And I make this solemn Declaration conscientiously believing the same

Made and subscribed by the above-named A.B.

Registrar or Justice of the Peace.

Merchant Shipping (Schedule.)

ACCOUNT OF TITLE OF SUBSCRIBING OWNERS.

Names of the several
subscribing Owners.

Nume and Description
of Owner.)

Account of Mortgages or Number of Sixty-fourth Ceruficates of Mongage or Shares held by each of Sale granted in respect the subscribing Owners. of Shares of subscribing Owners.

Aller accordingly if there is only One Appointer or One Allorney.

and C. D. of

(1.) We, the several above-mentioned Persons, whose Names are hereunto subscribed, being Owners of the above Ship in the Proportions set opposite our respective Names in the above Account of Title, (but subject to the several Mortgages above mentioned,) hereby appoint A. B. of and each of them, our Attornies and Attorney jointly or severally in our Names and on our Behalf to mortgage our Shares in the above Ship, and to execute and do all such Deeds, Malters, and Things as may be necessary for carrying into effect the Power hereby given.

(2.) We declare that the Amount of Money to be raised by Mortgage under this Power shall not exceed £ and that the Rate of Interest for every £100 by

at which the same is raised shall not exceed £

the Year.

(3.) We declare that the Power of mortgaging hereby given may be exercised at

(4.) We declare that the above Power shall not be exercised after the Expiration of Months from the Date hereof.

In witness whereof, we have hereunto subscribed our Names and affixed our Seals, this

Day of

(L.S.)
(L.S.)

E.F. of
G.H. of

*If the Mort

N.B.-Mortgages created under this Power must be indorsed on the Cergage is to cover tificate in the following Form, or as near therelo as Circumstances permit :— Advances, in

The

Day of

The within mentioned Shares in the Ship_
Day mortgaged to X. Y. of

*£

Signed

were this
to secure

and Interest.

Registrar or Consular Officer.

Merchant Shipping (Schedule.)

ACCOUNT OF TITLE TO THE ABOVE-MENTIONED SHIP.

Names of the Owners
of the Ship above-
mentioned.

(Name.)

Number of Sixty-fourth
Shares held by each
Owner.

Account of Mortgages, or Certificates of Mortgage, or Sale granted in respect of Ship.

Aller accord

ingly if only One Appointor or One Attor

ney.

(1) We, the several above-mentioned Persons, whose Names are hereunto subscribed, being Owners of the above Ship in the Proportions set opposite our respective Names in the above-mentioned Account of Title, (but subject to the several Mortgages above-mentioned) hereby appoint 4. B. of and C.D. of and each of them, our Attornies and Attorney jointly or severally in our Names and on our Behalf to sell the above Ship, and to execute and do all such Deeds, Matters, and Things as may be necessary for carrying into effect the Power hereby given.

(2.) We declare that the Ship shall not be sold for a less Sum than £

(3.) We declare that the Ship may be sold at

(4.) We declare that the above Power shall not be exercised after the Expiration of Months from the Date hereof.

In witness whereof, we have hereunto subscribed our Names and affixed our Seals, this

(L.S.)
(L.S.)

Day of

E.F. of G.H. of &c.

I, M. N., Registrar of

, hereby certify,

that the above-written Particulars relating to the
Ship
and to the Title of the several
above-mentioned Owners are correct; and I further
certify that the said Owners have executed this
Certificate in manner above appearing.

(Signed,)

Registrar.