectively given on the day the notice was delivered, or the electronic
communication was successfully transmitted, as the case may be. Any notice sent by prepaid registered mail will be
deemed conclusively to have been effectively given on the third business day
after posting; but if at the time of posting or between the time of posting and
the third business day thereafter there is a strike, lockout, or other labour
disturbance affecting postal service, then the notice will not be effectively
given until actually delivered. 

- 6 - 

6.6                 
Time is of the essence of this Agreement. 

6.7                 
It is understood and agreed by the parties to this Agreement that the only
duties and obligations of the Escrow Agent are those specifically stated herein
and no other. 

6.8                 
The parties expressly acknowledge that any previous agreement entered into by
them will terminate and have no further force or effect upon the execution and
delivery of this Agreement by all parties hereto. 

6.9                 
This Agreement may be executed in one or more counterparts, all of which will be
considered one and the same agreement and will become effective when one or more
counterparts have been signed by each of the parties and delivered to the other
parties, it being understood that all parties need not sign the same
counterpart. This Agreement may be executed by delivery of executed signature
pages by fax and such fax execution will be effective for all purposes. 

[THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK] 

- 7 - 

IN WITNESS WHEREOF the parties have caused this Escrow
Agreement to be executed as of the day and year first written above. 

CLARK WILSON LLP 

Per:    /s/
Signed                                               

          Authorized
Signatory 

 

TURNSTONE CAPITAL INC. 

 

Per: /s/ Yenny
Martinez                                   

Director 

 

THE ALKALINE WATER COMPANY INC. 

 

Per: /s/ Richard A.
Wright                                                       

Richard A. Wright, Vice-President, Secretary, Treasurer and Director

- 8 - 

SCHEDULE A 

FORM OF CANCELLATION RESOLUTION 

CANCELLATION RESOLUTION

CORPORATE RESOLUTION AUTHORIZING RETIREMENT/OUTRIGHT

CANCELLATION WITHOUT REISSUANCE OF THE
ATTACHED
CERTIFICATES

THE ALKALINE WATER COMPANY INC. 

	 	COMMON STOCK	 
	 	CLASS OF STOCK 	 

RESOLVED, THAT ISLAND STOCK TRANSFER STOCK, TRANSFER AGENT
FOR THE ABOVE CLASS OF STOCK FOR THE ABOVE COMPANY, IS AUTHORIZED BY THE COMPANY
TO CANCEL ALL CERTIFICATE(S) LISTED BELOW, WHICH ARE PRESENTED TO THE STOCK
TRANSFER AGENT FOR OUTRIGHT CANCELLATION, AND DECREASE THE OUTSTANDING SHARES ON
THE BOOKS OF THE COMPANY.

ORIGINAL CERTIFICATE(S) PRESENTED FOR CANCELLATION (PLEASE
TYPE) 

	Registered 	Certificate 	Number 	Cancellation 	Restricted or 
	Name 	Number 	Of Shares 	Date 	Free Trading 
	. 	  	  	  	  

	DECREASING THE NUMBER OF SHARES OUTSTANDING BY 
      _______________________  SHARES. 
	 
	
      (NOTE – THIS RESOLUTION IS ONLY
      USED TO DECREASE THE CONTROL BOOK, NOT
      FOR A CORPORATE STOCK TRANSFER).
      

	
       

	
      I, THE UNDERSIGNED, QUALIFIED OFFICER OF THE ABOVE
      NAMED COMPANY, DO HEREBY INDEMNIFY ISLAND STOCK TRANSFER AND THEIR
      EMPLOYEES AGAINST ANY AND ALL ACTIONS TAKEN BY THE ABOVE COMPANY,
      AND CERTIFY THAT THIS IS A TRUE COPY OF A RESOLUTION, SET FORTH AND
      ADOPTED ON THE BELOW DATE, AND THAT THE SAID RESOLUTION HAS NOT
      BEEN IN ANY WAY RESCINDED, ANNULLED OR REVOKED BUT THE SAME IS
      STILL IN FULL FORCE AND EFFECT. 

	X  /s/ Ricky
      Wright        
      	 	Ricky Wright	 
	OFFICER’S SIGNATURE 	 	OFFICER’S NAME PRINTED
      	 
	 	 	 	 
	Vice President 		January 25, 2016 	 
	TITLE OF OFFICER 	 	DATE 	 
	 	 	 	 
	 	 	 	 
	TELEPHONE NUMBER 	 	FACSIMILE NUMBER 	 

NOTE 

NOTE-ALL CERTIFICATE(S) LISTED ABOVE FOR OUTRIGHT
CANCELLATION MUST BE PRESENTED TO ISLAND STOCK TRANSFER
PRIOR TO THE EXECUTION OF THIS RESOLUTION. 

- 9 - 

NOTE-IF ANY CERTIFICATE(S) IS (ARE) NOT IN THE
POSSESSION/CONTROL OF THE COMPANY AND THE COMPANY WISHES TO STOP THE TRANSFER OF
THE CERTIFICATE(S), PLEASE HAVE AN OFFICER COMPLETE A STOP TRANSFER RESOLUTION,
NOT A CANCELLATION RESOLUTION. 

NOTE-THIS RESOLUTION WILL NOT TAKE THE PLACE OF A STOP
TRANSFER RESOLUTION, IF YOU WISH TO PLACE A STOP ON A CERTIFICATE PLEASE
COMPLETE A STOP TRANSFER RESOLUTION. 

	- 10 - 
	  
	SCHEDULE B 
	  
	FORM OF STOCK POWER OF ATTORNEY 
	  
	All certificates to be transferred must be enclosed
      with this stock power 
	
      The signature to this assignment must correspond with the
      name as written upon the face of the certificate in every particular
      without alteration or enlargement or any change whatsoever. The signature
      of the person executing this power must be guaranteed by an eligible
      Guarantor Institution such as a Commercial Bank, Trust Company, Securities
      Broker/Dealer, Credit Union, or Savings Association participating in a
      Medallion Program approved by the Securities Transfer Association, Inc. No
      other form of signature guarantee is acceptable. 

STOCK POWER 

For value received I/we hereby sell, assign and transfer unto

	The Alkaline
      Water Company Inc. 
	       (Print or Type Name)    
	  
	7730 E Greenway
      Road, Suite 203, Scottsdale, AZ 
	       (Address of
      Transferee) 

SS# or Tax ID
99-0367049_________________________________ 

	<>[Number of Shares] ______________shares of .    	The Alkaline Water Company Inc
		(Name of Company) 
	Represented by certificate number(s)___ 	<>[Certificate Number]
      ________________________________ .

The undersigned does (do) hereby irrevocably constitute and
appoint Island Stock Transfer to transfer the said stock on the books of said
company with full power of substitution in the premises. 

(Must check one) Note: If any cost basis
information below is not completed the issuer will be notified and given two
weeks to provide the data. If the data is not provided at the end of the
two weeks, the request will not be processed and will be rejected back to the
issuer.

	Original Cost $[Amount] 	Original Issuance/Purchase
      Date__<>[Date of Issue] 
	 	 
	Current Cost for this transaction
      $0                    
       	 

Gift____ Purchase/Sell__X__ (Includes
both Private and Public Purchases) Compensation _____ (Includes payment for
services) 

 

Date January 25, 2016

 

	/s/ Turnstone
      Capital Inc. 	 
	(Signature of Registered Holder completing the stock power)    	 
	 	 
	Turnstone
      Capital Inc. 	 
	(Print Name of Registered Holder) 	 
	 	 
	 	 
	(Signature of Joint Registered Holder completing the stock
      power) 	 
	 	 
	 	 
	(Print Name of Joint Registered Holder)

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