Sections 14(2) and 16.

(The appropriate particulars are required to be entered by the pawnbroker in the respective blank spaces before signature.)

Pledge No.

Pawned with (name of pawnbroker) of (address of pawnbroker) this ______ day of, [month], [year], by (name of pawner, as entered in the Pledge Book) of (address of pawner, as entered in the Pledge Book)

(Description of pledge)

(Amount of the loan)

1. The pawnbroker charges-

(a) For this ticket_______

(b) Interest at the rate per month of (APR). (If the term of the loan is less than one month, it will be charged for as one month. After the first calendar month, a part of the month exceeding 7 days will be charged for as a month and a part of a month not exceeding 7 days will not be charged for).

(c) The charge for storage of this pledge will be ________per month or any part of a month.