DECLARATION FORM
I Sri Swapan Kumar Sau, son of Late Gourhari Sau, Residing at premises no. 51/H, Garcha Road,
Kolkata _ 700 019 P.S. – Gariahat in the District of 24-Parganas South, West Bengal do hereby solemnly
affirm and declare as follows:-
1. That I am the absolute owner of the plot of Land described in the schedule below by way of
transfer vide regd. Deed no. 00342. Date 30.01.2009.
2. That I have been possessing the said plot of land since purchased a place of land mentioned in
the below schedule by virtue of a regd. Deed 00342. Date 30.01.2009 uninterruptedly and it is
free from all encumbrances.
3. That the said plot of land is neither vested not acquired by the Govt. and there is no proceeding
initiated in respect of the said plot of land for its vesting or acquisition till date.
4. That the said is not vested / does not fall under the preview of the Urban Land (Ceiling and
Regulation) Act.1976.
5. That the said plot of land is not involved in any court case.
6. That I shall apply for long term settlement of the said plot of land on such terms and conditions
and on payment of such salami and rent as the State Government may fix in this regard, if the
said plot of land is found to have already vested in the state at any point of time. In case of failure
to do so, I shall forthwith make over vacant and peaceable possession of the said land to the
State Govt.
7. That I shall make over the possession of the said plot of land to the State Govt. without any claim,
if the said plot of land is found to have already been acquired by the State Govt. at any Point of
time.
8. That I shall pay regularly the land revenue in respect of the said plot of land as may be fixed by
the State Govt. in accordance with the provision of the West Bengal Land Reforms Act. 1955 as
amended from time to time.
9. That I shall abide by all the terms and conditions as may be fixed by the State Govt. from time to
time for holding the said plot of land as per provision of law for the time being in force.
10. That the mutation granted shall be liable to be cancelled is any information provided with the
mutation application is found to be not true.
11. That the statements made hereinabove are true to the best of my information, knowledge and
believe and nothing material has cancelled there in.
Date:-
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Signature of the Deponent with date and place.