SCHEDULE 5 FORM OF NOTICE PROSPECTIVELY NOMINATING DOMINANT TENEMENT

NOTICE PROSPECTIVELY NOMINATING DOMINANT TENEMENT

Superior:

(see note for completion 1)

Description of land which is to be the servient tenement:

(see note for completion 2)

Description of land nominated as dominant tenement:

(see note for completion 2)

Specification of condition met:

(see note for completion 3)

Terms of real burden:

(see note for completion 4)

Any counter-obligation:

(see note for completion 4)

Title to the superiority:

(see note for completion 5)

Title to land nominated as dominant tenement:

(see note for completion 5)

Service:

(see note for completion 6)

I swear [or affirm] that the information contained in the notice is, to the best of my knowledge and belief, true.

Signature of superior:

(see note for completion 7)

Signature of notary public:

Date: .