Prepared by me

CONVEYANCER

APPLICATION AND AFFIDAVIT IN TERMS OF REGULATION 53(1)

OF ACT NO. 47 OF 1937

I, the undersigned,

do hereby make oath and say:

1. I am the registered holder of DEED OF TRANSFER NO ;

2. The said DEED OF TRANSFER NO has been lost under circumstances

which are totally unknown to me;

3. The said Deed has not been pledged and is not being detained by anyone as security

for debt or otherwise, but has been actually lost and cannot be found though diligent search

has been made therefor;

4. I hereby apply to the Registrar of Deeds at _________ in terms of Regulation

__________________________ for the issue to me of a copy of the said DEED OF

TRANSFER NO , and I undertake that, if the same should into my possession

 or custody, I shall deliver or transmit it to the said Registrar of Deeds, at

_________________
I certify that the Deponent has acknowledged that he/she knows and understands the contents of

this Affidavit and that it is the truth, which Affidavit was SIGNED AND SWORN to me before at

___________________ on this day of 2014

COMMISSIONER OF OATHS

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Adress

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