Mortgaged property: ______________________________________
Mortgagor(s): _____________________________________
Borrower(s): _________________________________

I _________________________________________ Solicitor of mortgagor of _________________ hereby acknowledge that I have this day received from _________________________ [mortgagee solicitor’s].All the document of title relating to the schedule hereto which relate to mortgage to the said by a mortgage date __________________ which mortgage has been this day paid off by me.

The schedule above referred
to:__________________________________________________________________________[list of the document].

Signature: ________

Dated :