MEMORANDUM ON the _________ day of _____________ the undersigned
(husband) of (address, etc.) in consideration of his natural love and affection for his
wife the undersigned (wife) (hereinafter called the Donee) gave and by word of mouth
expressed himself to give to the donee all the furniture effects and movable property
specified in the schedule hereto annexed for her own use and benefit absolutely and at
the same time delivered the said furniture effects and moveable property to the donee
and placed her in possession and control thereof and the donee at the same time
accepted the said gift.
Date :

THE SCHEDULE ABOVE REFERRED TO:
(List of furniture, etc. included in the gift)

[Signature of donor and donee]