At the time of receiving his dividend in case of a voluntary assignment, each creditor shall sign triplicate releases in the following form:

The undersigned creditors of E.F., an insolvent, for and in consideration of the sums of money set opposite our respective names, and received by us from A.B., assignee of the estate of E.F., an insolvent, do hereby release the said E.F. from any and every debt, demand and liability which we had or may have had against him, at the date of his assignment, on the day of , Anno Domini eighteen¹ hundred and , whether due or not; and hereby agree that no suit, action or execution shall be maintained for or by reason of such debt, demand, or liability, reserving, however, to ourselves the right to avoid this release, upon showing any of the matters or things which, under the insolvent laws, shall entitle us to retain our respective claims against said insolvent, notwithstanding our participation in the settlement of his estate.

Witness our hands, the dates set opposite our respective names.