Panchayat:Repo18/vol2-page1562

(or)

In the Case of huts, four Copies each of a site plan showing the outline of the built-up area, the boundaries of the plot and nearby streets duly signed by the owner,

(or)

in the case of Constructions under approved Schemes as mentioned in rule 72 of the Building Rules with total floor area of building upto 60 Sq. metres and number of floors limited to two and a stair room, where the Construction has to be done by individuals separately, four copies each of a site plan showing the outline of the built-up area, the boundaries of the plot and nearby streets, duly signed by the owner.

(iii) Copies of the cases pending before or direction, judgement etc., by Courts, Tribunal, Ombudsman etc. there of pertaining to or with reference to the plot or Constructions. (To be compulsorily disclosed by the owner/applicant) (Please specify: Enclosed/Not Applicable

(iv) Copies of any Government Orders, circulars, any form of communication against the plot/land or any construction works therein (Tobe Compulsorily disclosed by the owner/applicant) (Please specify: Enclosed/ Not Applicable

(v) Orders granting exemption from the provisions of the Kerala Building Rules, 1984, obtained earlier, if any Please specify:/Enclosed/Not Applicable

(vi) Copy of orders granting exemption from the provisions of the Town Planning Schemes, obtained earlier Please specify: Enclosed/Not Applicable (vii) Copy of additional documentary evidence, if any, :

(i)...........................................

(ii)...........................................

(iii).................................

I declare that the details furnished in the drawings and other documents/enclosures submitted are correct to the best of my knowledge and belief.

I further declare that to the best of my knowledge and belief, there is no Court case or direction or communication from any authority including government other than declared by mesus above specific to the plot or Constructions therein, for permitting this construction.

I further declare that I am fully aware of the fact that the Government may, at any time cancel the order(s) issued and take appropriate legal action if the information furnished by me is found false or facts are suppressed or misrepresented.

........................................................................

(Signature of the owner/(s)) Name:

CERTIFICATE & DECARATION OF THE CENSEE

Thereby declare that the information furnished in the drawings and the other documents/enclosures submitted are Correct to the best of my knowledge and belief.

I also declare that I have the qualification for the licensee prescribed under the provisions of KMBR 1999/kpbr 2011.

I further declare that I am fully aware of the fact that the Government may, at anytime cancel the order(s) issued and take appropriate legal action, if the information furnished by me is found false or the facts are suppressed or misrepresented.

...............................................................

(signature of the Licensee)

Name: --------------------

Reg. No. : ------------------

Address : --------------------

Place : ---------------

Date : ----------------

ഈ താൾ 2018 -ലെ പഞ്ചായത്ത് റെപ്പോ നിർമ്മാണം യജ്ഞത്തിന്റെ ഭാഗമായി സൃഷ്ടിച്ചതാണ്.