This ____ day of ____ 19____
(Signed) Governor.
FORM III.
The Minerals Proclamation, 1910 (Northern Nigeria), Mining Lease.
[Insert nature of lease. See s. 17.]
This lease is granted to ____ of ____ for mining purposes upon or under [here describe area with boundaries] as the same is delineated on the map attached hereto for the period of ____ years from the date hereof according to the true intent and meaning of the said Proclamation and subject to the provisions of the said Proclamation or of any Proclamation amending, altering, or repealing the same, and to all such rules and regulations as may from time to time be made under such Proclamation or Proclamations.
Dated this ____ day of ____ 19 ____
(Signed) Governor.