FORM IV
FORM OF PROTEST OF BILL OF EXCHANGE FOR NON-ACCEPTANCE
[Section 8]

 On the________day of__________200_______ I,_____________ (here give the name), notary appointed under the Notaries Act, 1952, of________ in_____________(here state the local area for which the notary has been appointed) in __________ at the request of _______________(here give the name) of__________ did, at ___________ in person, and having failed to do so, then by registered letter cause due and customary presentment to be made to, and did demand acceptance of the bill of exchange hereto annexed (or "a literal transcript whereof and of everything written or printed thereon is hereto annexed") from ______________(here give the name), the person upon whom the said bill is drawn, to which demand he made answer (state terms of answer, if any) (or "to which demand he gave no answer"); wherefore, I, the said notary, at the request aforesaid, by this writing, do, in the presence of ___________(here give the name) and ___________(here give the name), witnesses, protest the drawer of the said bill of exchange and all other parties thereto and all others concerned for all exchange, re-exchange and all other parties thereto and all others concerned for all exchange, re-exchange, and all costs, damages, and interest present and to come for want of acceptance of the said bill.
 Which I attest
 Signature of Notary
 Place and date ________
Signature of witnesses                                                                                  (Should be of the locality)
1. ______________
2. ______________