Duty Use Only

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30800812A

T3 THE BACK OF THIS FORM MUST NOT BE USED Land Victoria, 570 Bourke Street, Melbourne, 3000, Phone 8636-2010

Transfer of Land By Mortgagee or Annuitant Section 77 Transfer of Land Act 1958

Privacy Collection Statement The information from this form is collected by the Registrar of Titles under statutory authority and is used for the purpose of maintaining publicly searchable registers and indexes.

Lodged by

Name:

Phone:

Address:

Reference:

Customer Code:

The mortgagee or annuitant being the proprietor of the mortgage or charge described in exercise of the power of sale conferred by the Transfer of Land Act 1958 transfers to the transferee the estate and interest of the registered proprietor in the land described for the consideration expressed- - together with any easements created by this transfer; - subject to the subsisting encumbrances specified; and - subject to any easements reserved by this transfer or restrictive covenant contained or covenant created pursuant to statute and included in this transfer.

Land: (volume and folio)

Mortgage or Charge number under which power of sale is excercised:

Consideration:

Mortgagee or Annuitant: (full name)

Transferee: (full name and address including postcode)

Subsisting encumbrances:

The Creation and/or Reservation of Easement and/or Restrictive Covenant set out in the approved Annexure Page A1 (if attached) forms part of this transfer.

Dated:

Execution and attestation: