In the Magistrate's Court for the District/Region of ...................................................................................

held at .................................................... Case No. ........................................ of 20.........

In the matter between

..................................................................................................................... Applicant

and

................................................................................................................. Respondent

To the Registrar/Clerk of the Court.

I,....................................................., of......................................, the above-mentioned respondent, hereby admit that the property attached in the above matter is subject to a hypothec to the above applicant to the extent of R...............and I consent to the sale of the said property in satisfaction of the said amount of R........... plus costs and sheriff's charges.

Dated at....................................this............................day of............., 20......,

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

Respondent

Witnesses:

1        .........................................................................

Signature and address

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

2        .........................................................................

Signature and address

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