The deed of mortgage executed on this________ day of 20__ by____ (Name and address) herein called as the mortgagor in favor of ______(Name) herein called as the mortgagee. The mortgagor transferred by simple mortgage the properties described and mentioned in the above schedule hereto unto the mortgagee by way of security for the repayment of sum of Rs._____ advanced by the mortgagee to the mortgagor subject to the terms and the conditions therein contained.

Dated this on___ day of ___ 20___

Signature

Witnesses

1.