Record of Mortgage by Deposit of Title Deeds

To,...........
(Name of Mortgagee)
(Address)
Sir,
      I have to record that I have this day deposited with you the title-deeds (as per List hereto attached) relating to my immoveable property situate at ... and consisting of land admeasuring about ... Sq. Metres and bearing S.No. ...with a building thereon being Municipal No.... with intent to create a security thereof for repayment of the loan of Rs…………..lent and advanced by you to me, this day, with interest @......p. c. per annum.
Dated this ..........day of……..
Yours faithfully, 
(Mortgagor)