DETAILS OF CAVEAT DEALING and AFFECTED MINERAL TITLE/S If space is insufficient, a schedule of affected titles must be attached Caveat Dealing Number: Mineral Title Type Mineral Title Number Applicant/Holder of Title EXECUTION OF DOCUMENTS Companies -This instrument is to be executed in accordance with Section 127 of the Corporations Act, or by a person (i.e. agent or representative) with written authority to act on behalf of the Caveator. Individuals - This instrument is to be executed by the Caveator/s and witnessed by a person who has attained the age of 18 years. Caveator/s - Company ……………………………………… (Director - Signature) ……………………………………… (Authorised Representative - Signature) .………………………….………….. (Print Name) ……………………………………… ……………………………….…….. (Director / Secretary - Signature) (Print Name) ……………………………….…….. (Print Name) Caveator/s Individuals – ……………………………………… ……………………………………… (Signature) (Signature) ……………………………………… ……………………………………… name) (Print name) ……………………………………… ……………………………………… (Signature of witness) (Signature of witness)
DETAILS OF CAVEAT DEALING and AFFECTED MINERAL TITLE/S If space is insufficient, a schedule of affected titles must be attached Caveat Dealing Number: Mineral Title Type Mineral Title Number Applicant/Holder of Title EXECUTION OF DOCUMENTS Companies -This instrument is to be executed in accordance with Section 127 of the Corporations Act, or by a person (i.e. agent or representative) with written authority to act on behalf of the Caveator. Individuals - This instrument is to be executed by the Caveator/s and witnessed by a person who has attained the age of 18 years. Caveator/s - Company ……………………………………… (Director - Signature) .………………………….………….. (Print Name) ……………………………….…….. (Director / Secretary - Signature) ……………………………….…….. (Print Name) ……………………………………… (Authorised Representative - Signature) ……………………………………… (Print Name) Caveator/s – Individuals ……………………………………… (Signature) ……………………………………… name) ……………………………………… (Signature of witness) ……………………………………… (Signature) ……………………………………… (Print name) ……………………………………… (Signature of witness)
af34-withdrawl-of-caveat.docx