Application for Advance.

To the Manager of the Permanent Equitable Building and Investment Society of Wellington.

Sir,—I propose to borrow from your Society the sum of________ being the value of________ Shares in the Society, on the following security, viz.;—

Nature or Description of Security.

(If town acre, state number and street, frontage and depth of land; or if country land, state number of acres, number of section, and district.)

What does the property consist of? __________

Nature of Buildings, if any? __________

Situation? __________

Tenure? __________

If leasehold, the amount of ground rent per annum __________

When, and to whom payable? __________

Is the property subject to a prior mortgage? __________

Time for which advance is required ________________________________

Interest, when payable_____________________

If insured __________

Amount __________

In what Office __________

Valuation Survey Fee_____________

And I offer, on demand, to execute a mortgage of the above property to the Society, in accordance with the Rules of the Society, and if from any cause I fail to complete the transaction, I undertake, on demand, to pay you the reasonable costs of investigating the Title and preparing the necessary Mortgage Deed, in accordance with the said Rules.