DIOCESE OF WILLOCHRA. Churchwarden / Secretary. of congregation. do hereby certify that the number of persons from this congregation

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SCHEDULES TO THE REGULATIONS PAGE 1 SCHEDULE "A" RETURN OF COMMUNICANTS [Regulation One. Clause 2(1)] I,, Churchwarden / Secretary of congregation at do hereby certify that the number of persons from this congregation entered in the Roll Book as communicants who have signed the first schedule of the Constitution as at the last day of August is. Signed Churchwarden / Secretary / / Date Last Amended May 2016

SCHEDULES TO THE REGULATIONS PAGE 2 SCHEDULE "B" ELECTION OF LAY MEMBERS OF SYNOD I,, hereby certify to the Registrar that the following were elected as Lay Members of Synod for the [Regulation One. Clause 6] Parish / Ministry District of in accordance with the provision of Regulation 1, and that they have signed the Third Schedule of the Constitution. Lay Members of Synod Name Postal Address Telephone Reserve Lay Members of Synod Name Postal Address Telephone Signed Chair of the meeting or other proper person. / / Date

SCHEDULES TO THE REGULATIONS PAGE 3 SCHEDULE "C" ELECTION OF NOMINATORS [Regulation Four Clause 3] I,,hereby certify to the Registrar that the following were elected as Nominators for the Parish / Ministry District of in accordance with the provisions of the Regulations 1 and 4, and that they have signed the Third Schedule of the Constitution. Nominators (5 persons) Name Postal Address Telephone Reserve Nominators (5 persons) (Numbers indicate order of precedence as decided by meeting). Name Postal Address Telephone 1. 2. 3. 4. 5. Signed Chair of the meeting or other proper person. / / Date

SCHEDULES TO THE REGULATIONS PAGE 4 SCHEDULE "D" RETURN OF CHURCH OFFICERS [Regulation Five Clause 18] I,, Chair / Secretary of the Annual Meeting of the Vestry of Church at do certify that the following officers for this congregation were appointed or elected at the Meeting held on the day of / and that they have signed the Third Schedule of the Constitution if such be required by the Regulations. Office Name Address Telephone Signed Chair / Secretary / / Date

SCHEDULES TO THE REGULATIONS PAGE 5 SCHEDULE "E" MEMORIAL FOR RECOGNITION AS A MISSION TO SEAFARERS CENTRE [Regulation Ten Clause 2] We the undersigned communicants of the Anglican Church of Australia residing at or near having formed a Mission to Seafarers Centre, desire to be recognised by the Synod as a Centre under the title of and we hereby engage to abide by the Constitution and Regulations of the Diocese of Willochra. Signatures of Communicants / / Date

SCHEDULES TO THE REGULATIONS PAGE 6 SCHEDULE "F" MEMORIAL FOR RECOGNITION AS A CONGREGATION [Regulation Five Clause 2(2)] We the undersigned communicants of the Anglican Church of Australia residing at or near having formed a Congregation, desire to be recognised by the Synod as a Congregation under the title of and we hereby engage to abide by the Constitution and Regulations of the Diocese of Willochra. Signatures of Communicants / / Date

SCHEDULES TO THE REGULATIONS PAGE 7 SCHEDULE "G" FORM OF UNDERTAKING AND ENGAGEMENT UPON ENTRY TO THE DIOCESE [Regulation Four Clause 1(2)] I,, hereby engage and undertake to surrender and yield up to the Synod of the Anglican Church of Australia in the Diocese of Willochra Incorporated on demand of the Bishop or of the said Synod possession of all real and personal estate and effects which I may hold or be entitled to under Synod or in virtue of my office at the time if and when sentenced according to the Constitution and Regulations of the said Diocese to deprivation or suspension and that I will in all other respects conform to and abide by the said Constitution and Regulations. And in order to facilitate the recovery of possession by the said Synod of the said real and personal estate I hereby admit and acknowledge myself to be a tenant at will thereof of the said Synod. As witness my hand this day of / Signed

SCHEDULES TO THE REGULATIONS PAGE 8 SCHEDULE "H" APPLICATION FOR FACULTY [Regulation Five Clause C 2] To the Bishop of Willochra. We, the undersigned, Priest and Churchwardens of the Church of in the Parish / Ministry District of request you to grant a Faculty for to be placed in the said Church of Signed Priest Churchwarden Churchwarden / / Date

SCHEDULES TO THE REGULATIONS PAGE 9 SCHEDULE "I" DECLARATION OF ASSENT [Regulation Four Clause 1 (2)] The Anglican Church of Australia, being an Apostolic Church, receives and retains the Catholic Faith, which is grounded in Holy Scriptures and expressed in the Creeds, and within its own history, in the Thirty-Nine Articles, in the Book of Common Prayer and in the Ordering of Bishops, Priests and Deacons. Accordingly, I, do solemnly make the following declaration:- I firmly and sincerely believe in the Catholic Faith and I give my assent to the doctrine of the Anglican Church of Australia as expressed in the Thirty-Nine Articles, the Book of Common Prayer and the Ordering of Bishops, Priests and Deacons; I believe that doctrine to be agreeable to the Word of God: and in public prayer and administration of the sacraments I will use the form in the said book prescribed, and none other, except as far as shall be ordered by lawful authority. Signed AND PROMISE OF OBEDIENCE I, do promise that I will faithfully obey my Ordinary in all things lawful and canonical. Signed signed the above declaration and the Form of Undertaking and Engagement upon entry into the diocese on the day of on receiving the Bishop's licence as Witness

SCHEDULES TO THE REGULATIONS PAGE 10 SCHEDULE "J" FORM OF NOMINATION TO THE POSITION OF PARISH OR MINISTRY DISTRICT PRIEST [Regulation Four Clause 6 (3)] to the Right Reverend the Bishop of Willochra We the undersigned duly authorised to nominate clerics to the position of Parish Priest in the Parish of Ministry District Priest in the Ministry District of OR do hereby request you to invite the following persons in the order listed for the said appointment. 1. 2. 3. 4. 5. Dated this day of / Signatures of Nominators Adopted May 2017

SCHEDULES TO THE REGULATIONS PAGE 11 SCHEDULE "K" FORMAT OF CHARGE [Regulation Six Clause 6] To The Right Reverend The Bishop of Willochra: I/We of do hereby charge the Reverend of with having committed the ecclesiastical offence(s) of (Here state the offence or offences charged) 1. The facts which it is alleged constitute the said offence(s) are :- (Here set out in numbered paragraphs) (particulars of the facts alleged ) 2. The witnesses proposed to be called in support of such facts are:- (Here set out the names and addresses) (of the witnesses to be called ) 3. Copies of the following documents are submitted in support of such charge:- (Here list the documents [if any] submitted) AND I/We desire that this charge be duly heard and I/We do solemnly and sincerely declare that I/We do not make this charge from any private ill-will towards the said or with any view to my/our own profit and I/We further declare that I/We believe the charge(s) laid to be substantially true. Signature(s) Witness(es) Date / /

SCHEDULES TO THE REGULATIONS PAGE 12 SCHEDULE "L" FORM OF UNDERTAKING [Regulation 6 Clause 9(1)] IN THE MATTER of the Reverend of I, of do solemnly intend to attend as a witness and give evidence on the trial of the above matter before the Diocesan Tribunal. Signed Date / /

SCHEDULES TO THE REGULATIONS PAGE 13 SCHEDULE "M" DECLARATION [Regulation 6 Clause 3(2)] I, do solemnly and sincerely declare that I will well and truly hear and determine any matter referred to a Diocesan Tribunal of which I am selected as a member and that I will find according to the evidence to the best of my judgement and ability. Signed Date / /

SCHEDULES TO THE REGULATIONS PAGE 14 SCHEDULE N FAITHFULNESS IN SERVICE [Regulation Four Clause 1 (2)] I have read Faithfulness in Service, the code for personal behaviour and the practice of pastoral ministry by clergy and church workers in the Diocese of Willochra. (Appendix One to Regulation Thirteen.) I acknowledge that as a member of the clergy holding the Bishop s Licence or as a Church Worker 1 in the Diocese of Willochra I am bound by the provisions of Faithfulness in Service. I acknowledge that Failure to meet the standards of this Code will indicate an area where clergy and church workers require guidance and specialised help. Such failures may result in formal disciplinary action if the conduct infringes an applicable disciplinary rule of the Church or is a breach of an employment contract. 2 Signed: Clergy Person/Church Worker Date: / /20 Print Name: Ministry Unit: A Ministry Unit includes a parish, ministry district, congregation, chaplaincy or Licence as a PTO 1 See page 6 Faithfulness in Service for the definition of Church Worker. 2 See page 11 Faithfulness in Service: Preamble 3.4. Adopted May 2016