Form No. 46.

In the Matter of "The Native Land Court Act, 1894," and of a survey [or subdivisional survey] of [name of block or subdivision].

I,, Surveyor-General, hereby certify to the Court that the survey above mentioned was made previous to [or was in progress at the time of] the passing of the said Act, and that the same has been completed and the plan thereof, numbered, duly approved; and that the sum of ?, being the reasonable cost [or a portion of the reasonable cost] of such plan and survey, is now due and owing by the Native owners of the said land to such person as the Court shall decide to be entitled thereto