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LAND TITLE ACT
FORM C (Section 233) CHARGE
GENERAL INSTRUMENT - PART 1 Province of British Columbia PAGE OF PAGES
Your electronic signature is a representation that you are a designate authorized to
certify this document under section 168.4 of the Land Title Act, RSBC 1996 c.250,
that you certify this document under section 168.41(4) of the act, and that an
execution copy, or a true copy of that execution copy, is in your possession.
1. APPLICATION: (Name, address, phone number of applicant, applicant's solicitor or agent)
Deduct LTSA Fees? Yes
2. PARCEL IDENTIFIER AND LEGAL DESCRIPTION OF LAND:
[PID] [LEGAL DESCRIPTION]
STC? YES
3. NATURE OF INTEREST CHARGE NO. ADDITIONAL INFORMATION
4. TERMS: Part 2 of this instrument consists of (select one only)
(a) Filed Standard Charge Terms D.F. No. (b) Express Charge Terms Annexed as Part 2
A selection of (a) includes any additional or modified terms referred to in Item 7 or in a schedule annexed to this instrument.
5. TRANSFEROR(S):
6. TRANSFEREE(S): (including postal address(es) and postal code(s))
7. ADDITIONAL OR MODIFIED TERMS:
8. EXECUTION(S): This instrument creates, assigns, modifies, enlarges, discharges or governs the priority of the interest(s) described in Item 3 and
the Transferor(s) and every other signatory agree to be bound by this instrument, and acknowledge(s) receipt of a true copy of the filed standard
charge terms, if any.
Officer Signature(s) Execution Date Transferor(s) Signature(s)
Y M D
OFFICER CERTIFICATION:
Your signature constitutes a representation that you are a solicitor, notary public or other person authorized by the Evidence Act, R.S.B.C. 1996, c.124, to
take affidavits for use in British Columbia and certifies the matters set out in Part 5 of the Land Title Act as they pertain to the execution of this
instrument.
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