Panchayat:Repo18/vol1-page0860

construction under reference which was carried out on or before the 31st day of March, 2013

(e) Proof of having carried out the construction of unauthorised building(s) on or before the 31st day of March, 2013; Please specify: Enclosed/Not Applicable

(f) Proof of valid Registration of the licensee [Compulsory except in cases (ii) and (iii) of item (b) above); Please specify: Enclosed/Not Applicable

(g) Proof of qualification of Structural Engineer who has issued the structural stability certificate (Compulsory in the case of high-rise buildings, telecommunication towers and building if any above which such telecommunication tower is erected.) Please specify: Enclosed/Not Applicable

(h) 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 therein as mentioned in item 9 of the statement in this form. (To be compulsorily disclosed by the owner/applicant) Please specify: Enclosed/Not Applicable

(i) Copies of any Government orders, circulars, etc. against the plot/land or any construction works therein as mentioned in item 10 of the statement in this form (To be compulsorily disclosed by the owner/applicant) Please specify: Enclosed/Not Applicable

(j) Proof of having stopped the unauthorised construction works before 31st day of March, 2013 in complainants with of any communication from the Grama Panchayat or Government directing to stop the unauthorised construction: Please specify: Enclosed/Not Applicable

(k) Copy of plans approved and/or permit(s) issued if any, by the Secretary as per the provisions contained in the Act or Building Rules. Please specify: Enclosed/Not Applicable)

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

(m) Copy of orders granting exemption from the provisions of the Town Planning Schemes, obtained earlier (Please specify: Enclosed/Not Applicable

(n) Copy of documentary evidences, if any, showing the details of action, taken by the Grama Panchayat concerned against the unauthorised construction(s).Please specify: Enclosed/Not Applicable)

(o) Copy of documentary evidence, if any, enclosed, with reference to item 11of the Statement in this form. (Please specify)

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

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

ا.13............................................................................(name of owner) do hereby declare that the unauthorised construction as per the drawings and details enclosed was/were carried out on or before the 31st day of March, 2013, beyond which date, no construction works were carried out unauthorisedly and that the drawings and measurements therein conform to actual constructions made in the site and the unauthorised construction(s) is/are structurally stable.

I also declare that the details furnished in this application and, the drawings and other documents/ enclosures submitted therewith 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 specific to the plot or constructions therein, which prevents the regularisation of the unauthorised construction. 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 lake appropriate legal action, if the information furnished by me is found false or facts were suppressed or misrepresented.

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                                                                                                                                                                        (Signature of the owner) . 

Place....................................................... Name:.....................................................................

Date:........................................................ Address................................................................