SCHEDULE A

FORM D

Prepared by me

.........................................................

(Signature)

CONVEYANCER

.........................................................

(State surname and initials in block letters.)

COLLATERAL MORTGAGE BOND NO CMB .................................

WHEREAS:

.....................................................................................................................................................

appeared before me, ..................................................……………………………………………………………………… the official designated by the Director-General: Minerals and Energy and the said appearer, duly authorized thereto by a power of attorney which power of attorney was signed  at …………………......................................….  on the …………………… day of .............................. 20 ….....  and is filed in this office.

AND the said appearer declared that

WHEREAS his or her principal, the said …................................................................., is truly and lawfully indebted to ....................................... (hereinafter called the mortgagee)  in the sum of R. ......................... arising from and being .............................................. (here describe the clause of debt of the principal bond) as security for which indebtedness a mortgage bond (hereinafter called the principal bond) was registered in the Deeds Registry / Mineral and Petroleum Registration Office at ……………………………………......on the  ……………………………………………. over the property thereby specially hypothecated.

AND WHEREAS the mortgagee requires the indebtedness of the appearer's principal under the principal bond to be further secured by the hypothecation of the undermentioned

right as collateral security therefor.

NOW therefore the appearer renouncing all benefits arising from the legal exceptions ................................................. with the full force and effect of which he or she declared his or her said principal to be fully acquainted, did by these presents declare and acknowledge his or her said principal to be held and firmly bound into and in favour of the said ........................................... , his or her order or assigns in the aforesaid sum of R....................................... together with the sum of R........................................ as a preferent charge for costs and other matters as more fully set out in the principal bond and as collateral security for the due and proper repayment of the aforesaid sums with interest on  the capital sum and for the due and proper fulfillment of all the terms and conditions mentioned or referred to in the principal bond as well as all his or her said principal's  obligations thereunder the said appearer on behalf of his or her said principal hereby declared to bind specially as a ................................................ mortgage, (here describe  the right being bonded).

AND the said appearer further declared that this collateral bond shall be subject to all the terms and conditions set out in the principal bond as fully and effectually as if the same

had been inserted herein and to the special condition that upon payment and discharge of all obligations under the principal bond this collateral bond shall be null and void but shall otherwise be and remain in full force, virtue and effect.

IN WITNESS whereof I, the said Official, together with the appearer have subscribed to these presents and have caused the seal of office to be affixed thereto.

Signed, executed and sealed at the Mineral and Petroleum Titles Registration Office at PRETORIA on this …………………………………… day of …………………………………… 20 …...........

q.q.

In my presence,

DIRECTOR-GENERAL: MINERALS AND ENERGY.

Registered on the above date in the Register of Bonds under CMB ...................