The Great Priory of the United Religious, Military and
Masonic Orders of the temple and of St. John of Jerusalem, Palestine, Rhodes and Malta
Of England and Wales and its Provinces Overseas
INSTALLATION RETURN
This form must be completed using typescript or block letters and sent via the Provincial Vice -Chancellor to:
The Great Vice - Chancellor, The Chancery of the Orders, Mark Masons' Hall, 86 St. James's Street, London, SW1A 1PL
May 2012
Please take a photocopy of this form when completed and retain it for your Preceptory records
( ii )
( vi )
POSTCODE
9a. WAS INVESTED AS
** (select as applicable )
And served in the office for a full year, from one installation to the next
ON
DAY MONTH YEAR
HAVING BEEN REGULARLY ELECTED( complete one of the following )
IN PRECEPTORY
ON
DAY MONTH YEAR
DAY MONTH YEAR
KNIGHT
( Initials & Surname )
DAY MONTH YEAR
( Initials & Surname )
DAY MONTH YEAR
KNIGHT
13. SECOND CONSTABLE
12.
15.
14. FORENAMES IN FULL
11. FORENAMES IN FULL
10. FIRST CONSTABLE
WAS APPOINTED FIRST CONSTABLEAND INVESTED ON
GREAT OFFICER(S)
TREASURER
DAY MONTH YEAR
DATED
I hereby certify that the above is a correct return
SIGNATURE OF REGISTRAR
Inst Ret 03T
16. NAME OF REGISTRAR
REGISTRAR
If there have been any changes in respect of the below, please tick the appropriate box, and complete the details overleaf
WAS APPOINTED SECOND CONSTABLE AND INVESTED ON
AND WAS DULY INSTALLED PRECEPTOR OF THE ABOVE PRECEPTORY ON
DISPENSATION NUMBER
DAY MONTH YEAR
BEING ISSUED ON
9c. OR
9b. OR
WAS INSTALLED PREVIOUSLY ASPRECEPTOR IN PRECEPTORY
( v )
( iv )
( iii )
( i )
8. RESIDING AT
6. DECORATIONS AND HONOURS
5. FORENAMES IN FULL
4. PRECEPTOR
KNIGHT
( Initials & Surname )
7. STYLE OR TITLE
( e.g. Mr, Sir, Brigadier )
3. PROVINCIAL PRIORY
2.
1. PRECEPTORY NAME
INST
( Initials & Surname )
CHANGE OF DETAILS
2. FORENAMES IN FULL
1. INITIALS AND SURNAME
3. DECORATIONS AND HONOURS
(select as necessary)
5. ADDRESS
4. STYLE OR TITLE
( e.g. Mr, Sir, Brigadier )
DAY MONTH YEAR
POSTCODE
( vi )
( ii )
( i )
( iii )
( iv )
( v )
6. DATE OF BIRTH
7. TELEPHONE
MOBILE
WORK
FAX
HOME
(select as necessary)
1. INITIALS AND SURNAME
2. FORENAMES IN FULL
3. DECORATIONS AND HONOURS
4. STYLE OR TITLE
( e.g. Mr, Sir, Brigadier )
5. ADDRESS
DAY MONTH YEAR
6. DATE OF BIRTH
7. TELEPHONE
HOME
MOBILE
WORK
FAX
( i )
( ii )
( iii )
( iv )
( v )
( vi )
POSTCODE
GREAT OFFICER
1. INITIALS AND SURNAME
DAY MONTH YEAR
GREAT OFFICER
1. INITIALS AND SURNAME
DAY MONTH YEAR
3. GREAT RANK
3. GREAT RANK
2. DATE OF
( select as applicable )
2. DATE OF
( select as applicable )