First Part.—Form of Transfer.

This Deed made the ____ day of ____ one thousand eight hundred and ____ between (the Transferor and his address and description) of the first part (the Transferee and his address and description) of the second part and ____ of ____ of the third part Witnesseth that in consideration of the sum of this day paid to the said (Transferor) by the said (Transferer) the receipt whereof is hereby acknowledged the said (Transferor) doth assign and transfer unto the said (Transferee) shares of or in the capital stock of "The Fidelity and Accident Guaranty Company of New Zealand" numbered To hold under and subject to the covenants conditions and provisions contained in the articles and regulations of the said Company and to the laws and regulations for the time being of the said Company affecting the said shares and the said ____ (Transferee) doth for himself his heirs executors and administrators covenant with the said (Transferor) and also as a separate covenant with the said (as Trustee for and on behalf of the said Company) to perform and observe all and singular the covenants conditions provisions laws and ragulations hereinbefore referred to Witness the hands and seals of the said parties the day and year first before written.