Form of Transfer for Loans on Investing Shares.

I,____of____, in consideration of the sum of £____paid to me by the Trustees of the Mutual Benefit Building and Investment Society of Canterbury (Permanent) as a loan upon shares belonging to me in the said Society, and numbered as at the foot hereof (the receipt of same I hereby acknowledge), do hereby assign and transfer unto the said Trustees the above named shares as security for the repayment of the above amount, together with the interest and fines accruing upon the same, as per memorandum at foot; and I hereby agree that if I should make such default in the payment therein mentioned, that the principal sum, interest, and fines due in respect of the same should at any time amount to the full sum that would otherwise be then payable to me on the withdrawal of such shares from the Society, then the said shares hereby transferred by me shall thereupon become absolutely forefeited to the Society.