National Mortgage Form (v1.5) - National Land Registry Forms

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Lodger Details

Lodger Code

Name

Address

Lodger Box

Phone

Reference

Mortgage

Privacy collection Statement

The information in this form is collected under statutory authority and used for the purpose of maintaining publicly searchable registers and indexes.

Estate and/or interest being mortgaged

Land

Land Title Reference Part Land Affected? Land Description

Mortgagor

Mortgagor 1 Individual Corporation Other Organisation Given Name(s) Family Name Name ACN ARBN Name differs to Folio? Name on Title Reason for Difference Australian Address Postal Delivery Address Overseas Address Property Name Floor Type Number Suffix Unit Type Number To Street Number To Name Type Locality State Postcode Delivery Type Number Locality State Postcode Address Capacity Who will be signing Power of Attorney Reg'd Dealing Num. Power Of Attorney Date Multi-person Company: Director & Director or Director & Secretary sign Multi-person Company: One Director only signs Sole Person Company: Sole Director / Secretary signs Sole Person Company: Sole Director signs Authorised Officer Number of signatories required Signer 1 Signer Name Signer Organisation Signer Role Signer 2 Signer Name Signer Organisation Signer Role Signer 3 Signer Name Signer Organisation Signer Role Signer 4 SignerName4 Signer Organisation Signer Role Signer 5 Signer Name Signer Organisation Signer Role

Mortgagee

Mortgagee 1 Individual Corporation Other Organisation Given Name(s) Family Name Name ACN ARBN Australian Credit Licence Australian Address Postal Delivery Address Overseas Address Property Name Floor Type Number Suffix Unit Type Number To Street Number To Name Type Locality State Postcode Delivery Type Number Locality State Postcode Address Capacity Tenancy (inc. share) Who will be signing Power of Attorney Reg'd Dealing Num. Power Of Attorney Date Multi-person Company: Director & Director or Director & Secretary sign Multi-person Company: One Director only signs Sole Person Company: Sole Director / Secretary signs Sole Person Company: Sole Director signs Authorised Officer Number of signatories required Signer 1 Signer Name Signer Organisation Signer Role Signer 2 Signer Name Signer Organisation Signer Role Signer 3 Signer Name Signer Organisation Signer Role Signer 4 SignerName4 Signer Organisation Signer Role Signer 5 Signer Name Signer Organisation Signer Role

Terms and Conditions of this Mortgage

The mortgagor mortgages the estate and/or interest in land specified in this mortgage to the mortgagee as security for the debt or liability described in the terms and conditions set out or referred to in this mortgage, and covenants with the mortgagee to comply with those terms and conditions.

(a) Document Reference

(b) Additional terms and conditions

National Mortgage Form (v1.5) [Website Revision 13]