Security under the Excise Act 1901
By this security the Subscribers are, pursuant to the Excise Act 1901 , bound to the CEO (as defined in that Act) in the sum of--[ here insert amount or mode of ascertaining amount intended to be paid in default of compliance with condition ]--subject only to this condition that if--[ here insert the condition of the security ]--then this security shall be thereby discharged. *
Dated the day of 20 .
Names and Descriptions of | Signatures of Subscribers | Signatures of Witnesses |
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* NOTE--If liability is not intended to be joint and several and for the full amount, here state what is intended, as, for example, thus--"The liability of the subscribers is joint only," or "the liability of (mentioning subscriber) is limited to (here state amount of limit of liability or mode of ascertaining limit)."