I , of , in consideration of the sum of paid to me [or, as the case may be], into the Bank of England [or Bank of Ireland], in the name and with the privity of the accountant general of the Court of Chancery, ex parte “the promoters of the undertaking” [naming them], or to A.B., of , and C.D., of , [two trustees appointed to receive the same], pursuant to the [here name the special Act], by the [here name the company or other promoters of the undertaking], incorporated [or constituted] by the said Act, do hereby convey to the said company [or other description], their successors and assigns, all [describing the premises to be conveyed], together with all ways, rights, and appurtenances thereto belonging, and all such estate, right, title, and interest in and to the same as I am or shall become seised or possessed of, or am by the said Act empowered to convey, to hold the premises to the said company [or other description], their successors and assigns, for ever, according to the true intent and meaning of the said Act. In witness whereof I have F2hereunto set my hand and sealF2executed this instrument as a deed , the day of in the year of our Lord .

I , of in consideration of the rent-charge to be paid to me, my heirs and assigns, as herein-after mentioned, by “the promoters of the undertaking” [naming them], incorporated [or constituted] by virtue of the [here name the special Act], do hereby convey to the said company [or other description], their successors and assigns, all [describing the premises to be conveyed], together with all ways, rights, and appurtenances thereunto belonging, and all my estate, right, title, and interest in and to the same and every part thereof to hold the said premises to the said company [or other description], their successors and assigns, for ever, according to the true intent and meaning of the said Act, they the said company [or other description], their successors and assigns, yielding and paying unto me, my heirs and assigns, one clear yearly rent of , by equal quarterly [or half-yearly, as agreed upon,] portions, henceforth, on the [stating the days], clear of all taxes and deductions. In witness whereof I F3hereunto set my hand and sealF3executed this instrument as a deed , the day of in the year of our Lord .