FORM NO. I
PART – I
1. We, (1) ____________________________________________________, (2) ______________________ (3) __________________________________ AND (4) ___________________, all of ___________, Indian inhabitants, do jointly and severally solemnly affirm and declare as under:—
(i) That we are the Owners of property more particularly described in the Schedule hereunder written and which said property we have conveyed in favour of _______________ _____________ and _____________________ by a Deed of Conveyance dated ________ 200___.
(ii) That the aforesaid property is not “surplus vacant land “as defined under the provisions of the Urban Land (Ceiling & Regulation) Act, 1976 (hereinafter “the said Act”).
2. We understand that even if the document intending to transfer our aforesaid property is allowed to be registered, we will not be absolved of any liabilities under the provisions of the said Act relating to the said property, and that such transfer will be subject to all the provisions of the said Act. We also understand that the said property inspite of its transfer as proposed may be included in our holding if so required by the provisions of the said Act as and when the Competent Authority decides the statement filed by the Landholder under Section 6(1) of the Act, if any, or as and when the issue as to whether there is any surplus land with us is taken up for consideration.

SCHEDULE OF THE ABOVE PROPERTY
(Give detailed description of the property)

SIGNED AND DELIVERED by the )
Within named (1) ____________________ )
(2) _____________________ )
(3) _____________________ )
and (4) _____________________ )
in the presence of …… )
Before me

PART – II
We, (1) ____________________AND (2) _______________, both of __________, Indian Inhabitants, do jointly and severally solemnly affirm and declare as under:—
1. That By Deed of Conveyance dated _________ 200___ we have purchased the aforesaid property as described in the aforesaid affidavit of the Transferors.
2. We state that even after the proposed transfer of the said land our total extent thereon would be within the ceiling limit as specified under the Urban Land (Ceiling and Regulations)
Act, 1976.

SIGNED AND DELIVERED by the )
Within named (1) ___________________ )
(2) ___________________ )
in the presence of …… )
Before me
(NOTARY)

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