Whereas on [date] the Solicitor-General applied to this court for a forfeiture order against the following property: [property to which the application relates].
And whereas [New Zealand enactment] provides for the registration of title to (or charges over) property of that kind.
Now, therefore, the court, by this order, directs [authority responsible for administering the New Zealand enactment specified in the preceding paragraph] to enter on the register a note of the fact that an application has been made under the Proceeds of Crime Act 1991 for a forfeiture order against the property.
Dated at: [place, date].
High Court Judge/District Court Judge
Schedule form: amended, on 18 October 2016, by section 183(c) of the Senior Courts Act 2016 (2016 No 48).