A statement required to be lodged by a person under section 100 shall be in a form approved by the Commissioner and contain the following information:
(a) the name and address of the person;
(b) the name of the company;
(c) the date on which each relevant capital reduction or rights alteration, or both, occurred;
(d) if the person's entitlement has arisen—
(i) from capital reduction—the total of the unencumbered value, immediately prior to each relevant capital reduction, of the shares the subject of the capital reduction;
(ii) from rights alteration—the total of the unencumbered value, immediately prior to each relevant rights alteration, of the shares the subject of the rights alteration; or
(iii) from capital reduction and rights alteration—the aggregate of the totals under subparagraphs (i) and (ii);
(e) the total consideration paid to the person in relation to all relevant capital reductions or rights alterations, or both;
(f) such other information as may be required by the Commissioner.