And I make this solemn declaration conscientiously believing the same to be true.

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

Registrar, or Justice of the Peace.

ACCOUNT OF TITLE OF SUBSCRIBING OWNERS.

Names of the several
subscribing Owners.

(Name and Description
of Owner.)

Number of Sixty-fourth Shares
held by each of the subscribing
Owners.

Account of Mortgages or Certificates of Mortgage or Sale granted in respect of Shares of subscribing Owners.

Aller accordingly, if there is only one

appointor or one attorney.

(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 C. D. of

and each of them, our attorneys 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, matters, 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 at for every £100 by the

which the same is raised shall not exceed £

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

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 cor-
rect; and I further certify, that the said owners have executed
this certificate in manner above appearing.

N.B.-Mortgages created under this power must be endorsed on the certificate in the following form, or as near thereto as circumstances permit :

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.

Alter accordingly, if only one ap. pointor or one attorney.

(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 A. B. of and C. D. of

and each of them, our attorneys 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

day of

I, M. N., Registrar of

dc.

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.