FORM - 1 (Item 11 of Annexure - 1) Certified that the site plan and building plan of the HouseNo.............................................................. at ............................................ belonging to Sri/Smt .............................................................................. occupied by ............................................ have been verified by me and the dimension and areas indicated there in are found to be correct. It is also certified that the above building was constructed in the year ................................................. as per the following specifications. 1. Foundation: 2. Basement: 3. Superstructure : 4. Flooring : 5. Roofing: 6. Plastering : 7. Doors : 8. Windows : 9. Type of Sanitary fittings : 10. Electrical Installations : 11. Source of Water supply : 12. Any special feature : Date : Place : Signature of Engineer: Name : EXECUTIVE INSTRUCTIONS/ORDERS (FULL TEXT) qualification : address : Attested by Owner Head of the occupying Government Office. FORM - IV (Item 12 of Annexure - 10) RENT DEMAND AND DECLARATION OF CERTIFICATE I Sri/Smt .................................... H/o .......................................................... Owner of House No. ................................... Situated at ........................ am willing to give the building on rent to ...................... .................... duly charging a rent per month or the rent as fixed by the R & B Department whichever is less. Date: Place: Signature of Owner Name: Countersigned by Head of Occupying Office. FORM - V - III (Item 13 of Annexure -I) LAND VALUE CERTIFICATE This is to certify that the land rate of the .... .......................... Building bearing No. ........................... ........................ situated at ..................................... belonging to Sri/Smt ................................................ is Rs. .................................................. ( Rupees .....................................................................................) per Square Yard/Square Metre. Date : Place : Signature of Tahsildar. ANNEXURE -I A. APPLICATION FOR ISSUE OF REASONABLENESS OF RENT CERTIFICATE 1. Name of the occupying Department : 2. Name of the Office occupying the Building : 3. Designation of the Head of the Office : 4. Date of occupation : 5. Details of location of the building: : Municipal No. Name of the Owner : Furnishing the following details : 6. Site plan (Scale 1 : 500 or 1 CM = 1M) : 7. Building plan scale = 1; 100 or 1 CM=1 M) if a part is only occupied the same may be indicated in plan in Red Colour) : 8. Area of the Sire : 9. Plinth area of the building (If part of the building is occupied area of the same also may be mentioned separately). 10. Year of construction : 11. Certificate from a qualified or licensed Engineer certifying the correctness of dimensions in the plan, specification etc., in Form No. I : 12. Undertaking by the owner regarding the rent acceptance in Form No. II : 13. Land value certificate from Tahsildar in Form No. III : 14. Municipal Tax Receipt (to be furnished in original) : Signature of the Head of the office occupying the building. NOTE:-All plans, certificates and Tax Receipts etc., should be attested by the owner and occupying Department. To The Executive Engineer, R & B Division, ....................................... Sub: RENTS - Application for issue of reasonableness rent certificate by Executive Engineer, R & B - Regarding. I have to state that the building bearing No. ............................. situated at ........................... .................. belonging to Sri/Smt .......................................... P.O. .............................. is taken on rent for accommodating the Office the ....................................... The building was taken possession and occupied on ................. I request you to kindly issue reasonableness of rent certificate for the same all the required particulars as per Annexure-I with necessary certificate are enclosed duly authenticated. Date: Yours faithfully Place: Signature: Designation Office
