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| <big>'''ANNEXURE - 2'''</big>
| | [[പ്രമാണം:Page0050.jpg|Center|Iലഘുചിത്രം]] |
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| <big>'''14. CERTIFICATE8DECARATION OF THE LICENSEE REGISTERED UNDER CHAPTERXXIII OF THE BUILDING RULES'''</big>
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| I...................................(Name and Reg. No. of licensee) do hereby declare that the unauthorised construction as per the drawings and details enclosed was/were carried out on/before the 31st day of March, 2013, beyond which date, no construction works were carried out unauthorisedly.
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| I certify that all the drawings and measurements therein conform to actual constructions made in the site.
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| I further certify that, the unauthorised construction under reference is/are structurally stable. (strike out this certification if the unauthorised construction is a high-rise building and/or telecommunication tower).
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| I hereby declare that the information furnished in Form 1-A, the drawings and the other documents/ enclosures Submitted are correct to the best of my knowledge and belief. I also declare that to the best of my knowledge, there is no court case or direction or communication from any authority including government specific to the plot or constructions therein, which prevent regularisation of the unauthorised Construction.
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| I also declare that I have the qualification for the licensee prescribed under Building Rules. further declare that I am fully aware of the fact that the Government may, at any time cancel the order(s) issued under these rules and take appropriate legal action, if the information furnished by me found false or the facts are suppressed or misrepresented.
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| ....................................................................
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| (Signature of the Licensee)
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| Name........................................................................
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| Reg No................................
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| Place........................................................ Address ................................. .
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| Date:.............................
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| <big>'''ANNEXURE - 3'''</big>
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| <big>15. CERTIFICATE OF THESTRUCTURALENGINEER</big>
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| Registered under chapter XXIII of the Building Rules
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| (Applicable in the case of high-rise buildings, telecommunication towers and building if any above which such telecommunication tower is erected.)
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| I............................................. (Name and address of the Structural Engineer) here by certify that the unauthorised building(s)/Telecommunication Tower(s) (strike out which is/are not applicable) as per the drawings and Form I-A enclosed herewith is/are structurally stable.
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| I also here by certify that the building(s) above which the telecommunication Tower(s) applied for regularisation is/are erected as per the drawings and Form I-A enclosed herewith is/are structurally stable. (strike out this certification if the unauthorised building is not a telecommunication tower erected above a building.)
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| I declare that I have the qualification prescribed as per rule 2(1)(f) of these rules. I further declare that I am fully aware of the fact that the Government may, at any time cancel the order(s) issued under these rules and take appropriate legal action, if the information furnished by me is found false or facts are suppressed or misrepresented.
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| ................................................
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| (Signature of the Structural Engineer)
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| Place: ........................................ Name:..............................
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| Date:.................................. ......Address.......................,..............................
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| <big>'''FORM I-B'''</big>
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| <big>DETAILEDREPORT</big>
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| (to be prepared and furnished by the Secretary of the Grama Panchayat under rule 5 in quadruplicate)
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| ............................................Grama Panchayat
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| <big>INSPECTIONAND VERIFICATION REPORT</big>
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| 1. Application Received on ...............................
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| 2. Verified on ........................................
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| 3. Inspected on.....................................
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| 4. Particulars of Land
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| (a) Area of Land/Plot : ..............................................sq.meter
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| (b) Survey No. and Name of Village : ..............................................
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| (c) Re-survey No. and Name of Village
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| (d) Nature of ownership of land
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| (strike out the not applicable) : Sale Deed/Gift/Partition Deed/Puramboke/Others (specify)
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| 5. Particulars of the construction/building(s) : .........................................................................
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| (a) Occupancy of the construction/buildings:
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| (b) Built-up/Floor Area
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| <hr size = "10">
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| Sl. <br/> No. Area Description Authorised Buildings Unauthorised Building(s) Total Area (sq.meters)
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| <hr size = "10">
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| 1 Built-up area (sq. metres)
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