Schedule A.

(Form of Application for Lease.)

I herewith deposit the sum of twenty pounds as required by the Mining Lease Regulations of Otago, and I agree, if my application (the particulars of which are hereunder set forth) be investigated, that such sum shall in all respects be held subject to the terms of such Regulations, and that upon the approval of this application, I will execute a lease upon the basis therein stated if the Governor shall think fit to grant the same.